Chapter7 - Chapter 7 Chapter 7 Mood Disorders and Suicide I...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Chapter 7 Chapter 7 Mood Disorders and Suicide I 0. Unipolar mood disorders Mood Disorders: Characteristics 1. In mood disorders, disturbances of mood are intense and persistent enough to be clearly maladaptive 0. Depression, in terms of years lost to disability, is in the top five health conditions in the world and is #1 in U.S. 1. Disease burden of depression is 83.1 billion dollars Mood Disorders: Characteristics 2. The two key moods involved are mania and depression 3. In unipolar disorders the person experiences only severe depression 4. In bipolar disorders the person experiences both manic and depressive episodes Mood Disorders: Characteristics Mood Disorders: Characteristics 5. Differentiation among mood disorders in terms of: 2. Severity: degree of impairment 3. Duration: acute, chronic, intermittent Mood Disorders: Prevalence 6. The lifetime prevalence of unipolar disorder is 4. 13% for males 5. 21% for females 7. The lifetime prevalence for bipolar disorder ranges from 0.4–1.6% 8. Peak period in lifetime of onset: 18­22 Unipolar Mood Disorders: Range 9. Two fairly common causes of depression that are generally not considered mood disorders are 6. Loss and the grieving process 0. Death of loved one 7. Postpartum blues 1. 50­70% of mothers within 10 days 2. Hormones and new responsibilities 8. Sadness, discouragement, pessimism lasting short time after disappointment Unipolar Mood Disorders: Range Unipolar Mood Disorders: Range 10.The two main categories of mild to moderate depressive disorders are 9. Adjustment disorder with depressed mood 10. Dysthymia 3. Persistently depressed for 2 years (with intermittent normal moods) 4. 2.5 – 6% of population 5. Onset before 21 6. Stress makes worse Major Depressive Disorder: Characteristics 11.The diagnostic criteria for major depressive disorder require 11. That the person exhibit more symptoms than are required for dysthymia (markedly depressed mood) 12. That the symptoms be more persistent Major Depressive Disorder: Characteristics 12.Subtypes of major depression include 13. Major depressive episode with melancholic features 14. Severe major depressive episode with psychotic features (loss of contact with reality) 15. Major depressive episode with atypical features 16. Double depression: dysthymia & major depression Major Depressive Disorder: Characteristics 13.If major depression does not remit for more than 13. two years, chronic major depressive disorder is diagnosed 17. Typically episodes will remit & reoccur 14.Some people who experience recurrent depressive episodes show a pattern commonly known as seasonal affective disorder Major Depressive Disorder: Characteristics 15.Depressed mostly every day 16.Diminished interest in all activities 17.Weight loss or gain 18.Insomnia or hypersomnia 19.Psychomotor retardation or agitation 20.Fatigue 21.Feelings of worthlessness Unipolar Disorder: Biological Causal Factors 22.(1) Genetic contribution: Altered neurotransmitter activity in several systems is clearly associated with major depression – monoamine hypothesis 23.(2) The hormone cortisol also plays a role 24.(3) Depression may be linked to low levels of activity in the left anterior or prefrontal cortex 25.(4) Sleep and light may be factors Unipolar Disorder: Biological Causal Factors Unipolar Disorder: Biological Causal Factors (1) 0. Family studies and twin studies suggest a moderate genetic contribution 26.A specific gene that might be implicated in is major depressive disorder is the serotonin­transporter gene (transmission & reuptake) Unipolar Disorder: Biological Causal Factors (2) 27.Hypothalamic­pituitary­adrenal axis 18. With depressed individuals, negative feedback loop is closed down resulting in higher levels of cortisol 28.Cortisol negatively impacts hippocampus and serotonin 19. Results in memory impairments 20. Can create structural changes in brain if chronic Unipolar Disorder: Biological Causal Factors (3) 29.Studies showing asymmetry in activity of hemispheres of depressed individuals 21. Lower activity in prefrontal left hemisphere than in prefrontal right hemisphere 22. Lower left ­ related to symptoms of reduced positive affect and approach behaviors 23. Higher right – related to symptoms of increased anxiety and negative affect Unipolar Disorder: Biological Causal Factors Unipolar Disorder: Biological Causal Factors (4) 30.Disruptions of the following may also play a role: 24. 