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Chapter 7 Mood Disorders and Suicide. An Overview of Depression and Mania Mood Disorders Depressive disorders Affective disorders Depressive neuroses.

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Presentation on theme: "Chapter 7 Mood Disorders and Suicide. An Overview of Depression and Mania Mood Disorders Depressive disorders Affective disorders Depressive neuroses."— Presentation transcript:

1 Chapter 7 Mood Disorders and Suicide

2 An Overview of Depression and Mania Mood Disorders Depressive disorders Affective disorders Depressive neuroses Gross deviations in mood Depression Mania

3 An Overview of Depression Major depressive episode Extreme depression 2 weeks Cognitive symptoms Physical dysfunction Anhedonia Duration - 4 to 9 months, untreated

4 An Overview of Mania Manic episode Exaggerated elation, joy, euphoria 1 week, or less Cognitive symptoms Physical dysfunction Duration – 3 to 6 months, untreated Hypomanic episode

5 Structure of Mood Disorders Unipolar disorders Depression or mania alone Typically depression Bipolar disorders Depression and mania Mixed episodes

6 Structure of Mood Disorders Diagnostic considerations Accompanying symptoms Overlap between disorders Severity Course Recurrent Alternating Seasonal

7 Depressive Disorders: An Overview Major Depressive Disorder No mania/hypomania Single episode Rare Recurrent 4 episodes (lifetime) Duration – 4 to 5 months

8 Major Depressive Disorder Onset Low until early teens Mean age = 30

9 Dysthymic Disorder Milder symptoms 2+ years Chronic Persistent Depressive Disorders: An Overview

10 Onset = early 20s Early onset = before 21 Greater chronicity Poor prognosis Stronger familial component Median duration = 5 years Depends on comorbidity Dysthymic Disorder


12 Double Depression Major depressive episodes and dysthymic disorder Dysthymia first Severe psychopathology Poor course High recurrence rates Depressive Disorders: An Overview

13 Depression frequently follows loss 62% after death Pathological or Complicated Grief Severity of symptoms Dysfunction Persistence of symptoms Grief and Depression

14 Bipolar I Disorder: An Overview Alternating major depressive and manic episodes Single manic episode Recurrent Symptom free for 2 months

15 Bipolar I Disorder: An Overview Statistics Onset = age 18 Childhood Chronic Suicide

16 Bipolar II Disorder Alternating major depressive and hypomanic episodes Statistics Onset = age 19 to 22 Childhood Chronic

17 Cyclothymic Disorder Alternating manic and depressive episodes Less severe Persists longer Chronic symptoms Adults = 2+ years children and adolescents= 1+ year

18 Cyclothymic Disorder Statistics Onset = age 12 or 14 Chronic Lifelong Female>Male Risks for Bipolar I/II

19 Symptom Specifiers Atypical Melancholic Chronic Catatonic Psychotic Mood congruent/ incongruent Postpartum Additional Defining Criteria


21 Course Specifiers Longitudinal course Rapid cycling pattern Seasonal pattern Depression vs. mania Melatonin Phototherapy CBT Additional Defining Criteria

22 Prevalence of Mood Disorders

23 Children and Adolescents Similar to adults Symptom presentations Prevalence Early childhood Adolescence Misdiagnosis ADHD Conduct disorder Prevalence of Mood Disorders

24 Elderly Prevalence may depend on setting Symptom profile Female : Male = 1:1 Diagnostic difficulty Comorbidities Prevalence of Mood Disorders

25 Across Cultures Similar prevalence among US subcultures Exceptions Physical or somatic symptoms Comparability Prevalence of Mood Disorders

26 Among the creative Higher prevalence Melancholia Mania Gender differences Prevalence of Mood Disorders

27 More alike than different Almost all depressed persons are anxious Not all anxious persons are depressed Negative affect Core symptoms of depression Anhedonia Slowing Negative cognitions Overlap of Anxiety and Depression

28 Familial and Genetic Influences Family Studies Adoption Studies Twin Studies Bipolar Unipolar Higher concordance with higher severity Higher heritability for females Causes of Mood Disorders : Biological


30 Shared genetic vulnerability High familial heritability Same genetic factors General predisposition Except mania? Depression and Anxiety: The Same Genes?

31 Neurotransmitter Systems Serotonin - depression The permissive hypothesis Dopamine Norepinephrine Dopamine - mania Causes of Mood Disorders : Biological

32 Endocrine System Stress hypothesis Overactive HPA axis Neurohormones Elevated cortisol Suppressed hippocampal neurogenesis Dexamethasone suppression test (DST) Causes of Mood Disorders : Biological

33 Sleep and Circadian Rhythms REM sleep Reduced latency Increased intensity Decreased slow wave sleep Sleep deprivationeffects Causes of Mood Disorders : Biological

34 Brain Wave Activity Indicator of vulnerability? Greater right side anterior activation Less alpha wave activity Causes of Mood Disorders : Biological

35 Stressful life events Context Meaning Timing Effects of stress Poorer treatment response Delayed remission Trigger for episode or relapse Causes of Mood Disorders : Psychological

36 Reciprocal-gene environment model Stress triggers depression Depressed individuals create or seek out stressful situations Interaction with vulnerability Genetic Psychological Causes of Mood Disorders : Stress

