1. Chapter 7 Mood Disorders and Suicide
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 7
Mood Disorders and Suicide
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2. Range of Emotions
A person with a mood disorder experiences emotions that are extreme and, therefore, abnormal.

3. What Are Mood Disorders?
Unipolar depressive disorders
Only depressive episodes
Bipolar depressive disorders
Manic and possibly depressive episodes (but not necessary)
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4. The Prevalence of Mood Disorders
Lifetime prevalence for bipolar disorder is near 1%
About twice as common in women than men
12-month prevalence rates are nearly 7%
Lifetime prevalence of unipolar depression is nearly 17%
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5. Mild, brief non-depression
Can be normal and adaptive
Sadness, hopelessness, and pessimism are common human experiences
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6. Persistent Depressive Disorder (Dysthymic Disorder )
Mild to moderate version of depression
Lasts a long time
Intermittent normal moods occur briefly
Lifetime prevalence of 2.5 to 6%
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7. Major depressive episode: Overview and defining features
Extremely depressed mood lasting at least two weeks
Cognitive symptoms – feelings of worthlessness, indecisiveness
Disturbed physical functioning (sleep and eating)
Anhedonia – loss of pleasure/interest in usual activities

8. Major Depression: An Overview
Major depressive disorder
Single episode – highly unusual
Recurrent episodes (2 or more major depressive episodes separated by at least 2 months of no depression) – more common
From grief to depression
Pathological or impacted grief reaction

9. Major Depressive Disorder
Specifiers
Major depressive episode with melancholic features
Severe major depressive episode with psychotic features
Major depressive episode with atypical features
Major depressive episode with catatonic features
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10. Major Depressive Disorder
Persistent major depressive disorder
Major depression does not remit for more than two years
Seasonal affective disorder
Recurrent depressive episodes with a pattern
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11. Causal Factors in Unipolar Mood Disorders
Biological causal factors
Psychological causal factors
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12. Biological Causal Factors
Biological factors
Heredity
Altered neuro-transmitter activity
Hormones
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13. Figure 7. 1: Number of Stressful Life Events vs
Figure 7.1: Number of Stressful Life Events vs. Probability of Major Depressive Episode
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14. Biological Causal Factors
Genes
Serotonin-transporter gene
Three combinations
Gene-environment interaction research
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15. Biological Causal Factors
Disruptions
Sleep
Circadian rhythms
Exposure to sunlight (seasonal)
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16. Psychological Causal Factors
Depression
Stressful life events
Risk-related vulnerability factors
Neuroticism or negative affectivity
Early adversity or parental loss
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17. Psychological Causal Factors
Theorists
Freud
Behaviorists
Cognitive model
Freud believed that depression was anger turned inward
Behaviorists used conditioning to explain depression
Beck proposed a cognitive model of depression
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18. Figure 7.3: Beck’s Cognitive Model of Depression
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19. Cognitive distortions
All-or-nothing thinking (splitting) – Conception in absolute terms, like "always", "every", "never", and "there is no alternative". (See also "false dilemma" or "false dichotomy".)
Overgeneralization – Extrapolating limited experiences and evidence to broad generalizations. (See also faulty generalization and misleading vividness.)
Magical thinking - Expectation of specific outcomes based on performance of unrelated acts or utterances. (See also wishful thinking.)
Mental filter (arbitrary inference)– Inability to view positive or negative features of an experience, for example, noticing only a tiny imperfection in a piece of otherwise useful clothing.
Disqualifying the positive – Discounting positive experiences for arbitrary, ad hoc reasons.
Jumping to conclusions – Reaching conclusions (usually negative) from little (if any) evidence. Two specific subtypes are also identified:
Mind reading – Sense of access to special knowledge of the intentions or thoughts of others.
Fortune telling – Inflexible expectations for how things will turn out before they happen.
Magnification and minimization – Magnifying or minimizing a memory or situation such that they no longer correspond to objective reality. This is common enough in the normal population to popularize idioms such as "make a mountain out of a molehill." In depressed clients, often the positive characteristics of other people are exaggerated and negative characteristics are understated. There is one subtype of magnification:
Catastrophizing – Inability to foresee anything other than the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable.
Emotional reasoning – Experiencing reality as a reflection of emotions, e.g. "I feel it, therefore it must be true."
Should statements – Patterns of thought which imply the way things "should" or "ought" to be rather than the actual situation the person is faced with, or having rigid rules which the person believes will "always apply" no matter what the circumstances are. Albert Ellis termed this "Musturbation".
Labeling and mislabeling – Limited thinking about behaviors or events due to reliance on names; related to overgeneralization. Rather than describing the specific behavior, the person assigns a label to someone or himself that implies absolute and unalterable terms. Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
Personalization – Attribution of personal responsibility (or causal role or blame) for events over which a person has no control

20. Figure 7.4: Negative Cognitive Triad
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21. Psychological Causal Factors
Theories
Reformulated helplessness theory
Hopelessness theory
Excessive rumination
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22. Psychological Causal Factors
Interpersonal effects
Lack of social support or social skills
Hostility and rejection from others
Marital dissatisfaction
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23. The Structure of Mood Disorders
Mania
Hypomanic episode – less severe than manic episode that lasts at least 4 days

