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Prepared by: Ashlea R. Smith, PhD Argosy University – Phoenix Second Edition This multimedia product and its contents are protected under copyright law. The following are prohibited by law: -any public performance or display, including transmission of any image over a network; -preparation of any derivative work, including the extraction, in whole or in part, of any images; -any rental, lease, or lending of the program. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Mood Disorders Chapter 6 Copyright © 2012 by Pearson Education, Inc. All rights reserved. What Are Mood Disorders? Suicide The Etiology of Mood Disorders The Treatment of Mood Disorders Copyright © 2012 by Pearson Education, Inc. All rights reserved. Syndromes in which a disturbance in mood is the predominant feature Take the form of low or high mood -Depression (abnormally low mood) -Mania (abnormally high mood) Three distinct mood disorders -Major depressive disorder -Dysthymic disorder -Bipolar disorder Copyright © 2012 by Pearson Education, Inc. All rights reserved. Persistent sad or low mood that is severe enough to impair a person’s interest in or ability to engage in normally enjoyable activities -Disturbance in psychological, emotional, social, and physical functioning -Episodic illness (single episode lasts two weeks to several months; can be recurrent) 40% of people diagnosed with MDD actually sleep and eat more than usual. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Figure 6.1 The Different Forms of Depression Copyright © 2012 by Pearson Education, Inc. All rights reserved. A chronic state of depression; the symptoms are the same as those of major depression, but they are less severe Persistent, lasting two or more years and an individual is never without symptoms for more than two months Leads to severe outcomes (social isolation, high suicide risk, and mislabeled as moody or difficult) Copyright © 2012 by Pearson Education, Inc. All rights reserved. A period of abnormal elevated or irritable mood lasting for at least one week or requires hospitalization Individual must possess three or more of the following: (a) inflated self esteem, (b) decrease need for sleep, (c) talkativeness, (d) flight of ideas, (e) distractibility, and (f) increased goal-directed activity Copyright © 2012 by Pearson Education, Inc. All rights reserved. Both episodic depressed mood and episodic mania (formerly manicdepressive disorder) Mania Long-term illness Mood shifts between two emotional “poles” Categories of Bipolar -Bipolar I (full blown mania alternates with episodes of major depression) -Bipolar II (hypomania mood elevation that is abnormal yet not severe enough to impair functioning or require hospitalization) Bipolar II is more common than Bipolar I; however, because of the high levels of productivity and creativity associated with the hypomania, one may view the episodes in a more positive light. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Requires lifelong treatment and clinical management! Figure 6.2 The Different Types of Bipolar Illness Cyclothymic disorder a condition characterized by fluctuations that alternate between hypomanic symptoms and depressive symptoms. Rapidly cycling bipolar disorder have four or more severe mood disturbances within a single year. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Mixed state is symptoms of mania and depression that occur at the same time. A condition characterized by fluctuations that alternate between hypomania and depression Episodes not as severe as with mania or major depression Persist for at least two years Copyright © 2012 by Pearson Education, Inc. All rights reserved. Approximately 16.2% of people age 18 and older report major depressive disorder at some point. Most common psychiatric disorder worldwide Median age of onset is 30 years (Kessler et al., 2005) Prevalence rates: -Major depression 32.6-35.1 million U.S. adults -Dysthymia 2.5% of general population -Depression ranks fourth in Global Burden of Disease (WHO, 2011) Copyright © 2012 by Pearson Education, Inc. All rights reserved. Women are twice as likely to suffer from depression than their male counterparts. Fact or fiction? Yes, across all cultures women are twice as likely to suffer from major depression at 10 to 25% versus men at 5 to 12%. Puberty, premenstrual period, pregnancy, post partum period, and menopause are all considered risk factors for mood disorders. Fact or fiction? Yes, rates of depression do vary by age, but these reproductive events are all indentified as risk factors. