7 - Mood Disorders & Suicide

Mood disorders

experiences emotions that are extreme and, therefore, abnormal

• Extreme sadness

• Mild sadness

• Normal emotions

• Mild elation

• Extreme elation

Range of Emotions:

• Unipolar Depressive Disorders

• Bipolar Depressive Disorders

What Are Mood Disorders? (2)

Unipolar Depressive Disorders

Only depressive episodes.

Bipolar Depressive Disorders

Manic and possibly depressive episodes (but not necessary).

women

Mood Disorders:

• About twice as common in ____

Mild, Brief Non-Depression

• Can be normal and adaptive

• Sadness, hopelessness, and pessimism are common human experiences.

• Mild

• Moderate

• Severe

Severity of depression:

• Single Episode

• Recurrent Episode

Course of depression:

Persistent Depressive Disorder (Dysthymic Disorder)

Mild to moderate version of depression

Persistent Depressive Disorder (Dysthymic Disorder)

• Lasts a long time

• Intermittent normal moods occur briefly

Major depressive episode

• Extremely depressed mood lasting at least two weeks

• Cognitive symptoms – feelings of worthlessness, indecisiveness

• Disturbed physical functioning (sleep and eating)

• Anhedonia

Anhedonia

loss of pleasure/interest in usual activities

- Single episode - highly unusual

- Recurrent episodes (2 or more major depressive episodes separated by at least 2 months of no depression) - more common

With Seasonal Pattern

At least two or more episodes in past 2 years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring)

• No other nonseasonal episodes in the same 2-year period.

• Major depressive episode with melancholic features

• Severe major depressive episode with psychotic features

• Major depressive episode with atypical features

• Major depressive episode with catatonic features

Major Depressive Disorder - Specifiers: (4)

(Pointers!!!)

• Persistent major depressive disorder

• Seasonal affective disorder

Major Depressive Disorders: (2)

Persistent major depressive disorder

Major depression does not remit (disappear) for more than two years.

Seasonal affective disorder

Recurrent depressive episodes with a pattern (change of seasons)

• the episodes occur during the fall and winter months and remit during the spring and summer months.

• Heredity

• Altered neurotransmitter activity

• Hormones

• Genes

• Disruptions

Biological Causes of Unipolar Mood Disorders: (5)

• Serotonin-transporter gene

• Three combinations

• Gene-environment interaction research

Genes:

• Sleep

• ​Circadian rhythms

• Exposure to sunlight (seasonal)

Disruptions:

• Stressful life events

• Risk-related vulnerability factors

• Neuroticism or negative affectivity

• Parental loss

Psychological Causal Factors for Depression:

• Freud

• Behaviorists

• Cognitive model

Theorists in Depression: (3)

• Early experience

• Formation of dysfunctional beliefs

• Critical incident(s)

• Beliefs activated

• Negative automatic thoughts

• Symptoms of depression:

- Behavioral

- Motivational

- Affective

- Cognitive

- Somatic

Beck's Cognitive Model of Depression:

(Pointers!!!)

• The Self

• The Future

• The World

Negative Cognitive Triad:

(Pointers!!!)

Reformulated helplessness theory

suggests that depression arises when individuals attribute negative events to internal, stable, and global causes.

• Internal: Believing the cause is due to their own personal failings.

• Stable: Believing the cause is permanent and unchangeable

• Global: Believing the cause will affect all aspects of their life.

Hopelessness theory

This theory proposes that a particular subtype of depression is caused by feelings of hopelessness

Excessive rumination

This refers to a repetitive and passive focus on one's symptoms of distress and possible causes and consequences of these symptoms, rather than on solutions.

Mania / Manic episode

Elevated, expansive mood for at least one week

• 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

Symptoms for Manic episode:

(At least 3 of the following)

​

Hypomanic episode

Less severe than a manic episode, lasting at least 4 days

Bipolar I disorder

Includes at least one manic or mixed episode.

Bipolar II disorder

Includes hypomanic episodes but not full-blown manic or mixed episodes.

