Mood Disorders and Suicide Flashcards

MOOD DISORDERS AND SUICIDE

Types of Mood Disorders

• Major Depressive Disorder
• Premenstrual Dysphoric Disorder
• Postpartum Depression
• Seasonal Affective Disorder (SAD)
• Persistent Depression
• Bipolar Disorder

Some Symptoms of Depression

• Mood disturbances:
  • Emotional state marked by great sadness
  • Feelings of worthlessness and guilt
• Cognitive or ‘thinking’ disturbance:
  • Self-criticism, self-blame
  • Indecisiveness, slowed thinking, thoughts of death or suicide
• Physiological (somatic) and behavioral disturbance:
  • Loss of sleep, appetite, and sexual desire
  • Loss of interest and pleasure in usual activities
• Symptoms vary between cultures
• Children: somatic symptoms are most common early signs
• Most depressed individuals focus on somatic symptoms (~85%)

Some Symptoms of Mania

• An emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans.
• May be characterized by:
  • Euphoric mood
  • Excessively talkative
  • Difficult to interrupt
  • Shifting from topic to topic
  • Need for activity
  • Grandiose thinking
  • Little need for sleep
  • Poor planning

Prevalence of Major Depressive Disorder

• Nearly 8% of adults are diagnosed in any given year.
• People are most likely to develop their first depressive episode between the ages of 30 and 40.
• Lifetime prevalence rates in U.S.: from 5.2% to 17.1%
  • Similar ranges were found in a cross-cultural study
• In Canada, lifetime prevalence could vary from 20% to 50%
• 2x more common in women than in men
  • Difference appears in adolescence and is maintained across the lifespan

Major Depressive Disorder (DSM-5)

• Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
  • Note: Do not include symptoms that are clearly attributable to another medical condition.
  • a. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
  • b. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  • c. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
  • >5%
  • d. Insomnia or hypersomnia nearly every day.
  • e. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
  • f. Fatigue or loss of energy nearly every day.
  • g. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  • h. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
  • i. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Major Depressive Disorder (DSM-5) Continued

• The episode is not attributable to the physiological effects of a substance or another medical condition.
  • Note: Criteria A–C represent a major depressive episode.
  • Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.
• At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
• There has never been a manic episode or a hypomanic episode.
  • Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance- induced or are attributable to the physiological effects of another medical condition.

Premenstrual Dysphoric Disorder

• Mood lability, irritability, dysphoria, and anxiety symptoms that occur repeatedly during the premenstrual phase and remit around the onset of menses or shortly thereafter.
• Symptoms include:
  • Mood lability, irritability, anger, depressed mood, hopelessness, anxiety, tension, feelings of overwhelm, insomnia or hypersomnia, changes in appetite etc.
• Estimated prevalence in the US 1.3%
• The prevalence of premenstrual dysphoric disorder symptoms in adolescent girls may be higher than that observed in adult women.

Postpartum or Peripartum Onset Depression

• Major depression during pregnancy or in the first four weeks following childbirth
  • about 50% of episodes begin before delivery
• Can include feelings of anxiety, guilt, agitation, weepiness, difficulty bonding with or caring for baby, and even panic attacks
• Can appear with or without psychotic features (0.002%)
• In Canada, almost one-quarter (23%) of mothers who recently gave birth reported feelings consistent with either post-partum depression or an anxiety disorder.
  • About 7% meet diagnostic criteria

Seasonal Affective Disorder

• No longer a discrete diagnosis - it’s a specifier of MDD.
• Full remittance is necessary during other seasons, and the pattern must continue for at least 2 years
• Is not restricted to winter. SAD can coincide with different seasons
• Highest rates of SAD can be found among people who live in the Canadian Arctic (up to 18% of population)

Bipolar Disorder

• Bipolar 1 - Involves recurring mood episodes (manic, depressive, and hypomanic), but the occurrence of at least one manic episode is necessary for diagnosis.
  • Peak age at onset is between 20 and 30 years, but occurs throughout the life cycle.
  • Mean age at onset is 22 years and slightly younger for women (21.5 years) than for men (23.0 years)
• Bipolar 2 - characterized by recurring mood episodes consisting of one or more major depressive episodes and at least one hypomanic episode
  • Average age at onset is mid-20s
• Prevalence rate for bipolar disorder is about 4.4%

Persistent Mood Disorders

• Symptoms for at least 2 years and are not severe enough to warrant a diagnosis of Major Depressive Disorder (MDD) or manic episode.
• Cyclothymic disorder
  • Numerous and alternating periods of hypomania and depression
  • Symptoms at least half the time with no more than two consecutive, symptom-free months
  • Lifetime prevalence of 2.5%
• Persistent Depressive disorder
  • Mild to moderate depressed moods most of the day nearly every day for at least two years
  • At least two of the other symptoms of MDD
  • Lifetime prevalence of 4.6%
• Double Depression
  • People with persistent depressive disorder may also experience episodes of MDD

Psychoanalytic Theory of Depression

• Freud theorized that the potential for depression begins in early childhood during the oral period.
  • children’s needs are insufficiently or oversufficiently met causing fixation in this stage.
  • depression comes about through rejection and dependency
• Very little empirical support for this theory.

Beck's Theory of Depression

• Thinking is biased toward negative interpretations
• Negative triad
  • Negative views of the self, the world, and the future
• Principal Cognitive Biases
  • Arbitrary inference
  • Selective abstraction
  • Overgeneralization
  • Magnification and minimization

Beck Depression Inventory (BDI II)

• Beck Depression Inventory Scale used in the assessment of major depressive disorder.
• Self-report scale of 23 items rated on a 3-point scale.
• Classifies individuals as having low, moderate, or significant depression based on scale total.

Learned Helplessness

• Individual’s passivity and sense of being unable to act and control own life is acquired through unpleasant experiences and traumas that were unsuccessfully controlled.
• Attribution and Learned Helplessness
  • Revised theory is the concept of attribution
    • Global attributions
    • Attributions to stable factors
    • Attributions to internal characteristics
• Learned Hopelessness
  • Advantage of theory is that it can deal with the comorbidity of depression and anxiety disorders

Interpersonal Theory of Depression

• Sparse social networks that provide little support
  • this decreases an individual’s ability to handle negative life events.
  • and increases their vulnerability to depression.
• Depressed people also elicit negative reactions from others and are low in social skills.
• They also constantly seek the reassurance of others.

Biological Theories

• Heritability estimate = 35%
  • Relatives of unipolar probands are at an increased risk for unipolar depression
• Serotonin transporter gene-linked promoter region (5-HTTLPR) is being considered
• Drug actions suggest that depression and mania are related to serotonin, norepinephrine, and dopamine.
  • Anti-depressants and mood stabilizer (anti-manic) medications may work by changing the responsiveness of receptors (which may be too insensitive in people with depression and too sensitive in people with mania) for these neurotransmitters.

More Biological Theories

• Neuroendocrine System
  • HPA axis may play a role in depression.
  • Limbic area of brain (closely linked to emotion) affects the hypothalamus which in turn controls endocrine glands (release of hormones).
  • Increased levels of cortisol in depressed patients
• Disorders of thyroid function are often seen in bipolar patients.
  • Thyroid hormones can induce mania.
• Right hemisphere dysfunction
  • Sense of indifference or flatness

Therapies for Mood Disorders

• Psychological Therapies
  • Psychodynamic Therapies
  • Cognitive and Behavior Therapies
  • Mindfulness-Based Cognitive Therapy
  • Psychological Treatment for Bipolar Disorder
• Biological Therapies
  • Electroconvulsive therapy (ECT)
  • Drug therapy