Download Basic Statistics for the Behavioral Sciences

Chapter 6
Mood Disorders and Suicide
An Overview of Depression and Mania
• Mood disorders
– Gross deviations in mood
– Major depressive episodes
– Manic and hypomanic episodes
An Overview of Depression and Mania
• Types of DSM-IV-TR depressive disorders
– Major depressive disorder
– Dysthymic disorder
– Double depression
An Overview of Depression and Mania
• Types of DSM-IV-TR bipolar disorders
– Bipolar I disorder
– Bipolar II disorder
– Cyclothymic disorder
Major Depression:
An Overview
• Major depressive episode: Overview and
defining features
– Extremely depressed mood lasting at least two
weeks
– Cognitive symptoms – feelings of worthlessness,
indecisiveness
– Disturbed physical functioning
– Anhedonia – loss of pleasure/interest in usual
activities
The Structure of Mood Disorders
• Mania
• Hypomanic episode
– Dysphoric manic episode or mixed manic episode
The Structure of Mood Disorders
• Features of a manic episode
– Elevated, expansive mood for at least one week
– Inflated self-esteem, decreased need for sleep,
excessive talkativeness, flight of ideas or sense
that thoughts are racing, easy distractibility,
increase in goal-directed activity or psychomotor
agitation, excessive involvement in pleasurable
but risky behaviors
– Impairment in normal functioning
Major Depression:
An Overview
• Major depressive disorder
– Single episode – highly unusual
– Recurrent episodes – more common
• From grief to depression
– Pathological or impacted grief reaction
Dysthymia: An Overview
• Overview and defining features
– Symptoms are milder than major depression
– Persists for at least two years
– No more than two months symptom free
– Symptoms can persist unchanged over long
periods (≥ 20 years)
• Facts and statistics
– Late onset – typically in the early 20s
Double Depression:
An Overview
• Overview and defining features
– Major depressive episodes and dysthymic disorder
– Dysthymic disorder often develops first
• Facts and statistics
– Associated with severe psychopathology
– Associated with a problematic future course
Bipolar I Disorder:
An Overview
• Overview and defining features
– Alternations between full manic episodes and
depressive episodes
• Facts and statistics
– Average age of onset is 15-18 years
– Can begin in childhood
– Tends to be chronic
– Suicide is a common consequence
Bipolar II Disorder:
An Overview
• Overview and defining features
– Alternations between major depressive and
hypomanic episodes
• Facts and statistics
– Average age of onset is 19-22 years
– Can begin in childhood
– 10% to 25% of cases progress to full bipolar I
disorder
– Tends to be chronic
Cyclothymic Disorder:
An Overview
• Overview and defining features
– Chronic version of bipolar disorder
– Manic and major depressive episodes are less
severe
– Manic or depressive mood states persist for long
periods
– Must last for at least two years (one year for
children and adolescents)
Cyclothymic Disorder:
An Overview
• Facts and statistics
– Average age of onset is 12 to 14 years
– Most are female
– Cyclothymia tends to be chronic and lifelong
– One third to one half develop full-blown bipolar
Prevalence of Mood Disorders
• Worldwide lifetime prevalence
– 16% for major depression
• 6% have experienced major depression in last year
• Sex differences
– Females are twice as likely to have major
depression
– Bipolar disorders equally affect males and females
Prevalence of Mood Disorders
• Occurs less often in prepubertal children
• Rapid rise in adolescents
• Adults over 65 have about 50% less than
adults
• Bipolar same in childhood, adolescence and
adults
• Prevalence of depression seems to be similar
across subcultures
Life Span Developmental Influences on
Mood Disorders
• Three-month-olds can show depression
• Children below nine do not show class mania
or bipolar symptoms
• Mood disorder are often misdiagnosed as
ADHD
• Children are being diagnosed with bipolar at
increasingly high rates
Life Span Developmental Influences on
Mood Disorders
• Depression in elderly between 14% and 42%
– Corroccurance with anxiety disorders
– Less gender imbalance after 65 years of age
• Cultural differences exist
– Hopi say they are “Heartbroken”
– Native American population have four times the
rate as the general population
Mood Disorders: Familial and Genetic
Influences
• Family studies
– Rate is high in relatives of probands
– Relatives of bipolar probands tend to have
unipolar depression
Mood Disorders: Familial and Genetic
Influences
• Twin studies
– Concordance rates are high in identical twins
• two to three times more likely to present with mood
disorders
– Severe mood disorders have a strong genetic
contribution
– Heritability rates are higher for females compared
to males, 40% women and 20% men
Mood Disorders: Familial and Genetic
Influences
• Twin studies
– Vulnerability for unipolar or bipolar disorder
• Appears to be inherited separately
– Some genetic factors are common for mood and
anxiety disorders
Mood Disorders: Neurobiological
Influences
• Neurotransmitter systems
– Serotonin and its relation to other
neurotransmitters
– Mood disorders are related to low levels of
serotonin
– Permissive hypothesis
Mood Disorders: Neurobiological
Influences
• The endocrine system
– Elevated cortisol
– Hippocampus and neurogenesis
• Sleep disturbance
– Hallmark of most mood disorders
– REM and depression
– Relation between depression and sleep
Mood Disorders: Psychological
Dimensions (Stress)
• Stressful life events
– Stress is strongly related to mood disorders
• Poorer response to treatment
• Longer time before remission
– The relation between context of life events and
mood
– Reciprocal-gene environment model
– The relationship between stress and bipolar is also
string
Mood Disorders: Psychological
