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Mood Disorders and Suicide

Mood Disorders and Suicide. Chapter 6. Outline. Mood disorders, depression and mania Depressive disorders Bipolar disorders Causes of mood disorders Treatment of mood disorders Suicide. Mood disorders, depression and mania. Mood disorders

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Mood Disorders and Suicide

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  1. Mood Disorders and Suicide Chapter 6

  2. Outline • Mood disorders, depression and mania • Depressive disorders • Bipolar disorders • Causes of mood disorders • Treatment of mood disorders • Suicide

  3. Mood disorders, depression and mania • Mood disorders • Group of disorders involving severe and enduring disturbances in emotion (mood) (prevalence in population between 8% and 19%) • Major depressive episode • Extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms (worthlessness, indecisiveness) and physical symptoms (altered sleeping pattern, changes in appetite and weight, loss of energy) • Mania • Episode of joy and euphoria marked by individual’s extreme pleasure in every activity, hyperactivity, little sleep • Hypomania • less severe version of a manic episode that does not cause marked impairment in social or occupational functioning • Dysphoric manic or mixed episode • the individual experiences both elation and depression or anxiety at the same time

  4. Mood disorders, depression and mania • Unipolar mood disorder • Individuals experience either depression or mania but not both • Bipolar mood disorder • Individuals alternate between depression and mania

  5. Mood disorders • Additional statistics • 32% of children with ADHD also met criteria for major depression • 18% to 20% of nursing home residents may experience major depressive episodes • 20% of a group of famous American poets exhibited bipolar disorders • There seems to be significant overlap between anxiety and depression with respect to causes and occurrence

  6. Depressive disorders • Major depressive disorder, single episode • Involves only one major depressive episode in lifetime (very rare – 85% of single episodes are followed by repeated episodes) (12% suicidal attempts) • Major depressive disorder, recurrent Y-Barbara • Involves repeated major depressive episodes separated by a period of at least 2 months during which the individual was not depressed • Dysthymic disorder • the same symptoms as major depressive disorder but presented in milder form, the depressed mood continues for at least 2 years • Double depression • Combination of major depression episodes and dysthymic disorder

  7. Depressive disorders • Usual onset is 25 years but is decreasing • Depressive episodes last from 2 weeks up to years • Adult patients with dysthymic disorder are more likely to commit suicide than patients with major depressive disorder • Depression can result from grief • Pathological grief reaction involves psychotic features, suicidal ideation, severe loss of weight or energy that persists more than 2 months • Therapy involves reexperiencing the trauma under supervision and finding meaning in the loss

  8. Bipolar disorders • Bipolar I disorder  Y-Mary • Depressive episodes alternate with full manic episodes (17% suicidal attempts) (onset at age 18) • Bipolar II disorder • Depressive episodes alternate with hypomanic episodes (24% suicidal attempts) (onset at age 22) • Cyclothymic disorder • Chronic alternation of mood elevati+on and depression that does not reach the severity of manic or major depressive episodes • Seasonal affective disorder (SAD) • Mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring in the winter (10% in New Hampshire and 2% in Florida)

  9. Causes of mood disorders • biological factors • if one twin presents with a mood disorder, an identical twin is approximately three times more likely than a fraternal twin to have a mood disorder (heritability approx. 40% for women) • psychological factors • stressful life events, hopelessness, negative cognitive styles - overgeneralization • social and cultural factors • marital dissatisfaction • 70% of people suffering with major depressive disorder or dysthymia are women

  10. Causes of mood disorders

  11. Treatment of mood disorders • Medications • Antidepressants (number of side effects) • Monoamine oxidase (MAO) inhibitors (negative interactions with tyramine) • Selective serotonergic reuptake inhibitors (SSRIs) (side effects) • Lithium (weight gain, danger of poisoning) • Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) as an alternative to ECT • Psychosocial treatments • Cognitive therapy • Interpersonal therapy • Combined treatments  V-Bipolar • in depression (medication and psychosocial treatments) • in bipolar disorders (combining medication and family and/or CBT is crucial)

  12. Suicide • 8th leading cause of death in the USA (30 000 people a year) for people aged 25-34 • Among teenagers, suicide is the 3rdleading cause of death • The suicide rate for young men in the USA is the highest in the world • Males are four to five times more likely to commit suicide than females • 90% of suicides are committed by people suffering from psychological disorder • 60% are associated with mood disorders • 25%-50% with alcohol use and abuse • 10% borderline personality disorder

  13. Suicide • Suicidal attempt • Suicidal ideation • Types of suicide (‘formalized’ suicide – altruistic suicide, egoistic suicide, fatalistic suicide etc.) • Psychological autopsy (postmortem psychological profile of a suicide victim) • Imitation of suicide (teenager or celebrity) • Suicide prevention • cognitive-behavioral problem-solving approach • strong social support and hopefulness • treatment of psychiatric and personality disorders

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