2621 Mood Disorders and Suicide

1. 2621 Mood Disorders and Suicide Moods Enduring states of feeling that color our psychological lives. Mood disorders Are disturbances in mood that impair functioning.

2. Major Depression Must exhibit 5 or more features and one of the features must be either depressed mood/loss of interest for most of the day. Major depressive disorder is based on the occurrence of one or more major depressive episodes in the absence of manic or hypomanic episodes.

3. Other features Significant weight gain or loss insomnia/hypersomnia agitation/slowed movement fatigue/loss of energy sense of worthlessness/guilt decreased concentration suicidal thoughts

4. Affects 1 in 5 adults (17%) in the U.S. at some point in their life. The �common cold� of psychological problems.

5. Risk factors Age (younger more likely to develop than older) SES marital status gender (women more likely than men)

6. Cont. risk factors sociocultural (Af-A less likely to be depressed than whites/hispanics) multinational study shows that rates of depression are rising. Lowest rates of depression in Taiwan; highest rates in Beirut. Increases in depression may be due to increasing urbanization and fragmentation of the family, exposure to war and increased incidence of violence.

7. Reactive depression Depression linked to negative events while Endogenous depression is born from within To distinguish between reactive/ endogenous, endogenous exhibits more physical symptoms (weight loss, insomnia) while reactive exhibits less physical symptoms.

8. Seasonal Affective Disorder Features fatigue excessive sleep craving for carbohydrates weight gain Affects women more than men

9. Cont. SAD features Most common among young adults though half of those with SAD report episodes beginning in childhood or adolescence. Treatment involves exposure to 2 to 3 hours of artificial light (phototherapy)

10. Postpartum Depression Postpartum blues occurs fairly frequently and lasts a couple of days. (normal) Postpartum Depression may persist for months or even a year or more. Features disturbance in appetite/sleep low self-esteem difficulty concentrating

11. Dysthymic Disorder Milder but chronic Affects about 3% of the adult population at some point in their life. It is more common in women than in men A person may experience Major Depression along with dysthymia: Double Depression.

12. Features Pessimism self-pity inactivity feelings of inadequacy low self-esteem

13. Bipolar Disorder Mood swings between mania/depression First episode may be either mania or depression Mania may last from a few weeks to several months but are shorter in duration and end more abruptly

14. Cont. bipolar Bipolar I (Mixed type): one or more manic episodes Bipolar II: one or more depressive episode and one hypomania (a milder form of mania) episode but never a full blown manic episode. Relatively uncommon affecting .4% to 1.6% for bipolar d/o and .5% for bipolar II d/o Affects men and women at the same rate.

15. Features of mania Sudden elevation of mood unusually cheerful boundless energy pressured speech � distractible rapid flight of ideas inflated sense of self show poor judgment become argumentative

16. Cyclothymic Disorder Means Circle/spirit individual experiences mild mood swings for at least 2 years hypomania is a period of elevated mood; not as severe as manic episode depressed mood is not as severe as Major Depression.

17. Theoretical Perspectives Stress and Mood d/o stressors such as loss of loved one unemployment physical illness marital discord poverty pressure at work prejudice/discrimination have been contributed to depression Relationship between stress/depression may be moderated by coping styles/social support.

18. Psychodynamic Depression represents anger directed inward rather than against others. In bereavement where there is ambivalent feelings, this can create rage/guilt. To preserve the lost object, people introject (bring inward) their mental representations of the other person into themselves. This causes the rage/guilt to turn inward resulting in depression.

19. Cont. Psychodynamic For bipolar d/o, there is a shifting dominance over the personality by ego/superego: in depression, superego is dominant producing exaggerated notions of guilt/wrong. After a time, ego rebounds/asserts supremacy, produces feelings of elation/self-confidence = manic.

20. Humanistic/Existential Depression = no meaning Lose self-esteem when lose friends/family

21. Learning Focus on situational factors such as the loss of positive reinforcement. Depression equals too little reinforcement from environment. Then less activity deplete opportunity/less reinforcement encourages withdrawal. Depression may also become a reinforcer.

22. Cognitive Beck�s cognitive triad equals negative beliefs about self, environment, future. Typical cognitive distortions: all or nothing � emotional reasoning overgeneralization � should statement mental filter � labeling/mislabeling disqualifying the positive � personalization jumping to conclusions magnification/minimization

23. Cognitive-specificity hypothesis Depressive thoughts center on loss, self-depreciation, pessimism. Anxiety centers on physical danger, threats.

24. Learned Helplessness A combination of behavioral/cognitive: situational factors foster attitudes that lead to depression. Shock dogs/attributional style internal/external global/specific stable/unstable

25. Biological Genetic Stronger for bipolar than unipolar Uncertain what is inherited. Biochemical Neurotransmitters involved deficiencies in norepinephrine = depression excess in norepinephrine = mania serotonine, acetylcholine deficiencies thyroid hormones

26. Treatment Psychodynamic Helps people understand their ambivalent feelings toward the lost object.

27. Cont. Treatment Humanistic/Existential Become aware of authentic feelings need self-actualization living according to one�s own values/choices

28. Cont. Treatment Behavioral Depression is learned/ therefore unlearn it. Cognitive Identify distorted, self-defeating thoughts/substitute more rational thoughts.

29. Cont. Treatment Biological antidepressants tricyclics monoamine oxidase inhibitors (MAO inhibitors) serotonin-reuptake inhibitors (SSRI)

30. Side Effects of tricyclics, MAO Inhibitors Dry mouth constipation, blurred vision confusion delirium

31. Side Effects of Serotonin Upset stomach headaches agitation insomnia sexual problems

32. Lithium side-effects Potential toxic effects impair memory slow people down

33. Electro-convulsive therapy Used to treat major depression when antidepressants don�t work. Don�t know why it works. Controversy over memory loss as side effect.

34. Suicide Who? More Whites than Af-A More women attempt; more men succeed Elderly more likely than teens.

35. Cont. suicide Why? People think there is a narrow range of options available. Connected to stress.

36. Cont. Suicide Theoretical Psychodynamic anger turned murderous or motivated by death instinct- a tendency to return to tension-free state before birth. Humanistic/existentials Suicide is a perception that life is meaningless/ hopeless. Sociocultural: alienation in today�s society

37. Cont. Suicide Learning Reinforcement of previous attempts/ effects of stress Cognitive: positive outcome expectancies Social-learning - modeling Biological - genetic

38. Predicting Suicide Hopelessness Sudden sorting of affairs Sudden peace/calm interpreted as hope.