Download Mood Disorders and Suicide

Mood Disorders and Suicide
Chapter 6
Outline
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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
– 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
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
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
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
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
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)
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
Causes of mood disorders
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)
Suicide
• 8th leading cause of death in the USA (30 000
people a year) for people aged 25-34
• Among teenagers, suicide is the 3rd leading
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
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