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Women are twice as likely to suffer from major depression (10%) than men (5%) Common in lower SES Impact of unemployment and lack of education and financial resources Impact of reproductive events Approximately 80% of new mothers will develop the “baby blues.” Postpartum Depression (PPD) Higher rates of depression in Whites at 17.9% Copyright © 2012 by Pearson Education, Inc. All rights reserved. Less common than major depression Unrelated to race, sex, and family income Men & mania vs. Women & Affects people of all ages depression when it comes to episodes with bipolar disorder? More common in: The average age of -Lower SES onset of the first manic episode is -Anxiety disorder (comorbidity) 18 years old. -Substance abuse disorder (comorbidity) -Affects males and females equally 0.9-1.3% (Merikangas, 2007) Copyright © 2012 by Pearson Education, Inc. All rights reserved. Age risk between 18 and 43, with the typical onset occurring at the age of 30 Typical warning signs In childhood both boys and girls are equally affected 2.5% of children 8.3% of adolescents After adolescence rates of depression increases for girls (2 to 1) Risk factors for depression Copyright © 2012 by Pearson Education, Inc. All rights reserved. In children, mania may be chronic (irritability and temper tantrums) Older adult population 1% over 60 report bipolar disorder Difficulty in differentiating bipolar disorder from ADHD, conduct disorder, ODD, and schizophrenia After that age, mania and depression symptoms result from medical illness especially stroke (Van Gerpen et al., 1999) Onset in childhood and adolescent more severe Time span between mania and depression factors Copyright © 2012 by Pearson Education, Inc. All rights reserved. Can occur with medical conditions (heart disease, CNS disease, cancer, & migraines, Fleischhacker et al., 2008) 72.1% of people with major depressive disorder had additional disorders 59.2% anxiety disorder 24% substance abuse disorder 30% impulse disorders Genetic and environmental factors Copyright © 2012 by Pearson Education, Inc. All rights reserved. Copyright © 2012 by Pearson Education, Inc. All rights reserved. What factors do you think contribute to suicide rates being the highest among whites and American Indians/Alaskan natives in the United States? Key Points: Keep in mind that suicide ranks as the eighth leading cause of death in United States—2 to 5% of people have attempted suicide (Moscicki, 1999). Additionally, males are more likely to commit suicide (usually by violent methods hanging or firearms) than females, even though females attempt suicide more often. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Components of depression Eighth leading cause of death 2 to 5% of people in the United States attempt suicide (Moscicki, 1999) U.S. 17.7 per 100,000 males, 4.5 per 100,000 females Underreported due to misclassification of singlevehicle car accidents WHO estimates that one million people die from suicide every year, 16 per 100,000 Highest rate of male suicides in Belarus, Lithuania, 50 per 100,000 Copyright © 2012 by Pearson Education, Inc. All rights reserved. Range from thoughts to detailed plans Suicidal ideation (SI) (thoughts of suicide) -Passive (wish to be dead without a plan) -Active (thoughts and includes a detailed plan) Parasuicides (superficial cutting and OD on nonlethal medications) Previous attempts at suicide increase the risk of suicide 30-40 times (Harris & Barraclough, 1997) Copyright © 2012 by Pearson Education, Inc. All rights reserved. The lowest rates of male suicides were found in Asian/Pacific Islanders and for females Non-Hispanic Blacks had the lowest suicide rate (CDC, 2009)What factors do you think contribute to these lower rates of suicide among these populations? Males vs. Females Methods used by males Risk factors for youth Events to spark SI for adolescents Events to spark SI for elderly Highest rates among whites and American Indian/Native Indians Copyright © 2012 by Pearson Education, Inc. All rights reserved. What methods do you believe adolescents use to commit suicide? Figure 6.3 Percentage of High School Students Who Attempted Suicide by Sex and Race/Ethnicity How do you explain the fact that more Hispanic teenagers are more likely to attempt suicide versus in adulthood more Anglo and Native Americans attempt suicide? Why do you feel that more adolescent females attempt suicide versus adolescent males? Copyright © 2012 by Pearson Education, Inc. All rights reserved. What types of programs, resources, or education should be provided to target adolescents with suicidal ideation? 89% of individuals diagnosed with major depression have attempted suicide in past 12 months (Kessler, 2005). Family history (family members across generations have committed suicide) Psychiatric illness (90% of attempted or completed suicides are committed by people with mental illness) Biological factors (very low levels of serotonin, impulsivity, and pathological aggression) Approximately 50% of patients with bipolar disorders attempt suicide during their lifetime. