Transcript Chapter 6 - Weber State University

Chapter 6
Mood Disorders
And Suicide
What Are Mood Disorders?
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Mood Disorders
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Mania
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Intense and unrealistic feelings of excitement
and euphoria.
Depression
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Disturbances of mood that are intense and
persistent enough to be clearly maladaptive.
Feelings of extraordinary sadness and dejection.
Unipolar disorders
Bipolar disorders
Unipolar Mood Disorders
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Depressions that are not mood disorders
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Lifetime prevalence rates are
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Loss and the grieving process
Other normal mood variations
13% for males and 21 % for females
Average age for adolescent depression is
decreasing over the past decade.
Highly correlated with suicide
Unipolar Mood Disorders
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Mild to moderate depressive disorders
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Dysthymia
Persistently depressed mood, more days than not for
the past 2 years and have two of the symptoms of
major depressive disorder (see next slides).
 Not less severe symptoms than major depression.
 Differs from MDD in that symptoms are not every day
 Average duration for dysthymia is five years.
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Adjustment disorder with depressed mood
Identifiable stressor
 Less than six months
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Major Depressive Disorder
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Major Depressive Disorder (DSM-IV Criteria)
 Person must experience either markedly
depressed mood or marked loss of interest in
pleasurable activities most of every day for at
least 2 weeks.
 The person must experience at least 4 or more
of the symptoms below during the same period:
Fatigue or loss of energy
 Insomnia or hypersomnia
 Decreased appetite and weight loss or gain
 Psychomotor agitation or retardation
 Diminished ability to think or concentrate
 Self denunciation (worthlessness) or excessive guilt
 Recurrent thoughts of suicide or death
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Major Depressive Disorder Subtypes
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Melancholic Type
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Severe Major Depressive Episode with
Psychotic Symptoms
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Loss of contact with reality including delusions
or halucinations.
Mood-Congruent and Mood Incongruent
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Loss of pleasure & other symptoms.
Congruent (negative content – disease or
death)
Incongruent (Positive content – hero)
Postpartum
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More closely fits adjustment disorder diagnosis
Major Depressive Disorder
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Distinguishing major depression
Depression as a recurrent disorder
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Single Episode vs Recurrent Episode
Average duration of untreated MDD (6 months)
Recurrence vs Relapse
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Relapse is when symptoms return quickly before the
depressive episode has run its course.
26% of patients have a recurrence within 1 yr
76% of patients have a recurrence within 10 yrs
Seasonal affective disorder
Biological Causal Factors In Unipolar
Disorders
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Heredity factors
Biochemical factors
Neuroendocrine factors
Sleep and other biological rhythms
Psychosocial Causal Factors In
Unipolar Disorders
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Stressful life events
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Endogenous depression
Chronic stress
Individual differences in responses to
stressors
Vulnerability and invulnerability factors
Psychosocial Causal Factors In
Unipolar Disorders
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Diathesis-stress models
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Personality and cognitive diathesis
Neuroticism
Early parental loss as a diathesis
Psychosocial Causal Factors In
Unipolar Disorders
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Psychodynamic theories
Behavioral theories
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Depressed persons receive fewer
positive verbal reinforcements and
moods tend to vary with both their
positive rates of reinforcement and their
negative experiences.
Beck’s Cognitive Model of Depression
Helplessness and Hopelessness
Theories of Depression
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Learned helplessness
Similarities between depression and
helplessness
The role of attributional style
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Three critical dimensions
Internal/External
 Global/Specific
 Stable/Unstable
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The hopelessness theory of depression
Bipolar Disorders
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Cyclothymia
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Bipolar disorder
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Hypomania
Bipolar disorder with a seasonal pattern
Schizoaffective disorder
Causal Factors in Bipolar Disorder
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Biological causal factors
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Heredity factors
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Higher heritability than unipolar depression
Biochemical factors
Serotonin remains low in both up and down of cycle
 Dopamine and noripinephrine appear to be elevated
in manic state.