Cyclothymic Disorder

• Less severe than those of bipolar disorder

• Symptoms present for at least 2 years

• Lacking severe symptoms and psychotic features of bipolar disorder

• males and female

• adolescence or young adulthood

• 18 to 22

Bipolar Disorders (I and II) - Characteristics

• Occur equally in _____.

• Usually start in ________.

• Average age of onset is ______ years.

The Manic-Depressive Spectrum:

• Heredity

• Neurotransmitters like norepinephrine, serotonin, and dopamine

• Abnormalities in ion transportation across the neural membrane

• Cortisol levels

• Shifting patterns of blood flow to prefrontal cortex

• Disturbances in biological rhythms

Biological Causal Factors in Bipolar Disorder:

• Stressful life events

• Personality variables

• Low social support

• Pessimistic attributional style

Psychological Causal Factors in Bipolar Disorder

• Native Americans

• African-Americans

• __________ have relatively high rates of depression

• __________ have relatively low rates

• Pharmacotherapy

• Alternative biological treatment

• Psychotherapy

• SSRI

Treatments for Bipolar Disorder (Mood Disorders): (3)

Pharmacotherapy

involves using antidepressants, mood-stabilizing, and antipsychotic drugs to treat mood disorders

Lithium

common mood stabilizer for bipolar disorder.

Selective Serotonergic Reuptake Inhibitors (SSRIs)

Specifically block reuptake of serotonin

Fluoxetine (Prozac)

is the most popular SSRI

Selective Serotonergic Reuptake Inhibitors (SSRIs)

pose some risk of suicide particularly in teenagers

• Negative side effects

• Electroconvulsive therapy

• Transcranial magnetic stimulation

• Deep brain stimulation

• Bright light therapy

Alternative Biological Treatments in Bipolar Disorder:

Electroconvulsive therapy (ECT)

Effective for cases of severe depression.

Electroconvulsive therapy (ECT)

Involves applying a brief electrical current to the brain, resulting in temporary seizures.

• Usually requires six to 10 outpatient treatments.

• Side effects are few and include short-term memory loss.

• It is uncertain why ECT works.

• Relapse is common (60%).

• Cognitive-behavioral therapy

• Behavioral activation treatment

• Interpersonal therapy

• Family and marital therapy

Forms of Effective Psychotherapy in Mood Disorders:

• Helps change negative thought patterns to improve behavior and emotions.

• Reintroduces positive activities to uplift mood and break negative behavior patterns.

• Focuses on improving current relationships to enhance mental well-being.

• Helps families and couples build healthier relationships and improve communication.

Suicide risk

is a significant factor in all types of depression.

Suicide

ranks among the top ten leading causes of death

• low but increasing

• 10-14

Suicide in Children:

- Rates are very ________.

- Suicide in children age ____ has increased by 70% since 1981.

- Multiple risk factors are involved.

tripled

Suicide in Adolescents and Young Adults:

- Rates ____ between the mid-1950s and mid-1980s.

- Multiple risk factors are involved.

• Impulsivity

• Aggression

• Pessimism

• Family psychopathology or instability

• Genetics

• Sociocultural factors

Psychosocial Factors in SUICIDE:

• Genetics

• Reduced serotonergic activity

Biological Causal Factors in SUICIDE:

Whites

Ethnicity: ____ have higher rates of suicide than African Americans.

• communicate

• nonlethal

Suicidal Ambivalence:

- Some people do not wish to die but instead want to _______.

- Methods are _____.

- Actions are arranged so that intervention by others is likely.

• notes

• love and concern

• hostile

Suicide Notes:

- Only 15-25% of completed suicides leave ____.

- Some notes include statements of _________

- Others include very ____ content.

• Treatment of a person's current mental disorder(s).

• Crisis intervention.

• Working with high-risk groups.

Suicide Prevention and Intervention:

Columbia-Suicide Severity Rating Scale (C-SSRS).

Crisis Intervention utilizes the _____________

• Antidepressant medication or lithium.

• Benzodiazepines.

• ​Cognitive-behavioral therapy.

Prevention of suicide can take the form of treatment of the underlying mental disorder(s) using: (3)

• Hotlines

• Hotline Efficacy

Crisis Interventions: