Download Mood Disorders and Suicide

Chapter 5
Mood Disorders and Suicide
Copyright © 2006 Pearson Education Canada Inc.
Overview
Several terms to describe problems
associated with emotional response
systems
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Emotion
Affect
Mood
Clinical Syndrome
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Overview
Emotion - refers to a state of arousal that is defined by subjective states
of feelings, such as sadness, anger, and happiness.
Affect - refers to pattern of observable behaviours associated with
emotions (e.g. facial expression, voice pitch).
Mood - refers to a pervasive and sustained emotional response that can
influence a person’s perception of the world (e.g. depressed mood).
Clinical Syndrome - is a combination of emotional, cognitive, and
behavioural symptoms associated with a depressed mood (e.g. clinical
depression).
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Overview
How can we differentiate between normal sadness
& clinical depression?
1. The mood change is pervasive across situations and
persistent over time.
2. The mood change may occur in the absence of any
precipitating events.
3. The depressed mood impairs social and occupational
functioning.
4. The change in mood is accompanied symptoms that
include cognitive, somatic, and behavioral features.
5. The nature of the mood change is different than normal
sadness.
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Overview
Mood disorders - are defined in terms of
episodes
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discreet periods of time in which the person’s
behaviour dominated by depressed or manic
mood or both.
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Symptoms & Features
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emotional symptoms
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cognitive symptoms
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somatic symptoms
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behavioural symptoms
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Emotional Symptoms
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brief negative emotions serve a useful communicating
function
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prolonged, intense emotions become problematic to our
daily functioning
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dysphoric mood (e.g. feeling gloomy), anxiety
In mania there is euphoria, elation, as well as irritability
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Cognitive Symptoms
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changes in the way people think
unrealistic expectations
preoccupations and cognitive distortions
thinking slowed down or sped up
memory difficulties
self-blame
Suicidal ideation
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Somatic Symptoms
Clinically significant changes in:
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fatigue
aches & pains
sleep patterns
appetite
hygiene
Sexual drive
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Behavioural Symptoms
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apparent lack of caring for others
changes in the things people do and how
they do them
psychomotor retardation in depressed
individuals
sped up, impulsive behaviour in mania
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Contemporary Perspective
Unipolar Disorders
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dysthymia
major depressive disorder
Bipolar Disorders
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bipolar I
bipolar II
cyclothymic disorder
Mixed episode
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Dysthymia
Represents a chronic mild depressive condition that
has been present for many years (i.e., at least 2)
- depressed mood most of the day on more days than not,
plus 2 or more of the following:
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Poor appetite or overeating
Insomnia or hypersomnia
Low energy
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
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Bipolar II
A person who has experienced at least one major
depressive episode, at least one hypomanic episode, and
no full blown manic episodes.
Hypomania - episodes of increased energy that is not as
severe as full blown mania.
Cyclothymia - numerous hypomanic episodes and
numerous periods of depression during a 2 year period.
Mixed Episode – The criteria is met for a manic and major
depressive episode for 1 week period.
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Subtypes and Descriptors
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episode specifiers
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Early vs. late onset
psychotic
post-partum onset
melancholia
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severe form of depression
possible different etiology
biological treatments successful
course specifiers
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seasonal affective disorder
rapid cycling
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denotes poor prognosis for bipolar disorder
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Course and Outcome
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Unipolar Disorders
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onset generally in middle age, average age is mid 40s
10% have depression for 2 years
50% will recover within 6 months
of those, 50% will relapse in 3 years
Bipolar Disorders
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onset typically between 28-33 yrs - 1% of population
could start as manic or depressive
average duration of an episode: 2-3 months
Onset
is gradual - 5 - 15% will be rapid cyclers
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Comorbidity
40% of alcohol dependent people are
alcohol dependent
– Anxiety disorder and depression is
closely linked
– Psychotic features
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Epidemiology
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incidence/prevalence
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gender
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difficult to measure as many people do not seek treatment
Approximately 30% seek treatment
women are far more vulnerable to depression
12% women and 7% males
culture
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depression is a universal phenomena
Higher in some cultures (e.g., Aboriginal Canadians)
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Epidemiology
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Lifespan Risk
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most frequent among young and middle-aged
adults
Elderly is hard to diagnose
Cross-Generational Comparisons
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People born after WW II more likely to develop a
mood disorder then previous generations
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Etiological Considerations
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Social Factors
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Depression: Stressful life events
Bipolar: goal-attainment events
Psychological factors
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Cognitive vulnerability
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Etiological Considerations:
Cognitive Theory
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Beck’s theories:
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distortions leading to and sustaining depression
depressive triad (demeaning sense of self, world, others)
negative schema formation
ABCD Model
hopelessness
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refers to the person’s negative expectations about future
events and the associated belief that these events cannot
be controlled
depressogenic attributional style
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Etiological Considerations:
Interpersonal Factors
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certain people create difficult circumstances
that increase stress
self-critical people elicit criticism and
rejection from others
person’s own behaviour causes negative life
events
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Specific Interpersonal Factors
A) social relationships
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negative effects on others’ moods
negative interactions
smaller social networks
B) response styles & gender
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ruminative vs. distracting style
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Biological Factors: Genetics
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family studies
twin studies
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genetic risk/sensitivity to stress
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heritability of depression: 52%
80% for bipolar disorder
predisposition to coping ability
mode of transmission & linkage studies
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single-gene vs. polygenic
chromosome 18: bipolar
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Twin study
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DANISH STUDY: Bertelson (1977)
bipolar probands
MZ 69 %
DZ 19 %
unipolar probands
MZ 54 %
DZ 24 %
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Biological Factors:
Neurotransmitters
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catecholamine hypothesis (not enough
norepinephrine)
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SSRIs (selective serotonin reuptake inhibitors)
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block re-uptake of serotonin
6-8 weeks for optimal effectiveness
Prozac, Paxil, Zoloft
Side effects are less severe, however, the side effects are
weight gain, headaches, sexual dysfunction
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Treatment: Unipolar Disorders
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Cognitive Therapy
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Interpersonal Therapy
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alter maladaptive schemas
focus on relationships
Antidepressant medications
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SSRIs
TCAs (dopamine, norepinepherine)
MAOIs
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Depression Medications
40-50% improve
 20-30 improve partially
 20-25 do not respond at all
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Treatment: Bipolar Disorders
Lithium – 75% success rate
 anticonvulsant medications – 60%
success rate
 psychotherapy
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Electroconvulsive Therapy (ECT)
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severe cases/last resort
Unilateral vs. bilateral
2-3 sessions per week, 6-8 session overall
reason for effectiveness not understood
ethics of ECT controversial
Pervasive and persistant
Memory losss
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Suicide
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15-20% of mood disordered patients commit suicide
50% of completed suicides occur as a result of a
mood disorder
Suicide rates among Canadian adolescents have
doubled over the past 30 years
Ratio of attempted suicides to completed suicides
are 10:1
More women than men attempt suicide, however,
men are 4x more likely to kill themselves
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Suicide: Durkheim’s Classification
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egoistic
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altruistic
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sacrifice self for the group
anomic
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sense of meaninglessness
social crisis
fatalistic
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traumatic conditions
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Treatment of Suicidal Individuals:
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crisis centres/hot lines
medication
involuntary hospitalization
psychotherapy
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reduce lethality
negotiate agreements
offer support
expand perspective
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