25. 26. Sleep (higher REM and lower non­REM) Circadian rhythms (desynchronized) Exposure to sunlight (SAD) Unipolar Disorder: Psychosocial Causal Factors 31.Diathesis­stress models propose that some people have vulnerability factors that may increase the risk for depression 27. Genetic predispositions 28. Neuroticism as personality 7. Temperamental sensitivity to negative stimuli 29. Early long­term adversity in childhood Diathesis­stress model Unipolar Disorder: Psychosocial Causal Factors 32.Stressful life events are linked to depression Number of Stressful Life Events vs. Probability of Major Depressive Episode Unipolar Disorder: Psychosocial Causal Factors 33.Differentiation between types of stressful life 33. events 30. Independent life events: external (losing a job due to closing of company) 31. Dependent life events: internal (losing a job due to inability to do job effectively) 32. Greater depression from stress from dependent life events since likely to produce negative self­ perceptions Unipolar Disorder: Psychosocial Causal Factors 34.Freud believed that depression was anger turned inward (introjection of feelings toward loved one) 35.Behavioral model – loss of reinforcement 36.Beck proposed a cognitive model of depression 33. Cognitive symptoms contribute to affective symptoms Beck’s Cognitive Model of Depression Beck’s Cognitive Model of Depression 37.Beck's theory of depression 34. 35. 36. 37. Begin with underlying dysfunctional beliefs Depressogenic schemas (rigid, extreme) Activated by stress Develop in childhood from negative experiences Beck’s Cognitive Model of Depression 38.Beck's theory of depression 38. 38. Underlying dysfunctional beliefs become a pattern of negative automatic thoughts 39. Negative triad: thoughts about self, the world, and future 40. Dichotomous reasoning, selective abstraction, arbitrary inference Unipolar Disorder: Psychosocial Causal Factors 39.A reformulated helplessness theory proposes that a pessimistic attributional style is a diathesis for depression 41. Three dimensions of attributions 8. Internal/external 9. global/specific 10. Stable/unstable 42. Pessimistic attributional style 11. Problems due to internal, global, stable reasons 0. (e.g. I failed because I am stupid) Unipolar Disorder: Psychosocial Causal Factors 40.The hopelessness theory proposes that a pessimistic attributional style and one or more negative life events will not produce depression unless one first experiences a state of unless one first experiences a state of hopelessness 43. A hopelessness expectancy (inevitable bad outcome) is experienced 44. Pessimistic attributional style occurs in context of hopelessness expectancy 45. Depression results Unipolar Disorder: Psychosocial Causal Factors 41.Interpersonal problems and social skill deficits 46. 47. 48. 49. 50. Lack of social support Social skill deficits Depressive affect turns others “off” Depression – marital distress – depression Depressed parent – depressed children Mood Disorders and Suicide II 42.Bipolar disorders and suicide Bipolar Disorders: Features (I) 43.Bipolar disorders are distinguished from unipolar disorders by the presence of manic or hypomanic symptoms 44.Some people are subject to cyclical mood swings less severe than those of bipolar disorder; these are symptoms of cyclothymia Bipolar Disorders: Features (II) 45.Kraepelin called it manic­depressive insanity 45. (name ‘stuck’) 46.In bipolar I there is at least one episode of mania 47.In bipolar II there are hypomanic episodes (more common) 48.Seasonal episodes – bipolar with seasonal affective disorder Bipolar Disorders: Features (III) 49.Manic or hypomanic symptoms: markedly elevated euphoric expansive mood with irritability; impairment of social functioning 50.In hypomanic phase – can be creative & productive; may function in adaptive fashion 51.Depressive phase like unipolar Bipolar Disorders: Spectrum Bipolar Disorders: Prevalence & Onset 52.10­15% of unipolar become bipolar 51. Possible misdiagnosis 52. Medication can precipitate mania 53.Bipolar more episodic than unipolar 54.3% of population; equally in genders 55.Begins in young adulthood – recurrent 56.Intervals of relatively normal functioning Bipolar Disorders: Biological Causal Factors Bipolar Disorders: Biological Causal Factors (I) 57.There is a greater genetic contribution to bipolar disorder than to unipolar disorder 53. 