Transcript Women are twice as likely to suffer from

Prepared by:
Ashlea R. Smith, PhD
Argosy University – Phoenix
Second Edition
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Mood Disorders
Chapter 6
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What Are Mood Disorders?
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Suicide
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The Etiology of Mood Disorders
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The Treatment of Mood Disorders
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Syndromes in which a disturbance in
mood is the predominant feature
Take the form of low or high mood
-Depression (abnormally low mood)
-Mania (abnormally high mood)
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Three distinct mood disorders
-Major depressive disorder
-Dysthymic disorder
-Bipolar disorder
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Persistent sad or
low mood that is
severe enough to
impair a person’s
interest in or
ability to engage
in normally
enjoyable
activities
-Disturbance in psychological,
emotional, social, and physical
functioning
-Episodic illness (single episode
lasts two weeks to several
months; can be recurrent)
40% of people diagnosed
with MDD actually sleep
and eat more than usual.
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Figure 6.1 The Different
Forms of Depression
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A chronic state of depression; the symptoms
are the same as those of major depression,
but they are less severe
Persistent, lasting two or more years and an
individual is never without symptoms for
more than two months
Leads to severe outcomes (social isolation, high
suicide risk, and mislabeled as moody or difficult)
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A period of abnormal elevated or irritable
mood lasting for at least one week or
requires hospitalization
Individual must possess three or more of the
following: (a) inflated self esteem, (b)
decrease need for sleep, (c) talkativeness, (d)
flight of ideas, (e) distractibility, and (f)
increased goal-directed activity
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Both episodic depressed
mood and episodic mania
(formerly manicdepressive disorder)
Mania
Long-term illness
Mood shifts between two
emotional “poles”
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Categories of Bipolar
-Bipolar I (full blown mania
alternates with episodes of
major depression)
-Bipolar II (hypomania mood
elevation that is abnormal
yet not severe enough to
impair functioning or
require hospitalization)
Bipolar II is more common than Bipolar I;
however, because of the high levels of
productivity and creativity associated with the
hypomania, one may view the episodes in a
more positive light.
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Requires lifelong treatment and
clinical management!
Figure 6.2 The Different
Types of Bipolar Illness
Cyclothymic
disorder a
condition
characterized
by fluctuations
that alternate
between
hypomanic
symptoms and
depressive
symptoms.
Rapidly cycling bipolar disorder
have four or more severe mood
disturbances within a single year.
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Mixed state is
symptoms of mania
and depression that
occur at the same time.
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A condition characterized by fluctuations
that alternate between hypomania and
depression
Episodes not as severe as with mania or
major depression
Persist for at least two years
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Approximately 16.2% of
people age 18 and older
report major depressive
disorder at some point.
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Most common psychiatric disorder
worldwide
Median age of onset is 30 years (Kessler et
al., 2005)
Prevalence rates:
-Major depression 32.6-35.1 million U.S. adults
-Dysthymia 2.5% of general population
-Depression ranks fourth in Global Burden of Disease
(WHO, 2011)
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Women are twice as likely to suffer from
depression than their male counterparts.
Fact or fiction?
Yes, across all cultures women are twice as
likely to suffer from major depression at 10 to
25% versus men at 5 to 12%.
Puberty, premenstrual period,
pregnancy, post partum period, and
menopause are all considered risk
factors for mood disorders.
Fact or fiction?
Yes, rates of depression do vary by age, but
these reproductive events are all indentified as
risk factors.
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Women are twice as likely to suffer from
major depression (10%) than men (5%)
Common in lower SES
Impact of unemployment and lack of
education and financial resources
Impact of reproductive events Approximately 80% of
new mothers will develop
the “baby blues.”
Postpartum Depression (PPD)
Higher rates of depression in Whites at
17.9%
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Less common than major depression
Unrelated to race, sex, and family income
Men & mania vs. Women &
Affects people of all ages depression when it comes to
episodes with bipolar disorder?