Dimensions (Learned Helplessness)
• The learned helplessness theory of depression
– Lack of perceived control over life events
Mood Disorders: Psychological
Dimensions (Learned Helplessness)
• Learned helplessness and a depressive
attributional style
– Internal attributions
• Negative outcomes are one’s own fault
– Stable attributions
• Believing future negative outcomes will be one’s fault
– Global attribution
• Believing negative events will disrupt many life
activities
– All three domains contribute to a sense of
hopelessness
Mood Disorders: Psychological
Dimensions (Cognitive Theory)
• Negative coping styles
– Depressed persons engage in cognitive errors
– Tendency to interpret life events negatively
• Types of cognitive errors
– Arbitrary inference – overemphasize the negative
– Overgeneralization – negatives apply to all
situations
Mood Disorders: Psychological
Dimensions (Cognitive Theory)
• Cognitive errors and the depressive cognitive
triad
– Think negatively about oneself
– Think negatively about the world
– Think negatively about the future
• Seligman and Becks theories
Mood Disorders: Social and Cultural
Dimensions
• Marital relations
– Marital dissatisfaction is strongly related to
depression
– This relation is particularly strong in males
Mood Disorders: Social and Cultural
Dimensions
• Mood disorders in women
– Females over males
– Except bipolar disorders
– Gender imbalance likely due to socialization
Mood Disorders: Social and Cultural
Dimensions
• Mood disorders in women
– 70% of major depression and dysthymia are
women
– Perception of uncontrollability
– Parenting styles
– Stereotypical gender roles
– Social networks
– Women ruminate more than men
Mood Disorders: Social and Cultural
Dimensions
• Social support
– Extent of social support is related to depression
– Lack of social support predicts late onset
depression
– Substantial social support predicts recovery from
depression
An Integrative Theory
• Shared biological vulnerability
– Overactive neurobiological response to stress
• Inadequate coping and depressive cognitive
style
– Diathesis-stress model
• Biological, psychological and social factors all
influence the development of mood disorders
• Exposure to stress
Selective Serotonergic Reuptake
Inhibitors (SSRIs)
• Specifically block reuptake of serotonin
– Fluoxetine (Prozac) is the most popular SSRI
• SSRIs pose some risk of suicide particularly in
teenagers
• Negative side effects are common
Treatment of Mood Disorders: Tricyclic
Antidepressants
• Widely used (e.g., Tofranil, Elavil)
• Block reuptake
– Norepinephrine and other neurotransmitters
• Therapeutic effects
– Can take two to eight weeks
• Negative side effects are common
• May be lethal in excessive doses
Treatment of Mood Disorders:
Mixed Reuptake Inhibitors
• Venlafaxine (Effexor)- blocks norepinephrine
as well as serotonin
• Nefazodone (Serzone) – improves sleep
efficiency
• Both have fewer side effects than SSRIs
Treatment of Mood Disorders:
Monoamine Oxidase (MAO) Inhibitors
• Monoamine oxidase (MAO)
– Block monoamine oxidase
– This enzyme breaks down
serotonin/norepinephrine
– Slightly more effective than tricyclics
Treatment of Mood Disorders:
Monoamine Oxidase (MAO) Inhibitors
• Must avoid foods containing tyramine
– Examples include beer, red wine, cheese
– Many patients do not like the dietary restrictions
Treatment of Mood Disorders: Lithium
• Lithium is a common salt
– Primary drug of choice for bipolar disorders
– Can be toxic
• Side effects may be severe
– Dosage must be carefully monitored
– Lithium is a mood-stabilizing drug
• Why lithium works remains unclear
Treatment of Mood Disorders:
Electroconvulsive Therapy (ECT)
• ECT is effective for cases of severe depression
• The nature of ECT
– Involves applying brief electrical current to the
brain
– Results in temporary seizures
– Usually six to 10 outpatient treatments are
required
Treatment of Mood Disorders: ECT
– Side effects are few and include short-term
memory loss
– Uncertain why ECT works
– Relapse is common
• Transcranial Magnetic Stimulation (TMS)
– Uses magnets to generate a precise localized
electromagnetic pulse
Psychosocial Treatments
• Cognitive-behavioral therapy
– Addresses cognitive errors in thinking
– Also includes behavioral components
• Interpersonal psychotherapy
– Focuses on problematic interpersonal
relationships
•
•
•
•
Prevention
Combined treatments for depression
Prevention relapse of depression
Psychosocial treatments for bipolar
Psychosocial Treatments
• Outcomes with psychological treatments
– Comparable to medications
– Research does not suggest advantage for
combined treatment
The Nature of Suicide:
Facts and Statistics
• 11th leading cause of death in the United
States- maybe two to three times higher
• Overwhelmingly a white and Native American
phenomenon
• China and suicide rates
• Suicide rates are increasing, particularly in the
young
The Nature of Suicide: Facts and
Statistics
• Gender differences
– Males are more successful at committing suicide
than females
– Females attempt suicide more often than males
The Nature of Suicide:
Risk Factors
• Risk factors
– Suicide in the family
– Low serotonin levels
– Preexisting psychological disorder
– Alcohol use and abuse
– Stressful life event
– Past suicidal behavior
– Suicide contagion
• Treatment
Summary of Mood Disorders
• All mood disorders share:
– Gross deviations in mood
– Common biological and psychological vulnerability
• Occur in children, adults, and the elderly
• Onset, maintenance, and treatment are
affected by
– Stress
– Social support
Summary
• Suicide is an increasing problem
– Not unique to mood disorders
• Medications and psychotherapy produce
comparable results
• High rates of relapse
DSM-5 Proposed Changes
• http://www.dsm5.org/ProposedRevisions/Pag
es/MoodDisorders.aspx