37 Learned Helplessness (Seligman) Lack of perceived control Depressive Attributional Style Internal Stable Global Also characterizes anxiety Causes of Mood Disorders : Psychological

38 Sense of hopelessness Lack of perceived control Will not regain control Pessimism Before or after? Causes of Mood Disorders : Psychological

39 Negative Cognitive Styles Cognitive Theory of Depression (Beck) Cognitive errors in depression Negative interpretations Types of Cognitive Errors Arbitrary inference Overgeneralization Causes of Mood Disorders : Psychological

40 Becks Depressive Cognitive Triad Causes of Mood Disorders : Psychological

41 Cognitive Theory of Depression (Beck) Negative schemas Automatic thoughts Treatment implications Correcting the errors

42 Causes of Mood Disorders : Psychological Cognitive Vulnerability for Depression Pessimistic explanatory style Negative cognitions Hopelessness attributions Interactions with: Biological vulnerabilities Stressful life events

43 Mood Disorders: Social and Cultural Dimensions Marriage and Interpersonal Relationships Relationship disruption precedes depression Strongest effects for males Martial conflict vs. marital support Gender differences in causal direction

44 Mood Disorders: Social and Cultural Dimensions Mood Disorders in Women Prevalence: Females > males True for all mood disorders Except bipolar

45 Mood Disorders: Social and Cultural Dimensions Mood Disorders in Women Gender roles Perceptions of uncontrollability Socialization Access to resources

46 Mood Disorders: Social and Cultural Dimensions Social Support Related to depression Lack of support predicts late onset depression Substantial support predicts recovery for depression (not mania)

47 Integrative Theory of Mood Disorders Shared biological vulnerability Psychological vulnerability Exposure to Stress Social and interpersonal relationships

48 Integrative Theory of Mood Disorders

49 Treatment of Mood Disorders Changing the chemistry of the brain Medications ECT Psychological treatment

50 Treatment : Antidepressant Medications Tricyclics (Tofranil, Elavil) Frequently used for severe depression Block reuptake/down regulate Norepinephrine Serotonin 2 to 8 weeks to work Many negative side effects Lethality

51 Monoamine Oxidase (MAO) Inhibitors Block MAO Higher efficacy Fewer side effects Interactions Foods Medicines Selective MAO-Is Treatment : Antidepressant Medications

52 Selective Serotonin Reuptake Inhibitors Fluoxetine (Prozac) First treatment choice Block presynaptic reuptake No unique risks Suicide or violence Many negative side effects Treatment : Antidepressant Medications

53 Other medications Venlafaxine Similar to tricyclics Nefazodone Similar to SSRIs St. Johns Wort Questionable efficacy Treatment : Antidepressant Medications

54 Other issues Efficacy in special populations Children Elderly Preventing relapse Maintaining benefits Treatment : Antidepressant Medications

55 Treatment of Mood Disorders: Lithium Common salt Primary treatment for bipolar disorders Unsure of mechanism of action Narrow therapeutic window Too little –ineffective Too much – toxic, lethal

56 Treatment of Mood Disorders: Antimanics Other antimania drugs Carbamazepine Valproate Most frequently prescribed High efficacy Except suicide! Fewer side effects

57 Electroconvulsive Therapy Brief electrical current Temporary seizures 6 to 10 treatments High efficacy Severe depression Few side effects Relapse is common Treatment of Mood Disorders: ECT

58 Transcranial magnetic stimulation Localized electromagnetic pulse Fewer side effects Efficacy is likely good More studies needed Treatment of Mood Disorders: TMS

59 Psychological Treatment of Mood Disorders Cognitive Therapy Identify errors in thinking Correct cognitive errors Substitute more adaptive thoughts Correct negative cognitive schemas Behavioral Activation Increased positive events Exercise

60 Psychological Treatment of Mood Disorders Interpersonal Psychotherapy Address interpersonal issues in relationships Role disputes Loss New relationships Social skill deficits

61 Psychological Treatment of Mood Disorders CBT and IPT Outcomes Comparable to medications More effective than: Placebo Brief psychodynamic treatment

62 Combined Treatment of Mood Disorders Possible benefits above individual treatments 48% benefit from meds or CBT 73% benefit from combined More research is needed

63 Prevention of Mood Disorders Universal programs Selected interventions Indicated interventions Preventing relapse

64 Psychological Treatment of Bipolar Disorders Management of interpersonal problems Increase medication compliance Interpersonal and Social Rhythm Therapy Family-focused treatment

65 Suicide: Statistics Population specific Caucasians Native Americans Increasing rates Adolescents Elderly Gender differences Indices Attempts Ideations

66 Suicide: Past Conceptions Types of suicide (Durkheim) Altruistic Egoistic Anomic Fatalistic

67 Suicide: Risk Factors Family history Low serotonin levels Preexisting disorder Alcohol Past suicidal behavior Shameful/humiliating stressor Suicide publicity and media coverage

68 Suicide: Risk Factors

69 Suicide: Treatment Importance of assessment Previous attempts Recent events Ideation Plan Means Access

70 Suicide: Treatment No-suicide contract Hospitalization Complete or partial Problem solving therapy CBT

71 Future Directions Interaction between biology and psychology Biological challenge studies Induced depression Serotonin and pessimism

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