Transcript Abnormal Psychology Fifth Edition

Mood Disorders and
Suicide
Symptoms
Diagnosis
Course and Outcome
Frequency
Causes
Treatment
Suicide
 Major depression is the leading cause of disability
worldwide.
 Depression accounts for 10% of all disability.
 Affect: pattern of observable behaviors
 Facial expression, pitch of voice, body movements
 Mood: a pervasive and sustained emotional response
that can color perception.
Mood disorders are defined in terms of episodesdiscrete periods of time in which the person’s
behavior is dominated by either a depressed or
manic mood.
DSM-IV-TR defines 3 mood episodes.
1. Major depressive episode
2. Manic episode
3. Hypomanic episode
The 3 mood episodes form the basis of the 5 mood
disorders:
Unipolar disorders – individual experiences only
abnormally low moods (major depression,
dysthymia).
Bipolar disorders – individual experiences both
abnormally low and high moods (Bipolar I, Bipolar
II, cyclothymia).
Depression
Mania
 Hypomanic episode - a less extreme version of
a manic episode that is not severe enough to
significantly interfere with functioning.
1) Major depressive disorder
One or more major depressive episode(s)
No history of manic or hypomanic episodes
Subtypes
Catatonic Features
Psychotic Features
Melancholic Features
Postpartum Onset
Seasonal Pattern
2) Dysthymic Disorder: Two years or more of
consistently depressed mood and other symptoms
that are not severe enough to meet criteria for a
major depressive episode.
3) Bipolar I disorder
Combination of major depressive
episodes and manic episodes.
4) Bipolar II disorder
Combination of major
depressive episodes &
hypomanic episodes.
5) Cyclothymic disorder
Two years or more of consistent mood
swings between hypomanic highs and
dysthymic lows.
 Unipolar Disorders
 Average age of onset = 32 but impacts ALL age
groups.
 Length of episodes vary widely
 Relapse: a return of active symptoms
 Approximately ½ patients with MDD recover in
6 months
 Bipolar Disorders
 Onset usually occurs between 18 and 22 years.
 First onset can be depression or mania.
 Average duration of a manic episode runs
between 2 and 3 months.
 Long-term prognosis mixed
 Rapid Cyclers—experiencing at least 4 mood
episodes within a 12 month period
 Incidence and Prevalence
 16% of NSC-R study (n = 9,000) suffered from
depression.
 Lifetime risk of for bipolar I and II disorders
combined is close to 4%.
 Ratio of unipolar to bipolar disorders is at least
5:1.
 Gender Differences
 ♀ 2-3x more vulnerable to depression than ♂.
 ♀ are more likely than ♂ to present for
mental health services.
 More difficult for ♂ to admit to subjective
feelings of distress.
 Gender differences not typically observed for
bipolar mood disorders.
 Major losses of important people or rolesseem to
play a crucial role in precipitating major depression.
 Depression more likely when life events are associated
with feelings of humiliation, entrapment and defeat.
 Social Factors and Bipolar Disorders
 Less attention paid to bipolar disorders
 Weeks preceding the onset of a manic episode
marked by an increased frequency stressful life
events.
 Factors different than from depression
 Schedule-disrupting events
 Goal attainment
Psychological Factors: Cognitive
vulnerability
 Aaron Beck – pervasive and
persistent negative thoughts
central in the onset of depression
when activated by a negative event.
 Cognitive Triad
 Learned helplessness—Seligman
 Response Styles and Gender
 Ruminative style (women more likely)
 Distracting Style (men more likely)
 Interpersonal Factors and Social Behaviors
 Some depressed people create difficult
circumstances, increase the level of stress.
 Integration of Cognitive and Interpersonal
Factors
 Vulnerability to depression influenced by
childhood experiences.
 Genetics
 Twin Studies
 Genes play a more important role in bipolar
disorders
 Heritability (0–100): bipolar mood disorders
have heritability of 80%
 Polygenic
 Genetic Risk and Sensitivity to Stress
 Gender, “s” allele of the 5-HTT—NO
LONGER CITED AS DEFINITIVE
FIGURE 5-5
The
HypothalamicPituitary-Adrenal
(HPA) Axis is
activated in
response to stress.
FIGURE 5-6
Brain
regions
involved in
emotions
and mood
disorders
 Neurotransmitters
 More than 100 different neurotransmitters in
the CNS, and each is associated with several
types of postsynaptic receptors.
 The 3 most likely to play a role in depression
are: Serotonin, Norepinephrine, &
Dopamine
Cognitive therapy
Interpersonal therapy
 Cognitive restructuring
 Focuses on current
 Focuses on helping
relationships,
especially familial
 Attempts to improve
relationships by
building communication & problemsolving skills.
patients replace selfdefeating thoughts
with more rational
statements.
 Unipolar Disorders - Antidepressant Medications
 Four general categories
 Selective Serotonin Reuptake Inhibitors
(SSRIs), Selective Serotonin &
Norepinephrine Reuptake Inhibitors
(SSNRIs), Tricyclics, Monoamine Oxidase
Inhibitors (MOA-Is)
 Improvement typically four to six weeks
 Current episode often resolved within 12 weeks.
 Efficacy – only ~ 50%
SSRI’s
 Block reuptake of