24. The Structure of Mood Disorders
Features of a manic episode
Elevated, expansive mood for at least one week
At least 3 of the following:
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

25. Includes at least one manic or mixed episode Bipolar II disorder
Bipolar I disorder
Includes at least one manic or mixed episode
Bipolar II disorder
Includes hypomanic episodes but not full-blown manic or mixed episodes
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26. Cyclothymic Disorder Cyclical mood swings
Less severe than those of bipolar disorder
Symptoms present for at least 2 years
Lacking severe symptoms and psychotic features of bipolar disorder
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27. Bipolar Disorders (I and II)
About three times as many days are depressed as manic/hypomanic
Average age of onset is 18 to 22 years
Usually start in adolescence or young adulthood
Occur equally in males and females
Characteristics
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28. Figure 7.6: The Manic-Depressive Spectrum
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29. Causal Factors in Bipolar Disorder
Biological causal factors
Psychological causal factors
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30. Biological Causal Factors
Heredity
Norepinephrine, serotonin, and dopamine
Abnormalities in transportation of ions across neural membrane
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31. Biological Causal Factors
Other biological influences
Cortisol levels
Shifting patterns of blood flow to prefrontal cortex
Disturbances in biological rhythms
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32. Psychological Causal Factors
Stressful life events
Personality variables
Low social support
Pessimistic attributional style
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33. Sociocultural Factors Affecting Unipolar and Bipolar Disorders
Symptoms of mood disorders
Can differ widely across cultures and demographic groups
Prevalence of mood disorders
Also differs across cultures
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34. Cross-Cultural Differences in Depressive Symptoms
Examples
China and Japan
Other Asian beliefs
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35. Cross-Cultural Differences in Prevalence
Rates of depression vary more than rates of bipolar disorder
Lifetime prevalence of depression is 17-19% in the U.S., but only 1.5% in Taiwan
Reasons for different rates of depression are not yet clear
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36. Figure 7.7: Prevalence Rates for Depression across Several Nations
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37. Demographic Differences in the United States
Native Americans have relatively high rates of depression
African-Americans have relatively low rates
U.S. rates of unipolar depression inversely related to socioeconomic status
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38. Figure 7.8: Rates of Mood Disorders in Writers and Artists
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39. Treatments and Outcomes
Pharmacotherapy
Alternative biological treatments
Psychotherapy
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40. Lithium common mood stabilizer for bipolar
Pharmacotherapy
Antidepressants, mood-stabilizing, antipsychotic drugs used to treat mood disorders
Lithium common mood stabilizer for bipolar
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41. Specifically block reuptake of serotonin
Treatment of Mood Disorders: 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

42. Alternative Biological Treatments
Electroconvulsive therapy
Transcranial magnetic stimulation
Deep brain stimulation
Bright light therapy
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43. 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
Side effects are few and include short-term memory loss
Uncertain why ECT works
Relapse is common (60%)

44. Psychotherapy Forms of effective psychotherapy
Cognitive-behavioral therapy
Behavioral activation treatment
Interpersonal therapy
Family and marital therapy
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45. Suicide risk significant factor in all types of depression
Suicide ranks among the top ten leading causes of death
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46. The Clinical Picture and the Causal Pattern
Who Attempts and Who Commits Suicide?
Suicide in Children
Suicide in Adolescents and Young Adults
Other Psychosocial Factors Associated with Suicide
Biological Causal Factors
Sociocultural Factors
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47. Who Attempts and Who Commits Suicide?
Suicide attempts and age
Completed suicides and age
Gender differences
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48. Suicide in Children Rates very low but increasing
Suicide in children age has increased by 70% since 1981
Multiple risk factors
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49. Suicide in Adolescents and Young Adults
Rates tripled between the mid-1950s and mid-1980s
Multiple risk factors
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50. Other Psychosocial Factors Associated with Suicide
Impulsivity
Aggression
Pessimism
Family psychopathology or instability
Genetics
Sociocultural factors
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51. Biological Causal Factors
Genetics
Reduced serotonergic activity
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52. Sociocultural Factors
Ethnicity
Whites have higher rates of suicide than African Americans
Rates of suicide
Vary across cultures and religions
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53. Figure 7.10: U.S. Suicide Rates by Age, Gender, and Racial Group
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54. Suicidal Ambivalence
Some people do not wish to die but instead want to communicate
Methods are nonlethal
Actions arranged so that intervention by others is likely
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55. Suicide Notes Only 15-25% of completed suicides leave notes
Some notes include statement of love and concern
Others include very hostile content
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56. Suicide Prevention and Intervention
Current preventive efforts
Treatment of person’s current mental disorder(s)
Crisis intervention
Working with high-risk groups
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57. Treatment of Mental Disorders
Prevention of suicide can take the form of treatment of the underlying mental disorder(s)
Antidepressant medication or lithium
Benzodiazepines
Cognitive-behavioral therapy
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58. Crisis Intervention Intervention Primary objective Examples Hotlines
Hotline efficacy
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59. Unresolved Issues Is there a right to die?
Not all societies agree that others should interfere with suicide
Challenging ethical and legal questions remain
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