8­9% first degree relatives can be expected to have bipolar symptoms 54. 67% concordance rate in identical twins 58.Probably polygenetic in contribution 59.Different from unipolar disorder Bipolar Disorders: Biological Causal Factors (II) 60.Norepinephrine, serotonin, and dopamine all appear to be involved in regulating our mood states 55. Mania – excess dopamine 56. Depression ­ low levels of all three 61.Bipolar patients may have abnormalities in the way ions are transported across the neural membranes (sodium) 57. Lithium works by substituting for sodium Bipolar Disorders: Biological Causal Factors (III) 62.Other biological influences may include 58. Cortisol levels (elevated in bipolar) 58. 59. Thyroid functioning problematic 60. Disturbances in biological rhythms (sleep) 12. With manic, no sleep 13. With depression, frequent sleep Bipolar Disorders: Biological Causal Factors (IV) 63.Other biological influences may include 61. Shifting patterns of blood flow to the left and right prefrontal cortex 14. Left low during depression 15. Right low during mania 62. Changes in subcortical structures in limbic system more often than in unipolar Bipolar Disorder: Psychosocial Causal Factors (I) 64.Psychosocial causal factors include 63. Stressful life events can precipitate bipolar depressive or manic episodes 64. Personality variables (such as neuroticism and high levels of achievement striving) 16. Increase manic symptoms 17. Also pessimistic attributional style as in unipolar Bipolar Disorder: Psychosocial Causal Bipolar Disorder: Psychosocial Causal Factors (II) 65.According psychodynamic theorists, manic reactions are an extreme defense against or reaction to depression 65. Person has unstable self­esteem and unrealistic standards for success 66. Manic ideas serve as a defense against distressing thoughts (fear of not meeting expectations due to low self­esteem) Unipolar and Bipolar Disorders: Sociocultural Factors (I) 66.The prevalence of mood disorders seems to vary considerably among different societies 67. The psychological symptoms of depression are low in China and Japan 18. They tend to show somatic and vegetative symptoms (sleep, appetite, sex) 68. Among several groups of Australian aborigines there appear to be no suicides 19. Due to fear of death Unipolar and Bipolar Disorders: Sociocultural Factors (II) 67.In the United States, rates of unipolar depression are inversely related to socioeconomic status 69. Higher rates in lower SES groups 68.Rates of bipolar depression are directly related to 68. socioeconomic status 70. Higher rates in higher SES groups Mood Disorders in Writers and Artists 0. Figures such as these indicate such individuals are particularly likely to have a mood disorder Robert Schumann’s Work: Number of Compositions by Year Mood Disorders: Biological Treatments and Outcomes (I) 69.Many patients (60%) never seek treatment, and many of these patients will recover 70.Antidepressant, mood­stabilizing, and antipsychotic drugs are all used in the treatment of unipolar and bipolar disorders (MAO inhibitors, tricyclics, SSRI’s) (3 of 11 top selling drugs) Mood Disorders: Biological Treatments and Outcomes (II) 71.1950's MAO inhibitors used 71. Monoamine oxidase is enzyme breaks down serotonin and norepinephrine when released (problems with interactions with foods and medications) 72.1960's Tricyclics introduced 72. Increase transmission of serotonin and 72. norepinephrine (problems are that only 50% of patients helped; side effects; toxic in large doses) Mood Disorders: Biological Treatments and Outcomes (III) 73.1980's SSRI's introduced 73. 74. 75. 76. 77. 78. Serotonin specific re­uptake inhibitors Originally created for OCD More effective; fewer side­effects; less toxic Problems: lowered sex; sleep problems Prozac, zoloft, paxil, Wellbutrin, effexor, serzone, lexapro Mood Disorders: Biological Treatments and Outcomes (IV) 74.Antidepressant drugs usually require at least 3 to 4 weeks to take effect 75.Discontinuing the drugs when symptoms have remitted may result in a relapse 76.Lithium therapy has now become widely used as a mood stabilizer in the treatment of bipolar disorder 79. Effective 75% of time 80. Problems: lethargy, kidney malfunction, toxic Mood Disorders: Biological Treatments and Outcomes (V) 