Transcript Basic Statistics for the Behavioral Sciences

Chapter 6
Mood Disorders and Suicide
Range of Emotions
• A person with a mood disorder experiences
emotions that are extreme and, therefore, abnormal.
Types of depressive disorders
– Major depressive disorder
– Dysthymic disorder
– Double depression
Major Depression:
An Overview
• Major depressive episode:
Overview and defining features
– Extremely depressed mood lasting
at least two weeks
– Cognitive symptoms – feelings of
worthlessness, indecisiveness
– Disturbed physical functioning
(sleep and eating)
– Anhedonia – loss of
pleasure/interest in usual activities
Major Depression:
An Overview
• Major depressive disorder
– Single episode – highly unusual
– Recurrent episodes (2 or more
major depressive episodes
separated by at least 2 months of
no depression) – more common
• From grief to depression
– Pathological or impacted grief
reaction
Major Depression:
An Overview
• Major depressive disorder
Mean age is 30
Typical first episode is 4-9 months if untreated
Dysthymia: An Overview
• Overview and defining features
– Symptoms are milder than major depression
– Persists for at least two years in adults, one year in
children and adolescents
– No more than two months symptom free
– Symptoms can persist unchanged over long periods (≥
20 years)
• Facts and statistics
– Late onset – typically in the early 20s
Double Depression:
An Overview
• Overview and defining features
– Major depressive episodes and dysthymic disorder
– Dysthymic disorder often develops first
– Associated with severe psychopathology and
problematic future course
– High relates of relapse
Types of bipolar disorders
– Bipolar I disorder
– Bipolar II disorder
– Cyclothymic disorder
The Structure of Mood Disorders
• Mania
• Hypomanic episode – less severe than manic
episode that lasts at least 4 days
The Structure of Mood Disorders
• Features of a manic episode
– Elevated, expansive mood for at least one week
• At least 3 of the following:
– Inflated self-esteem, decreased need for sleep,
excessive talkativeness, flight of ideas or sense
that thoughts are racing, easy distractibility,
increase in goal-directed activity or psychomotor
agitation, excessive involvement in pleasurable
but risky behaviors
– Impairment in normal functioning
Bipolar I Disorder:
An Overview
• Overview and defining features
– Alternations between full manic or mixed
episodes and (but not necessarily) depressive
episodes and/or hypomania
• Facts and statistics
– Average age of onset is 15-18 years
– Can begin in childhood
– Tends to be chronic and acute
– Suicide is a common consequence – as high as
48% (usually during depressive episodes)
Bipolar II Disorder:
An Overview
• Overview and defining features
– Alternations between major depressive and
hypomanic episodes
• Facts and statistics
– Average age of onset is 19-22 years
– Can begin in childhood
– 10% to 25% of cases progress to full bipolar I
disorder
– Tends to be chronic
Cyclothymic Disorder:
An Overview
• Overview and defining features
– Milder but more chronic version of bipolar disorder
– hypomanic and dysthymic episodes that last a long
time
– Must last for at least two years (one year for
children and adolescents)
Cyclothymic Disorder:
An Overview
• Facts and statistics
– Average age of onset is 12 to 14 years
– 60% are female
– chronic and lifelong
– 1/3 to 1/2 develop bipolar
Prevalence of Mood Disorders
• Worldwide lifetime prevalence
– 16% for major depression
• Sex differences
– Females are twice as likely to have major depression
– Bipolar disorders equally affect males and females
– 1% for bipolar disorder
Prevalence of Mood Disorders
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Occurs less often in prepubertal children
Rapid rise in adolescence
Adults over 65 have about 50% less than adults
Three-month-olds can show depression
Children below nine do not show classic mania or
bipolar symptoms
• Mood disorders are often misdiagnosed as ADHD
• Children are being diagnosed with bipolar at
increasingly high rates
Life Span Developmental Influences on
Mood Disorders
• Depression in elderly between 14% and 42%
– Comorbidity with anxiety disorders
– Less gender imbalance after 65 years of age
• Cultural differences exist
– Hopi Native Americans - “Heartbroken”
– Native American population - 4 X the rate
Mood Disorders: Familial and Genetic
Influences
• Family studies
– Rate is high in first-degree relatives of probands (2-3 x
greater)
– Relatives of bipolar probands tend to have unipolar
depression
• Twin studies
– Concordance rates are high in identical twins (2-3 x)
– Severe mood disorders have strong genetic influence
– Heritability rates are higher for females compared to
males; 40% women and 20% men for depression
Mood Disorders: Familial and Genetic
Influences
• Twin studies
– Vulnerability for unipolar or bipolar disorder
• Appears to be inherited separately
– Some genetic factors are common for mood and
anxiety disorders (not mania though)
Mood Disorders: Neurobiological
Influences
• Neurotransmitter systems
– Low Serotonin and its relation to other
neurotransmitters causes mood disorders
– Permissive hypothesis – when serotonin is low, other
neurotransmitters are “permitted” to become
dysregulated
Mood Disorders: Neurobiological
Influences
• The endocrine system
– Elevated cortisol damages the hippocampus and
prevents neurogenesis
• Sleep disturbance
– Hallmark of most mood disorders
– REM and depression
