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Chapter 6

Chapter 6. Mood Disorders And Suicide. What Are Mood Disorders?. Mood Disorders Disturbances of mood that are intense and persistent enough to be clearly maladaptive. Mania Intense and unrealistic feelings of excitement and euphoria. Depression

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Chapter 6

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  1. Chapter 6 Mood Disorders And Suicide

  2. What Are Mood Disorders? • Mood Disorders • Disturbances of mood that are intense and persistent enough to be clearly maladaptive. • Mania • Intense and unrealistic feelings of excitement and euphoria. • Depression • Feelings of extraordinary sadness and dejection. • Unipolar disorders • Bipolar disorders

  3. Unipolar Mood Disorders • Depressions that are not mood disorders • Loss and the grieving process • Other normal mood variations • Lifetime prevalence rates are • 13% for males and 21 % for females • Average age for adolescent depression is decreasing over the past decade. • Highly correlated with suicide

  4. Unipolar Mood Disorders • Mild to moderate depressive disorders • Dysthymia • Persistently depressed mood, more days than not for the past 2 years and have two of the symptoms of major depressive disorder (see next slides). • Not less severe symptoms than major depression. • Differs from MDD in that symptoms are not every day • Average duration for dysthymia is five years. • Adjustment disorder with depressed mood • Identifiable stressor • Less than six months

  5. Major Depressive Disorder • Major Depressive Disorder (DSM-IV Criteria) • Person must experience either markedly depressed mood or marked loss of interest in pleasurable activities most of every day for at least 2 weeks. • The person must experience at least 4 or more of the symptoms below during the same period: • Fatigue or loss of energy • Insomnia or hypersomnia • Decreased appetite and weight loss or gain • Psychomotor agitation or retardation • Diminished ability to think or concentrate • Self denunciation (worthlessness) or excessive guilt • Recurrent thoughts of suicide or death

  6. Major Depressive Disorder Subtypes • Melancholic Type • Loss of pleasure & other symptoms. • Severe Major Depressive Episode with Psychotic Symptoms • Loss of contact with reality including delusions or halucinations. • Mood-Congruent and Mood Incongruent • Congruent (negative content – disease or death) • Incongruent (Positive content – hero) • Postpartum • More closely fits adjustment disorder diagnosis

  7. Major Depressive Disorder • Distinguishing major depression • Depression as a recurrent disorder • Single Episode vs Recurrent Episode • Average duration of untreated MDD (6 months) • Recurrence vs Relapse • Relapse is when symptoms return quickly before the depressive episode has run its course. • 26% of patients have a recurrence within 1 yr • 76% of patients have a recurrence within 10 yrs • Seasonal affective disorder

  8. Biological Causal Factors In Unipolar Disorders • Heredity factors • Biochemical factors • Neuroendocrine factors • Sleep and other biological rhythms

  9. Psychosocial Causal Factors In Unipolar Disorders • Stressful life events • Endogenous depression • Chronic stress • Individual differences in responses to stressors • Vulnerability and invulnerability factors

  10. Psychosocial Causal Factors In Unipolar Disorders • Diathesis-stress models • Personality and cognitive diathesis • Neuroticism • Early parental loss as a diathesis

  11. Psychosocial Causal Factors In Unipolar Disorders • Psychodynamic theories • Behavioral theories • Depressed persons receive fewer positive verbal reinforcements and moods tend to vary with both their positive rates of reinforcement and their negative experiences.

  12. Beck’s Cognitive Model of Depression

  13. Helplessness and Hopelessness Theories of Depression • Learned helplessness • Similarities between depression and helplessness • The role of attributional style • Three critical dimensions • Internal/External • Global/Specific • Stable/Unstable • The hopelessness theory of depression

  14. Bipolar Disorders • Cyclothymia • Hypomania • Bipolar disorder • Bipolar disorder with a seasonal pattern • Schizoaffective disorder

  15. Causal Factors in Bipolar Disorder • Biological causal factors • Heredity factors • Higher heritability than unipolar depression • Biochemical factors • Serotonin remains low in both up and down of cycle • Dopamine and noripinephrine appear to be elevated in manic state. • Other • Hormonal Problems • Blood flow in areas of the brain

  16. Bipolar Disorders: Features

  17. Causal Factors in Bipolar Disorder • Psychosocial causal factors in bipolar disorder • Stressful life events • Psychodynamic views