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Other
Hormonal Problems
 Blood flow in areas of the brain
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Bipolar Disorders: Features
Causal Factors in Bipolar
Disorder
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Psychosocial causal factors in bipolar
disorder
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Stressful life events
Psychodynamic views
Sociocultural Factors Affecting Unipolar
and Bipolar Disorders
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Cross-cultural differences in depressive
symptoms
A belief in self-sufficiency
Relieving losses
Demographic differences
Interpersonal Effects of Mood Disorders
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Lack of social support and social skills
deficits
The effects of depression on others
Marriage and family
Rates of Mood Disorders in Writers and
Artists
Robert Schumann’s Work: Number of
Compositions by Year
Treatments and Outcomes
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Pharmacotherapy
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Selective Serotonin-Reuptake Inhibitors
(SSRIs)
Lithium and other mood-stabilizing drugs
Electroconvulsive therapy (ECT)
Treatments and Outcomes
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Psychotherapy
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Cognitive-behavioral therapy
Interpersonal therapy (IPT)
Family and marital therapy
Suicide: Clinical Picture
Suicide
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Ninth leading cause of death for adults in U.S.
At least 2/3 of suicide attempters are under 35
Every 20 minutes someone in the U.S. suicides
May be as many as 6 million attempts per year
Women are 3 -4 times more likely to attempt
suicide
Men are 4-5 times more likely to succeed
Rates of attempts are 3-4 times higher in people
who are divorced or separated
Most attempts are related to relational discord
Guns are the means in 60% of suicides
Adolescent Suicide
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Seventh leading cause of death in 5-14 yo.
Third leading cause of death in 15-24 yo.
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Suicide rate in teens tripled from 1950’s to mid
1980’s.
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First two are accidents and homicides)
Similar trends are noted in 23 out of 29 countries studied
(Lester, 1988).
Between 7-16% of high school students report a
suicide attempt
Between 4-8% of 11th and 12th graders report a
suicide attempt
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These are the highest rates of attempts at any point in the
life span (large proportion have low lethality).
However, 9% of males in this age range and 1-4% of
females complete within 5 years.
Gender Differences
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More females attempt because
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Puberty, middle school, and identity transitions
Hormonal changes
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Diathesis-Stress Model (predisposition+stressor
Females tend to focus on emotions and related
thoughts more than males
Females face more descrimination
For males
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Socialization is more counter to suicide
Risk Factors for Adolescent Suicide
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Mental Disorders (more = more risk)
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Conduct Disorder and Substance Abuse are
more common in completers.
Mood Disorders (Depression & Anxiety) are
more common among nonfatal attempters.
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Negative life events (emotional pain)
Availability of firearms in the home.
Stage of life transitions (autonomy vs
control)
Genetic factors (twin studies )
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Hospitalized pts with low serotonin 10x risk
Contagion factors 1-13% (Velting, 1997)
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In almost every case suicide is caused by pain, a
certain kind of pain—psychological pain, or
“psychache”… Suicidal death, in other words, is an
escape from pain… Pain is nature’s great signal.
Pain warns us; pain both mobilizes us and saps our
strength; pain, by its very nature, makes us want to
stop it or escape from it… Psychache is the hurt,
anguish or ache that takes hold in the mind. It is
intrinsically psychological, the pain of excessively
felt shame, guilt, fear, anxiety, loneliness, angst, and
dread of growing old or of dying badly. When
psychache occurs, its introspective reality is
undeniable. Suicide happens when the psychache
is deemed unbearable and death is actively sought
to stop the unceasing flow of painful consciousness.
Suicide is a tragic drama in the mind (Schneidman,
1997, pp23, 29)
Depression Signs and Symptoms
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Depressed mood most of the day
Reduced interest in pleasurable activities
Weight changes
Sleep Problems
Psychomotor agitation or retardation
Lack of energy and motivation
Poor concentration
Feelings of worthlessness
Thoughts of death
Assessment of Suicidality I
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Depressive Disorders and other Mental
Health problems
Alcoholism and other Substance Abuse
Suicide Ideation
Prior Attempts
Lethal Methods
Isolation (friends and family)
Cognitive Rigidity (Hopelessness)
Assessment of Suicidality II
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Modeling (suicide in the family)
Economic or Work Problems
Marital Problems
Stress and Stressful Events
Anger, Aggression, Irritability
Physical Illness
Giving away personal items
Sudden happiness
Repetition and Combination of All Factors
Intervention
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Be direct
Pay attention
Accept without judgement
Be calm
Assure
Seek help