Chapter 7

Chapter 7

Mood Disorders & Suicide

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 2

Unipolar Depression Symptoms

Anhedonia Psychomotor retardation/agitation In severe cases

Hallucinations Delusions

Major depression—acute Dysthymic disorder—chronic


Subtypes of Depression

Depression with Melancholic Features Depression with Psychotic Features Depression with Catatonic Features Depression with Atypical Features Depression with Postpartum Onset Depression with Seasonal Pattern (SAD)


Symptoms of Depression Cognitive Poor concentration,

indecisiveness, poor self-esteem, hopelessness, suicidal thoughts, delusions

Physiological and Behavioral

Sleep or appetite disturbances, psychomotor problems, catatonia, fatigue, loss of memory

Emotional Sadness, depressed mood, anhedonia (loss of interest or pleasure in usual activities), irritability


Major Depression

Dysthymic Disorder

Five or more symptoms including sadness or loss of interest or pleasure

Three or more symptoms including depressed mood

At least 2 weeks in duration

At least 2 years in duration

Num

ber

of

sym

ptom

sD

urat

ion


Prevalence and Prognosis

Among adults, 18- to 29-year-olds are most likely to have had a major depressive episode in the past year.

Women are twice as likely to experience depressive symptoms as men.

Depression rates vary from 3% in Japan to 16% in the United States.


Bipolar Disorder

Mania combined with depression Bipolar I

Elevated, expansive or irritable mood >1 week Three additional symptoms

Bipolar II Severe depression, but mild mania (hypomania)

that does not involve hallucinations, delusions, or interfere with daily functioning

Cyclothymic Less severe but more chronic bipolar condition


Biologic Theories of Depression

Genetic Theory Genes predispose people to depression

Neurotransmitter Theories Dysregulation of neurotransmitters and their

receptors Brain Abnormalities

Altered brain-wave activities affect mood Neuroendocrine Factors

Hormonal dysregulation


Psychological Theories of Depression Behavioral Theories

Lewinsohn’s theory Learned helplessness theory

Cognitive Theories Aaron Beck’s negative cognitive triad Reformulated learned helplessness theory Ruminative response style


Psychological Theories of Depression, cont. Interpersonal Theories

Rejection sensitivity Excessive reassurance seeking

Sociocultural Theories Cohort effects Gender differences Ethnicity/race differences Cross-cultural differences


Theories of Bipolar Disorders

Genetic Factors- strong linkage Brain Abnormalities Neurotransmitter Factors

Dysregulation of the dopamine system Psychological Contributors

Greater sensitivity to rewards Increased stress Disruptions in routines


Drug therapy Tricyclics, monoamine oxidase inhibitors, mood

stabilizers, selective serotonin reuptake inhibitors –SSRI, selective serotonin-norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitor, anticonvulksant and atypical anticonvulsants

Electroconvulsive therapy (ECT) Repetitive transcranial magnetic stimulation

(rTMS) Vagus nerve stimulation Deep brain stimulation Light therapy for SAD

Biological Treatments


Psychological Treatments for Mood Disorders

Behavior Therapy Increase positive reinforcers and decrease aversive events by

teaching the person new skills for managing interpersonal situations and the environment

Cognitive-Behavioral Therapy Challenge distorted thinking and help the person learn more

adaptive ways of thinking and new behavioral skills Interpersonal Therapy

Examines the interpersonal relationships Interpersonal & Social Rhythm Therapy (ISRT)

Enhanced interpersonal therapy for bipolar disorder Family Focused Therapy

Reduces the interpersonal stress for bipolar disorder


Comparison of Treatments

Different therapies generally appear to be equally effective for the treatment of most people with depression

Combination of psychotherapy and drug therapy may be more effective than either type alone


Suicide

“Death from injury, poisoning, or suffocation where there is evidence (either explicit or implicit) that the injury was self-inflicted and that the decedent intended to kill himself/herself.” Centers for Disease Control and Prevention (CDC)

Among the three leading causes of death worldwide among people 15 to 44 years of age. (World Health Organization [WHO], 2008)


Gender Differences


National Differences


Understanding Suicide

Durkheim’s theory Egoistic suicide is committed by people who feel

alienated from others Anomic suicide is committed by those who

experience severe disorientation from society Altruistic suicide is committed by people who

believe that taking their own life will benefit society in some way.


Psychological Disorders & Suicide

Over 90% of people who commit suicide have probably been suffering from a diagnosable mental disorder

Depression increases the odds of a suicide attempt by approximately 6 times and bipolar disorder increases the odds of a suicide attempt by 7 times

Best predictor of suicidal thought and behavior is past suicidal thought and behavior. Among adolescents, a history of a previous suicide attempt increases the odds of suicide by 30 times among boys and 3 times among girls


Personality, Cognitive & Biological Factors Personality characteristic that seems best to predict

suicide is impulsivity Cognitive variable that most consistently predicts

suicide is hopelessness Children of parents who had attempted suicide were

6 times more likely to also attempt suicide than the children of parents who had a mood disorder but had not attempted suicide

Low serotonin levels are linked with suicidality even among people who are not depressed


Treatment & Prevention

Community-based prevention– Crisis intervention programs, suicide hotlines

Drug treatments– Lithium, selective serotonin reuptake inhibitors

Psychological treatments– Dialectical behavior therapy, psychotherapy

Chapter 7

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