Chapter 7

1. Chapter 7 MoodDisorders & Suicide

2. Unipolar Depression Symptoms • Anhedonia • Psychomotor retardation/agitation • In severe cases • Hallucinations • Delusions • Major depression—acute • Dysthymic disorder—chronic

3. Subtypes of Depression • Depression with Melancholic Features • Depression with Psychotic Features • Depression with Catatonic Features • Depression with Atypical Features • Depression with Postpartum Onset • Depression with Seasonal Pattern (SAD)

4. Symptoms of Depression

5. Major Depression Dysthymic Disorder Five or more symptoms including sadness or loss of interest or pleasure Three or more symptoms including depressed mood At least 2 weeks in duration At least 2 years in duration Number of symptoms Duration

6. Prevalence and Prognosis • Among adults, 18- to 29-year-olds are most likely to have had a major depressive episode in the past year. • Women are twice as likely to experience depressive symptoms as men. • Depression rates vary from 3% in Japan to 16% in the United States.

7. Bipolar Disorder • Mania combined with depression • Bipolar I • Elevated, expansive or irritable mood >1 week • Three additional symptoms • Bipolar II • Severe depression, but mild mania (hypomania) that does not involve hallucinations, delusions, or interfere with daily functioning • Cyclothymic • Less severe but more chronic bipolar condition

10. Biologic Theories of Depression • Genetic Theory • Genes predispose people to depression • Neurotransmitter Theories • Dysregulation of neurotransmitters and their receptors • Brain Abnormalities • Altered brain-wave activities affect mood • Neuroendocrine Factors • Hormonal dysregulation

11. Psychological Theories of Depression • Behavioral Theories • Lewinsohn’s theory • Learned helplessness theory • Cognitive Theories • Aaron Beck’s negative cognitive triad • Reformulated learned helplessness theory • Ruminative response style

12. Psychological Theories of Depression, cont. • Interpersonal Theories • Rejection sensitivity • Excessive reassurance seeking • Sociocultural Theories • Cohort effects • Gender differences • Ethnicity/race differences • Cross-cultural differences

13. Theories of Bipolar Disorders • Genetic Factors- strong linkage • Brain Abnormalities • Neurotransmitter Factors • Dysregulation of the dopamine system • Psychological Contributors • Greater sensitivity to rewards • Increased stress • Disruptions in routines

14. Biological Treatments • Drug therapy • Tricyclics, monoamine oxidase inhibitors, mood stabilizers, selective serotonin reuptake inhibitors –SSRI, selective serotonin-norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitor, anticonvulksant and atypical anticonvulsants • Electroconvulsive therapy (ECT) • Repetitive transcranial magnetic stimulation (rTMS) • Vagus nerve stimulation • Deep brain stimulation • Light therapy for SAD

15. Psychological Treatments for Mood Disorders • Behavior Therapy • Increase positive reinforcers and decrease aversive events by teaching the person new skills for managing interpersonal situations and the environment • Cognitive-Behavioral Therapy • Challenge distorted thinking and help the person learn more adaptive ways of thinking and new behavioral skills • Interpersonal Therapy • Examines the interpersonal relationships • Interpersonal & Social Rhythm Therapy (ISRT) • Enhanced interpersonal therapy for bipolar disorder • Family Focused Therapy • Reduces the interpersonal stress for bipolar disorder

16. Comparison of Treatments • Different therapies generally appear to be equally effective for the treatment of most people with depression • Combination of psychotherapy and drug therapy may be more effective than either type alone

17. Suicide • “Death from injury, poisoning, or suffocation where there is evidence (either explicit or implicit) that the injury was self-inflicted and that the decedent intended to kill himself/herself.” Centers for Disease Control and Prevention (CDC) • Among the three leading causes of death worldwide among people 15 to 44 years of age. (World Health Organization [WHO], 2008)

18. Gender Differences

19. National Differences

20. Understanding Suicide • Durkheim’s theory • Egoistic suicide is committed by people who feel alienated from others • Anomic suicide is committed by those who experience severe disorientation from society • Altruistic suicide is committed by people who believe that taking their own life will benefit society in some way.

21. Psychological Disorders & Suicide • Over 90% of people who commit suicide have probably been suffering from a diagnosable mental disorder • Depression increases the odds of a suicide attempt by approximately 6 times and bipolar disorder increases the odds of a suicide attempt by 7 times • Best predictor of suicidal thought and behavior is past suicidal thought and behavior. Among adolescents, a history of a previous suicide attempt increases the odds of suicide by 30 times among boys and 3 times among girls

22. Personality, Cognitive & Biological Factors • Personality characteristic that seems best to predict suicide is impulsivity • Cognitive variable that most consistently predicts suicide is hopelessness • Children of parents who had attempted suicide were 6 times more likely to also attempt suicide than the children of parents who had a mood disorder but had not attempted suicide • Low serotonin levels are linked with suicidality even among people who are not depressed

23. Treatment & Prevention • Community-based prevention • Crisis intervention programs, suicide hotlines • Drug treatments • Lithium, selective serotonin reuptakeinhibitors • Psychological treatments • Dialectical behavior therapy, psychotherapy