  18. Sociocultural Factors Affecting Unipolar and Bipolar Disorders • Cross-cultural differences in depressive symptoms • A belief in self-sufficiency • Relieving losses • Demographic differences

  19. Interpersonal Effects of Mood Disorders • Lack of social support and social skills deficits • The effects of depression on others • Marriage and family

  20. Rates of Mood Disorders in Writers and Artists

  21. Robert Schumann’s Work: Number of Compositions by Year

  22. Treatments and Outcomes • Pharmacotherapy • Selective Serotonin-Reuptake Inhibitors (SSRIs) • Lithium and other mood-stabilizing drugs • Electroconvulsive therapy (ECT)

  23. Treatments and Outcomes • Psychotherapy • Cognitive-behavioral therapy • Interpersonal therapy (IPT) • Family and marital therapy

  24. Suicide: Clinical Picture

  25. Suicide • Ninth leading cause of death for adults in U.S. • At least 2/3 of suicide attempters are under 35 • Every 20 minutes someone in the U.S. suicides • May be as many as 6 million attempts per year • Women are 3 -4 times more likely to attempt suicide • Men are 4-5 times more likely to succeed • Rates of attempts are 3-4 times higher in people who are divorced or separated • Most attempts are related to relational discord • Guns are the means in 60% of suicides

  26. Adolescent Suicide • Seventh leading cause of death in 5-14 yo. • Third leading cause of death in 15-24 yo. • First two are accidents and homicides) • Suicide rate in teens tripled from 1950’s to mid 1980’s. • Similar trends are noted in 23 out of 29 countries studied (Lester, 1988). • Between 7-16% of high school students report a suicide attempt • Between 4-8% of 11th and 12th graders report a suicide attempt • These are the highest rates of attempts at any point in the life span (large proportion have low lethality). • However, 9% of males in this age range and 1-4% of females complete within 5 years.

  27. Gender Differences • More females attempt because • Puberty, middle school, and identity transitions • Hormonal changes • Diathesis-Stress Model (predisposition+stressor • Females tend to focus on emotions and related thoughts more than males • Females face more descrimination • For males • Socialization is more counter to suicide

  28. Risk Factors for Adolescent Suicide • Mental Disorders (more = more risk) • Conduct Disorder and Substance Abuse are more common in completers. • Mood Disorders (Depression & Anxiety) are more common among nonfatal attempters. • Negative life events (emotional pain) • Availability of firearms in the home. • Stage of life transitions (autonomy vs control) • Genetic factors (twin studies ) • Hospitalized pts with low serotonin 10x risk • Contagion factors 1-13% (Velting, 1997)

  29. In almost every case suicide is caused by pain, a certain kind of pain—psychological pain, or “psychache”… Suicidal death, in other words, is an escape from pain… Pain is nature’s great signal. Pain warns us; pain both mobilizes us and saps our strength; pain, by its very nature, makes us want to stop it or escape from it… Psychache is the hurt, anguish or ache that takes hold in the mind. It is intrinsically psychological, the pain of excessively felt shame, guilt, fear, anxiety, loneliness, angst, and dread of growing old or of dying badly. When psychache occurs, its introspective reality is undeniable. Suicide happens when the psychache is deemed unbearable and death is actively sought to stop the unceasing flow of painful consciousness. Suicide is a tragic drama in the mind (Schneidman, 1997, pp23, 29)

  30. Depression Signs and Symptoms • Depressed mood most of the day • Reduced interest in pleasurable activities • Weight changes • Sleep Problems • Psychomotor agitation or retardation • Lack of energy and motivation • Poor concentration • Feelings of worthlessness • Thoughts of death

  31. Assessment of Suicidality I • Depressive Disorders and other Mental Health problems • Alcoholism and other Substance Abuse • Suicide Ideation • Prior Attempts • Lethal Methods • Isolation (friends and family) • Cognitive Rigidity (Hopelessness)

  32. Assessment of Suicidality II • Modeling (suicide in the family) • Economic or Work Problems • Marital Problems • Stress and Stressful Events • Anger, Aggression, Irritability • Physical Illness • Giving away personal items • Sudden happiness • Repetition and Combination of All Factors

  33. Intervention • Be direct • Pay attention • Accept without judgement • Be calm • Assure • Seek help

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