Serotonin
Prozac, Paxil, Zoloft
Most frequently used
Easier to use
Fewer side effects
 Sexual dysfunction,
weight gain
Less dangerous in
event of overdose
Tricyclics
 Block reuptake of
norepinephrine
 Imipramine and
amitripyline
 More side effects:
 Constipation,
drowsiness, drop in BP,
blurred vision
 Equal in efficacy as SSRIs
SSNRI’s
 Effexor, Cymbalta

MAO-I:
 Phenelzine (Nardil)
 Block reuptake of both
 Not as effective tricyclics
serotonin and
norepinephrine
 Long term effects less
known
 Side effects: Consuming
foods with tyramine
(cheese and chocolate)
often increases BP.
 Used in treatment of
anxiety disorders,
particularly agoraphobia
and panic.
 Electroconvulsive therapy (ECT)
 Electromagnetic Treatments
Deep brain stimulation
Lithium
 Effective treatment in
alleviation of manic
symptoms
 60% of patients
improve
 Non-compliance with
drug due to side effects
 Nausea
 Weight gain
 Memory problems
Anti Seizure medications
 Mood Stabilizers
 Depakot, Tegetrol
 Mechanism of how it
works is unknown
Psychotherapy
 Can be effective supplement to
biological intervention
 Combination of psychotherapy
and medication is more
beneficial than medication
alone.
 15 to 20% of all patients with mood disorders will
eventually kill themselves.
 S -- Sex
 A -- Age
 D -- Depression
 P – Previous Attempt
 E – Ethanol Abuse
 R – Rational Thought
 S – Social Support
 O – Organized Plan
 N – No Spouse
 S -- Sickness
 Classification of Suicide
 Nonsuicidal Self-Injury
 Deliberate self-harm without desire for
suicide: cutting, burning, scratching the skin
 Pain serves as useful purpose
 To punish the self
 Is a reflection of frustration and anger.
 Maladaptive way to regulate intense,
negative emotional states.
 Causes of Suicide
 Psychological Factors
 Psychological pain: social isolation, feelings
of being a burden, previous attempts
 Biological Factors
 Reduced levels of serotonin: poor impulse
control; violent and aggressive behaviors
 Potential for genetic predisposition
 Social Factors
 Availability of guns, media
 Treatment of Suicidal People
 Crisis Centers and Hotlines
 Primarily suicide prevention
 Efficacy for “saving lives” not demonstrated
 People with most lethal ideations will not call
 Offers valuable assistance to people in distress
 Psychotherapy
 Reduce lethality
 Treatment of Suicidal People
 Psychotherapy (continued)
 Negotiate agreements
 Provide support
 Replace tunnel vision with a broader perspective
 Medication
 SSRIs in treating depression lowers suicide rates.