Psych 2621 Ch.8 Mood Disorders and Suicide

Mood Disorders: General Characteristics

• Much more serious than typical emotional states that everyone feels

• involve significant disturbances in emotion, including extreme sadness (depression) or elation/irritability (mania)

• Are disabling (interfere with daily activities)

• are often associated with other serious psychological problems

  • panic attacks

  • substance abuse

  • personality disorders

Depression: Sign and Symptoms (mood disturbance)

• great sadness

• worthlessness and guilt

• withdrawal from others

• sit alone in silence

Depression: Signs and Symptoms (cognitive disturbance)

• self-criticism and self-blame

• indecisiveness and slow thinking

• thoughts of suicide or death

• trouble paying attention

Depression: Signs and symptoms (somatic disturbance)

• loss of sleep

• loss of sexual desire

• loss of interest in pleasure and usual activities

• sleep and appetite are affected

Depression sign and symptoms

• Symptoms vary between cultures

• Children: somatic symptoms are most common early signs

• Most depressed individuals focus on somatic symptoms

Mania :Signs and symptoms

Mania is characterized as:

• an emotional state or mood of intense but unfounded elation

• accompanied by irritability

• hyperactivity, talkativeness

• flight of ideas

Noticed by others due to:

• loud and incessant remarks

• sometimes full of puns, jokes, rhyming

• difficult to interrupt

• shifting from topic to topic

Diagnosis Major Depressive

• presence of the following 5 symptoms for at least 2 weeks

depressed mood or loss of interest and pleasure must be 1 of 5 symptoms

• sad, depressed mood, most of the day

• loss of interest and pleasure in usual activities

• difficulties in sleeping

• shift in activity level

Bipolar Disorder

Involves episodes of mania or mixed episodes that include symptoms of both mania and depression

• Diagnosis of a manic episode requires the presence of elevated or irritable mood and increased activity level

• Occurs more than in MDD

• Average onset is in the 20s

• Equally often in men and women

  • Severe manic episodes can result in violent behaviours (child or spousal abuse)

Heterogeneity

• The same diagnosis can vary greatly

• bipolar 1 disorder with mixed episodes

• bipolar 2 disorder (no full-blown mania)

  • Episodes of major depression accompanied by hypomania

Bipolar Disorder and Pregnancy

• Both manic and depressive episodes may occur during pregnancy or within 4 wks of childbirth

• Postpartum Depression (PD) - depression experienced by some mothers after giving birth “baby blues”

• 12% of mothers show this

Psychological Theories (Psychoanalytic Theory of Depression)

• Potential created in early childhood

• depression is seen to be like a mourner who over-identifies with lost loved one

Psychological Theories Cognitive Theories

Biological Theories

Genetic Data

• Bipolar

  • Concordance rate is as high as 85%

  • Adoption studies provide support for a strong heritable component

• MDD

  • Heritability estimate is 35%

  • Relatives of unipolar probands are at high risk for unipolar depression

• Neurochemistry

  • Decreased levels of norepinephrine and dopamine lead to depression

  • Increased levels lead to mania

  • Serotonin theory: serotonin produces both depression and mania

Drug actions suggest that depression and mania are related to serotonin, norepinephrine and dopamine

Biological Theories Neuroimaging Studies

• Main brain structures: amygdala, hippocampus, prefrontal cortex, and anterior cingulate

• MAO-A levels in the brain are elevated during untreated depression

Neuroendocrine System

• HPA axis may play a role in depression

  • Limbic area of the brain affects the hypothalamus, which in turn controls endocrine glands

• HPT axis may play a role in Bipolar Disorder

  • Disorders of thyroid function are often seen in bipolar patients

Therapies for mood disorders. (Psychological)

Psychological Therapies

• Psychodynamic Therapies

  • Repressed sense of loss from anger unconsciously turned inward

  • Achieve insight; encourages outward release

• Cognitive and Behaviour Therapies

  • Therapists work with clients to change their opinions of events and the self

  • Encourage clients to do things

• Mindfulness-Based Cognitive Therapy

  • Specifically to prevent relapse

  • Step back from one’s thoughts and feelings to see them as simply thoughts and feelings

• Psychological Treatment for Bipolar Disorder

  • CBT can target thoughts and behaviours that go away during mood swings

  • Education about BP and treatment and self and family

Therapies for Mood Disorders (Biological)

Biological Therapies

• Electroconvulsive therapy (ECT)

  • Most dramatic and controversial treatment for severe depression

  • Faster than antidepressants and therapies

  • bilateral and unilateral ECT

• Deep brain stimulation and repetitive Transcranial Magnetic Stimulation

• Drug Therapy

  • Most commonly used treatment

  • Often in conjunction with psychotherapy

  • Drug therapy for bipolar disorder: lithium

    • Fatal side affects

Suicide

• 9th leading cause of death in Canada in 2012

• 2nd cause of death in youth ages 15 to 24

  • Women have higher rates of suicide attempts but lower rates of suicide as compared to men

Suicide- Terminology

• Suicidal Ideation

  • Thoughts and intentions of killing oneself

  • attempt with plan(31.9%) and no plan (9.6%)

• Suicide attempts

  • hopelessness and self- criticism

  • self-injury behaviours intended to cause death but that do not lead to death

• Suicide gestures

  • self-injury in which there is no intent to die

• Suicide

  • Behaviours intended to cause death and death occurs

  • long-term predictors include severity of SI, hopelessness, depression, BP Diagnosis, being unemployed, insomnia

Preventing Suicide

• Treating the underlying mental disorder

• Treating Suicidality Directly

• Suicide Prevention Centres

• Government Suicide Prevention Programs in Canada