2621 Mood Disorders and Suicide

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2621 Mood Disorders and Suicide

• Moods
• Enduring states of feeling that color our
  psychological lives.
• Mood disorders
• Are disturbances in mood that impair functioning.

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Major Depression

• Must exhibit 5 or more features and one of the
  features must be either depressed mood/loss of
  interest for most of the day.
• Major depressive disorder is based on the
  occurrence of one or more major depressive
  episodes in the absence of manic or hypomanic
  episodes.

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Other features

• Significant weight gain or loss
• insomnia/hypersomnia
• agitation/slowed movement
• fatigue/loss of energy
• sense of worthlessness/guilt
• decreased concentration
• suicidal thoughts

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• Affects 1 in 5 adults (17) in the U.S. at some
  point in their life.
• The common cold of psychological problems.

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Risk factors

• Age (younger more likely to develop than older)
• SES
• marital status
• gender (women more likely than men)

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Cont. risk factors

• sociocultural (Af-A less likely to be depressed
  than whites/hispanics)
• multinational study shows that rates of
  depression are rising. Lowest rates of
  depression in Taiwan highest rates in Beirut.
• Increases in depression may be due to increasing
  urbanization and fragmentation of the family,
  exposure to war and increased incidence of
  violence.

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• Reactive depression
• Depression linked to negative events while
• Endogenous depression is born from within
• To distinguish between reactive/ endogenous,
  endogenous exhibits more physical symptoms
  (weight loss, insomnia) while reactive exhibits
  less physical symptoms.

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Seasonal Affective Disorder

• Features
• fatigue
• excessive sleep
• craving for carbohydrates
• weight gain
• Affects women more than men

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Cont. SAD features

• Most common among young adults though half of
  those with SAD report episodes beginning in
  childhood or adolescence.
• Treatment involves exposure to 2 to 3 hours of
  artificial light (phototherapy)

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Postpartum Depression

• Postpartum blues
• occurs fairly frequently and lasts a couple of
  days. (normal)
• Postpartum Depression
• may persist for months or even a year or more.
• Features
• disturbance in appetite/sleep
• low self-esteem
• difficulty concentrating

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Dysthymic Disorder

• Milder but chronic
• Affects about 3 of the adult population at some
  point in their life.
• It is more common in women than in men
• A person may experience Major Depression along
  with dysthymia Double Depression.

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Features

• Pessimism
• self-pity
• inactivity
• feelings of inadequacy
• low self-esteem

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Bipolar Disorder

• Mood swings between mania/depression
• First episode may be either mania or depression
• Mania may last from a few weeks to several months
  but are shorter in duration and end more abruptly

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Cont. bipolar

• Bipolar I (Mixed type) one or more manic
  episodes
• Bipolar II one or more depressive episode and
  one hypomania (a milder form of mania) episode
  but never a full blown manic episode.
• Relatively uncommon affecting .4 to 1.6 for
  bipolar d/o and .5 for bipolar II d/o
• Affects men and women at the same rate.

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Features of mania

• Sudden elevation of mood
• unusually cheerful
• boundless energy
• pressured speech distractible
• rapid flight of ideas
• inflated sense of self
• show poor judgment
• become argumentative

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Cyclothymic Disorder

• Means Circle/spirit
• individual experiences mild mood swings for at
  least 2 years
• hypomania is a period of elevated mood not as
  severe as manic episode
• depressed mood is not as severe as Major
  Depression.

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Theoretical Perspectives

• Stress and Mood d/o
• stressors such as
• loss of loved one
• unemployment
• physical illness
• marital discord
• poverty
• pressure at work
• prejudice/discrimination have been contributed to
  depression
• Relationship between stress/depression may be
  moderated by coping styles/social support.

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Psychodynamic

• Depression represents anger directed inward
  rather than against others.
• In bereavement where there is ambivalent
  feelings, this can create rage/guilt. To preserve
  the lost object, people introject (bring inward)
  their mental representations of the other person
  into themselves. This causes the rage/guilt to
  turn inward resulting in depression.

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Cont. Psychodynamic

• For bipolar d/o, there is a shifting dominance
  over the personality by ego/superego in
  depression, superego is dominant producing
  exaggerated notions of guilt/wrong. After a
  time, ego rebounds/asserts supremacy, produces
  feelings of elation/self-confidence manic.

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Humanistic/Existential

• Depression no meaning
• Lose self-esteem when lose friends/family

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Learning

• Focus on situational factors such as the loss of
  positive reinforcement.
• Depression equals too little reinforcement from
  environment.
• Then less activity deplete opportunity/less
  reinforcement encourages withdrawal. Depression
  may also become a reinforcer.

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Cognitive

• Becks cognitive triad equals negative beliefs
  about self, environment, future.
• Typical cognitive distortions
• all or nothing emotional reasoning
• overgeneralization should statement
• mental filter labeling/mislabeling
• disqualifying the positive personalization
• jumping to conclusions
• magnification/minimization

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Cognitive-specificity hypothesis

• Depressive thoughts center on loss,
  self-depreciation, pessimism.
• Anxiety centers on physical danger, threats.

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Learned Helplessness

• A combination of behavioral/cognitive
  situational factors foster attitudes that lead to
  depression. Shock dogs/attributional style
• internal/external
• global/specific
• stable/unstable

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Biological

• Genetic
• Stronger for bipolar than unipolar
• Uncertain what is inherited.
• Biochemical
• Neurotransmitters involved
• deficiencies in norepinephrine depression
• excess in norepinephrine mania
• serotonine, acetylcholine deficiencies
• thyroid hormones

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Treatment

• Psychodynamic
• Helps people understand their ambivalent feelings
  toward the lost object.

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Cont. Treatment

• Humanistic/Existential
• Become aware of authentic feelings
• need self-actualization
• living according to ones own values/choices

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Cont. Treatment

• Behavioral
• Depression is learned/ therefore unlearn it.
• Cognitive
• Identify distorted, self-defeating
  thoughts/substitute more rational thoughts.

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Cont. Treatment

• Biological
• antidepressants
• tricyclics
• monoamine oxidase inhibitors (MAO inhibitors)
• serotonin-reuptake inhibitors (SSRI)

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Side Effects of tricyclics, MAO Inhibitors

• Dry mouth
• constipation,
• blurred vision
• confusion
• delirium

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Side Effects of Serotonin

• Upset stomach
• headaches
• agitation
• insomnia
• sexual problems

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Lithium side-effects

• Potential toxic effects
• impair memory
• slow people down

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Electro-convulsive therapy

• Used to treat major depression when
  antidepressants dont work.
• Dont know why it works.
• Controversy over memory loss as side effect.

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Suicide

• Who?
• More Whites than Af-A
• More women attempt more men succeed
• Elderly more likely than teens.

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Cont. suicide

• Why?
• People think there is a narrow range of options
  available. Connected to stress.

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Cont. Suicide

• Theoretical
• Psychodynamic
• anger turned murderous or motivated by death
  instinct- a tendency to return to tension-free
  state before birth.
• Humanistic/existentials
• Suicide is a perception that life is meaningless/
  hopeless.
• Sociocultural alienation in todays society

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Cont. Suicide

• Learning
• Reinforcement of previous attempts/ effects of
  stress
• Cognitive positive outcome expectancies
• Social-learning - modeling
• Biological - genetic

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Predicting Suicide

• Hopelessness
• Sudden sorting of affairs
• Sudden peace/calm interpreted as hope.