More common in:
The average age of
-Lower SES
onset of the first
manic episode is
-Anxiety disorder (comorbidity)
18 years old.
-Substance abuse disorder (comorbidity)
-Affects males and females equally 0.9-1.3%
(Merikangas, 2007)
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Age risk between 18
and 43, with the typical
onset occurring at the
age of 30
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Typical warning signs
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In childhood both boys
and girls are equally
affected
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2.5% of children
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8.3% of adolescents
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After adolescence rates of
depression increases for
girls (2 to 1)
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Risk factors for depression
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In children, mania may be
chronic (irritability and
temper tantrums)
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Older adult population 1%
over 60 report bipolar
disorder
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Difficulty in
differentiating bipolar
disorder from ADHD,
conduct disorder, ODD,
and schizophrenia
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After that age, mania and
depression symptoms result
from medical illness
especially stroke (Van
Gerpen et al., 1999)
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Onset in childhood and
adolescent more severe
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Time span between mania
and depression factors
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Can occur with medical conditions (heart
disease, CNS disease, cancer, & migraines, Fleischhacker
et al., 2008)
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72.1% of people with major depressive
disorder had additional disorders
59.2% anxiety disorder
24% substance abuse disorder
30% impulse disorders
Genetic and environmental factors
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What factors do you think contribute to
suicide rates being the highest among
whites and American Indians/Alaskan
natives in the United States?
Key Points: Keep in mind that suicide ranks as the eighth leading cause of death in
United States—2 to 5% of people have attempted suicide (Moscicki, 1999). Additionally,
males are more likely to commit suicide (usually by violent methods hanging or firearms)
than females, even though females attempt suicide more often.
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Components of depression
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Eighth leading cause of
death
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2 to 5% of people in the
United States attempt
suicide (Moscicki, 1999)
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U.S. 17.7 per 100,000
males, 4.5 per 100,000
females
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Underreported due to
misclassification of singlevehicle car accidents
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WHO estimates that one
million people die from
suicide every year, 16 per
100,000
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Highest rate of male suicides
in Belarus, Lithuania, 50 per
100,000
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Range from thoughts to detailed plans
Suicidal ideation (SI) (thoughts of suicide)
-Passive (wish to be dead without a plan)
-Active (thoughts and includes a detailed plan)
Parasuicides (superficial cutting and OD on
nonlethal medications)
Previous attempts at suicide increase the risk of
suicide 30-40 times (Harris & Barraclough,
1997)
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The lowest rates of male suicides
were found in Asian/Pacific Islanders
and for females Non-Hispanic Blacks
had the lowest suicide rate (CDC,
2009)What factors do you think
contribute to these lower rates of
suicide among these populations?
Males vs. Females
Methods used by males
Risk factors for youth
Events to spark SI for adolescents
Events to spark SI for elderly
Highest rates among whites and American
Indian/Native Indians
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What methods do you believe
adolescents use to commit
suicide?
Figure 6.3 Percentage of High
School Students Who Attempted
Suicide by Sex and Race/Ethnicity
How do you
explain the fact
that more
Hispanic
teenagers are
more likely to
attempt suicide
versus in
adulthood more
Anglo and
Native
Americans
attempt suicide?
Why do you feel that more
adolescent females attempt
suicide versus adolescent males?
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What types of programs,
resources, or education
should be provided to
target adolescents with
suicidal ideation?
89% of individuals
diagnosed with major
depression have attempted
suicide in past 12 months
(Kessler, 2005).
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Family history (family members across generations
have committed suicide)
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Psychiatric illness (90% of attempted or
completed suicides are committed by people with
mental illness)
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Biological factors (very low levels of serotonin,
impulsivity, and pathological aggression)
Approximately 50% of patients with
bipolar disorders attempt suicide
during their lifetime.
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Ernest Hemingway
(over two generations—four
members—the writer, his
father, his brother, and his
sister all committed suicide)
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1996 Margaux
Hemingway (daughter of
Ernest’s oldest son; a
model; committed suicide)
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Vincent van Gogh and
his brother Cornelius
took own lives
Individuals with a family history of suicide are
2.5 times more likely to commit suicide than
those without a family history.