– Insomnia and depression linked
Mood Disorders: Psychological
Dimensions (Stress)
• Stressful life events
– Stress is strongly related to mood disorders
• Poorer response to treatment
• Longer time before remission
– The relation between context (interpretation) of
life events and mood
– Reciprocal-gene environment model
– Relationship between stress and bipolar is also
strong
Mood Disorders: Psychological
Dimensions (Learned Helplessness)
Learned helplessness (LH)- Lack of perceived control
over life events
• LH and a depressive attributional style
– Internal attributions
• Negative outcomes are one’s own fault
– Stable attributions
• Believing future negative outcomes will be one’s fault
– Global attribution
• Believing negative events will disrupt many life activities
Mood Disorders: Psychological
Dimensions (Beck’s Cognitive Theory)
• Negative coping styles
– Depressed persons engage in cognitive errors
– Tendency to interpret life events negatively
• Types of cognitive errors
– Arbitrary inference – overemphasize the negative
– Overgeneralization – negatives apply to all
situations
Mood Disorders: Psychological
Dimensions (Cognitive Theory)
• Cognitive errors and the
depressive cognitive triad
– Think negatively about oneself,
the world and the future
– Negative schema
Mood Disorders: Social and Cultural
Dimensions
• Marital relations
– Marital dissatisfaction is strongly related to depression
especially in males
• Mood disorders in women
– Females over males (70:30) except bipolar disorders
(50:50)
– Gender imbalance likely due to socialization
(perceptions of uncontrollability)
• Social support
– Extent of social support is related to depression and
predicts recovery from depression
An Integrative Theory
• Shared biological vulnerability
– Overactive neurobiological response to stress
• Inadequate coping and depressive cognitive
style
– Diathesis-stress model
• Biological, psychological and social factors all
influence the development of mood disorders
• Exposure to stress
Selective Serotonergic Reuptake
Inhibitors (SSRIs)
• Specifically block reuptake of serotonin
– Fluoxetine (Prozac) is the most popular SSRI
• SSRIs pose some risk of suicide particularly in
teenagers
• Negative side effects
Treatment of Mood Disorders:
Mixed Reuptake Inhibitors
• Venlafaxine (Effexor)- blocks norepinephrine
as well as serotonin
• Nefazodone (Serzone) – improves sleep
efficiency
• Both have fewer side effects than SSRIs
Treatment of Mood Disorders:
Monoamine Oxidase (MAO) Inhibitors
• Monoamine oxidase (MAO)
– Block monoamine oxidase enzyme that breaks
down serotonin and norepinephrine
– Slightly more effective than tricyclics
• Must avoid foods containing tyramine
– Examples include beer, red wine, cheese
– Many patients do not like the dietary restrictions
Treatment of Mood Disorders: Tricyclic
Antidepressants
• Used to be widely used (e.g., Tofranil, Elavil)
• Block reuptake
– Norepinephrine and other neurotransmitters
• Therapeutic effects
– Can take two to eight weeks
• Negative side effects are common
• May be lethal in excessive doses so not good
for suicidal tendencies
Treatment of Mood Disorders: Lithium
• Lithium carbonate is a common salt
– Primary drug of choice for bipolar disorders (50%
reduction in symptoms)
– Can be toxic
• Side effects may be severe
– Dosage must be carefully monitored
– Lithium is a mood-stabilizing drug
• Why lithium works remains unclear
Treatment of Mood Disorders:
Electroconvulsive Therapy (ECT)
• ECT is effective for cases of severe depression
• The nature of ECT
– Involves applying brief electrical current to the brain
– Results in temporary seizures
– Usually six to 10 outpatient treatments are required
– Side effects are few and include short-term memory loss
– Uncertain why ECT works
– Relapse is common (60%)
Psychosocial Treatments
• Cognitive-behavioral therapy
– Addresses cognitive errors in thinking
– Also includes behavioral components
• Interpersonal psychotherapy
– Identifies stressors and focuses on problematic
interpersonal relationships
• Prevention
• Combined treatments for depression more
effective (73% versus 48%)
• Prevention relapse of depression
• Psychosocial treatments for bipolar
The Nature of Suicide:
Facts and Statistics
• 11th leading cause of death in the United
States- maybe two to three times higher
• Overwhelmingly a white and Native American
phenomenon
• China and suicide rates (more females)
Suicidal ideation - thinking seriously about suicide
Suicidal plan – formulation of a specific method
Suicidal attempt – person survives
The Nature of Suicide: Facts and
Statistics
• Gender differences
– Males are more successful at committing suicide
than females
– Females attempt suicide more often than males
The Nature of Suicide:
Risk Factors
• Risk factors
– Suicide in the family
– Low serotonin levels
– Preexisting psychological disorder
– Alcohol use and abuse
– Stressful life event
– Past suicidal behavior
– Suicide contagion
• Treatment
Summary of Mood Disorders
• All mood disorders share:
– Gross deviations in mood
– Common biological and psychological vulnerability
• Occur in children, adults, and the elderly
• Onset, maintenance, and treatment are
affected by
– Stress
– Social support
Summary
• Suicide is an increasing problem
– Not unique to mood disorders
• Medications and psychotherapy produce
comparable results
• High rates of relapse
DSM-5 Proposed Changes
• http://www.dsm5.org/ProposedRevisions/Pag
es/MoodDisorders.aspx