77.Electroconvulsive therapy is often used with severely depressed patients 81. Helps if immediate risk or if antidepressants do not 81. work 82. Useful in both unipolar and bipolar disorders 83. Patient is better within two to four weeks 84. Problems of memory loss 78.TMS (transcranial magnetic stimulation) 85. Has possibility of being as effective as ECT or antidepressants Mood Disorders: Psychosocial Treatments and Outcomes (I) 79.The following forms of psychotherapy are also often effective: 86. Cognitive­behavioral therapy: Beck – evaluate beliefs & automatic thoughts 20. Correct biases and distortions 21. As good as medication; low relapse 87. Behavioral activation treatment – changing behavior to experience positive results 22. Become more engaged in environment and interpersonal relationships Mood Disorders: Psychosocial Treatments and Outcomes (II) 88. Interpersonal therapy – focus on interpersonal relationships 23. Primarily focus on interpersonal relationships as sources of support 89. Family and marital therapy – family as source of perceived negative feedback 24. Involvement of family context to modify feedback and 24. increase support Suicide 80.The risk of suicide is a significant factor in all types of depression 90. Depression 50 times more risk for suicide 91. 40­60% do so during depressive episode 81.Suicide ranks among the top ten leading causes of death in most Western countries 92. Actual suicides greater –many not reported 93. Tragic: ambivalence & effect on others Suicide: Who Attempts and Who Commits Suicide? (I) 94. Suicide attempts are most common in people between 25 and 44 years old 95. Completed suicides are most common in the elderly (65 and older) (loss of function, chronic pain) 96. Women are three times more likely to attempt suicide, but men are four times more likely to complete suicide 97. Higher among separated or divorced (three times more likely than married) Suicide: Clinical Picture Suicide: Who Attempts and Who Commits Suicide: Who Attempts and Who Commits Suicide? (II) 1. Rates of suicide among children seem to be increasing (up th 70%) (7 th leading cause) 2. Rates of suicides for people 15–24 tripled between the mid­1950s and mid­1980s 3. Among 15­24, third most common cause of death (highest of any age level of attempts) (10% students in high school) Suicide: Who Attempts and Who Commits Suicide? (III) 4. Conduct disorder and substance abuse are relatively more common among the completers of suicide (alcohol involved) 5. Mood disorders are more common among nonfatal attempters (also negative events; interpersonal problems; feelings of hopelessness) Suicide: Causal Factors 98. Genetic factors may play a role in risk for suicide (runs in families) 99. Reduced serotonergic activity appears to be associated with increased risk 100. Whites have much higher rates of suicide than African Americans 101. Rates of suicide vary across cultures and religions (low in Catholic & Islamic faiths) 102. Higher rates where social disorganization and absence of strong social ties Suicide: Suicidal Ambivalence Suicide: Suicidal Ambivalence 103. Some people do not really wish to die but instead want to communicate a dramatic message concerning their distress 104. Research has clearly disproved the tragic belief that those who threaten to take their lives seldom do so 25. 40% had clearly communicated suicidal intent 105. Increased risk after first attempt for future attempt (and more likely fatal) Suicide: Prevention and Intervention (I) 82.Difficult to prevent ­ most don't seek help 83.Currently there are two main thrusts to preventive efforts: 106. Treatment of the person’s current mental disorder(s) 107. Crisis intervention 26. Supportive and directive contact 27. Develop better coping strategies 28. Help see light at end of tunnel Suicide: Prevention and Intervention (II) 84.Many investigators have emphasized the need for broad­based preventive programs aimed at alleviating the problems of people who are in high­ risk groups 108. 108. 109. 110. E.g. older men, adolescents Provide social and interpersonal activities Make available sources for cognitive therapy Question! 85.Is there a right to die? End of Chapter 7 ...
View Full Document

This note was uploaded on 09/06/2011 for the course PSYC 3230 taught by Professor Hoyt during the Spring '08 term at University of Georgia Athens.

Ask a homework question - tutors are online