Ernest Hemingway, Vincent van Gogh, and his
brother Cornelius all suffered from bipolar
disorder. What is it about this disorder that
contributes to a high suicide risk?
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Only 1/5 to 1/3 leave behind suicide notes
Psychological autopsy (interviews with family,
friends, coworkers, and health care providers in an
attempt to identify psychological causes of suicide)
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Coroner (identifies the physical cause of death)
Impact on those left behind
Severity of suicidal ideation
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Interventions serve as a preventative
measure. Do you believe that if one is
engaging in self-injurious behavior
(cutting, burning, biting, etc.) that they
want to commit suicide? Why or why
not? In regards to treatment, do we target
these individuals differently than those
with a plan of suicide?
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Crisis intervention (suicide hotlines)
Focus on high-risk groups (children of parents with
mood disorders who have attempted suicide themselves)
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Societal level prevention (using teacher and peer
support)
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Preventing suicidal contagion (copycat suicides)
Use of critical incident debriefing (CID)
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Deliberate self-harm risk factor for
suicide
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Psychological intervention
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Psychosocial intervention
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Follow-up psychiatric care
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Biological
-Genetics and family studies
-Neuroimaging studies
-Environmental factors and life events
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Figure 6.4 Chromosomes in a Linkage
Study
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Both genes and environmental factors are
involved in the onset of depression
Gene’s double the risk of depression following
life stressors
37% of the risk of depression is attributed to
genetics.
Risk may lie on genes 1,3,4,68,11,12,15, and
18 but nothing is definite!
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Psychological
-Psychodynamic theory
-Attachment theory
-Behavioral theories
-Learned helplessness
-Cognitive theory
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Figure 6.5 Learned Helplessness
From Lilienfeld et al. (2009) Psychology: From
Inquiry to Understanding, Allyn & Bacon.
Copyright © 2009 Pearson Education, Inc.
Reprinted by permission of Pearson Education,
Inc.
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Psychological
- Focus on understanding
how thoughts, perceptions,
and behaviors influence
depression
- Cognitive-behavioral
therapy (CBT)
- Interpersonal psychotherapy
(IPT)
- Behavioral activation
(focuses on increased
contact with positive
reinforcement for
healthy behaviors which
results in positive
mood)
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Biological
- First-generation
antidepressants
(Tricyclic
antidepressants and
monoamine oxidase
inhibitors, MAOIs)
- Second-generations
antidepressants (SSRIs)
- Electroconvulsive Therapy
(ECT)
- Light therapy
- Transcranial magnetic
stimulation
- Deep brain stimulation
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Psychological
-Cognitive-behavioral therapy
(CBT to develop skills to
change inappropriate or
negative thought patterns)
- Interpersonal and social
rhythm therapy (IPSRT
promotes adherence to
regular daily routines)
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Biological
- Lithium (a naturally
occurring metallic element
used to treat bipolar
disorder, which moderates
glutamate levels in the
brain)
- Atypical antipsychotics
- Electroconvulsive
Therapy (ECT)
- Anticonvulsant
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Depends on nature and severity of the
symptoms
Placebo-controlled, randomized clinical
trials
Psychotherapy
Pharmacology
Empirical support
ECT
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1.
2.
3.
When considering a mood disorder diagnosis, it is
important to assess the duration of the mood change
and the degree of impairment on functioning.
Depression is the most common psychiatric disorder
worldwide.
A variety of factors increase a female’s risk to develop
depression, such as puberty, premenstrual period,
pregnancy, the postpartum period, and menopause.
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4.
5.
6.
If one is diagnosed with depression or bipolar disorder,
there is an increased risk for suicide and suicidal
ideation.
Both genetic and environmental factors play a role in
the development of depression.
For both bipolar disorder and major depression, both
psychotherapy and pharmacological treatments are
available.
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