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Ernest Hemingway (over two generations—four members—the writer, his father, his brother, and his sister all committed suicide) 1996 Margaux Hemingway (daughter of Ernest’s oldest son; a model; committed suicide) Vincent van Gogh and his brother Cornelius took own lives Individuals with a family history of suicide are 2.5 times more likely to commit suicide than those without a family history. Ernest Hemingway, Vincent van Gogh, and his brother Cornelius all suffered from bipolar disorder. What is it about this disorder that contributes to a high suicide risk? Copyright © 2012 by Pearson Education, Inc. All rights reserved. Only 1/5 to 1/3 leave behind suicide notes Psychological autopsy (interviews with family, friends, coworkers, and health care providers in an attempt to identify psychological causes of suicide) Coroner (identifies the physical cause of death) Impact on those left behind Severity of suicidal ideation Copyright © 2012 by Pearson Education, Inc. All rights reserved. Interventions serve as a preventative measure. Do you believe that if one is engaging in self-injurious behavior (cutting, burning, biting, etc.) that they want to commit suicide? Why or why not? In regards to treatment, do we target these individuals differently than those with a plan of suicide? Crisis intervention (suicide hotlines) Focus on high-risk groups (children of parents with mood disorders who have attempted suicide themselves) Societal level prevention (using teacher and peer support) Preventing suicidal contagion (copycat suicides) Use of critical incident debriefing (CID) Copyright © 2012 by Pearson Education, Inc. All rights reserved. Deliberate self-harm risk factor for suicide Psychological intervention Psychosocial intervention Follow-up psychiatric care Copyright © 2012 by Pearson Education, Inc. All rights reserved. Biological -Genetics and family studies -Neuroimaging studies -Environmental factors and life events Copyright © 2012 by Pearson Education, Inc. All rights reserved. Figure 6.4 Chromosomes in a Linkage Study Copyright © 2012 by Pearson Education, Inc. All rights reserved. Both genes and environmental factors are involved in the onset of depression Gene’s double the risk of depression following life stressors 37% of the risk of depression is attributed to genetics. Risk may lie on genes 1,3,4,68,11,12,15, and 18 but nothing is definite! Copyright © 2012 by Pearson Education, Inc. All rights reserved. Psychological -Psychodynamic theory -Attachment theory -Behavioral theories -Learned helplessness -Cognitive theory Copyright © 2012 by Pearson Education, Inc. All rights reserved. Figure 6.5 Learned Helplessness From Lilienfeld et al. (2009) Psychology: From Inquiry to Understanding, Allyn & Bacon. Copyright © 2009 Pearson Education, Inc. Reprinted by permission of Pearson Education, Inc. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Copyright © 2012 by Pearson Education, Inc. All rights reserved. Psychological - Focus on understanding how thoughts, perceptions, and behaviors influence depression - Cognitive-behavioral therapy (CBT) - Interpersonal psychotherapy (IPT) - Behavioral activation (focuses on increased contact with positive reinforcement for healthy behaviors which results in positive mood) Copyright © 2012 by Pearson Education, Inc. All rights reserved. Biological - First-generation antidepressants (Tricyclic antidepressants and monoamine oxidase inhibitors, MAOIs) - Second-generations antidepressants (SSRIs) - Electroconvulsive Therapy (ECT) - Light therapy - Transcranial magnetic stimulation - Deep brain stimulation Copyright © 2012 by Pearson Education, Inc. All rights reserved. Psychological -Cognitive-behavioral therapy (CBT to develop skills to change inappropriate or negative thought patterns) - Interpersonal and social rhythm therapy (IPSRT promotes adherence to regular daily routines) Copyright © 2012 by Pearson Education, Inc. All rights reserved. Biological - Lithium (a naturally occurring metallic element used to treat bipolar disorder, which moderates glutamate levels in the brain) - Atypical antipsychotics - Electroconvulsive Therapy (ECT) - Anticonvulsant Copyright © 2012 by Pearson Education, Inc. All rights reserved. Depends on nature and severity of the symptoms Placebo-controlled, randomized clinical trials Psychotherapy Pharmacology Empirical support ECT Copyright © 2012 by Pearson Education, Inc. All rights reserved. 1. 2. 3. When considering a mood disorder diagnosis, it is important to assess the duration of the mood change and the degree of impairment on functioning. Depression is the most common psychiatric disorder worldwide. A variety of factors increase a female’s risk to develop depression, such as puberty, premenstrual period, pregnancy, the postpartum period, and menopause. Copyright © 2012 by Pearson Education, Inc. All rights reserved. 4. 5. 6. If one is diagnosed with depression or bipolar disorder, there is an increased risk for suicide and suicidal ideation. Both genetic and environmental factors play a role in the development of depression. For both bipolar disorder and major depression, both psychotherapy and pharmacological treatments are available. Copyright © 2012 by Pearson Education, Inc. All rights reserved.