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SS440: Unit 6 Mood Disorders and Suicide Dr. Angela Whalen Kaplan University.

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Presentation on theme: "SS440: Unit 6 Mood Disorders and Suicide Dr. Angela Whalen Kaplan University."— Presentation transcript:

1 SS440: Unit 6 Mood Disorders and Suicide Dr. Angela Whalen Kaplan University

2 An Overview of Mood Disorders Mood disorders ▫ Gross deviations in mood ▫ Major depressive episodes ▫ Manic and hypomanic episodes

3 An Overview of Mood Disorders (continued) Types of DSM-IV-TR depressive disorders ▫ Major depressive disorder ▫ Dysthymic disorder ▫ Double depression Types of DSM-IV-TR bipolar disorders ▫ Bipolar I disorder ▫ Bipolar II disorder ▫ Cyclothymic disorder

4 Major Depression: An Overview Major depressive episode: Overview and defining features ▫ Extremely depressed mood lasting at least 2 weeks ▫ Cognitive symptoms – feelings of worthlessness, indecisiveness ▫ Disturbed physical functioning ▫ Anhedonia – loss of pleasure/interest in usual activities

5 Dysthymia: An Overview Overview and defining features ▫ Symptoms are milder than major depression ▫ Persists for at least 2 years ▫ No more than 2 weeks symptom free ▫ Symptoms can persist unchanged over long periods (≥ 20 years)

6 Dysthymia: An Overview (continued) Facts and statistics ▫ Late onset – typically in the early 20s ▫ Early onset – before age 21  Greater chronicity  Poorer prognosis

7 Double Depression: An Overview Overview and defining features ▫ Major depressive episodes and dysthymic disorder ▫ Dysthymic disorder often develops first Facts and statistics ▫ Associated with severe psychopathology ▫ Associated with a problematic future course

8 Bipolar I Disorder: An Overview Overview and defining features ▫ Alternations between full manic episodes and depressive episodes Facts and statistics ▫ Average age of onset is 18 years ▫ Can begin in childhood ▫ Tends to be chronic ▫ Suicide is a common consequence

9 Bipolar II Disorder: An Overview Overview and defining features ▫ Alternations between major depressive and hypomanic episodes Facts and statistics ▫ Average age of onset is 22 years ▫ Can begin in childhood ▫ 10% to 13% of cases progress to full bipolar I disorder ▫ Tends to be chronic

10 Cyclothymic Disorder: An Overview Overview and defining features ▫ Chronic version of bipolar disorder ▫ Manic and major depressive episodes are less severe ▫ Manic or depressive mood states persist for long periods ▫ Must last for at least 2 years (1 year for children and adolescents)

11 Cyclothymic Disorder: An Overview (continued) Facts and statistics ▫ Average age of onset is 12 to 14 years ▫ Most are female ▫ Cyclothymia tends to be chronic and lifelong ▫ High risk for developing bipolar I or II disorder

12 Differences in the Course of Mood Disorders Course specifiers ▫ Longitudinal course  Past history of mood disturbance  History of recovery from depression and/or mania ▫ Rapid cycling pattern  Applies to bipolar I and II disorder only ▫ Seasonal pattern  Episodes covary with changes in the season

13 Mood Disorders: Additional Facts and Statistics Worldwide lifetime prevalence ▫ 16% for major depression Sex differences ▫ Females are twice as likely to have major depression ▫ Gender imbalance disappears after age 65 ▫ Bipolar disorders equally affect males and females

14 Mood Disorders: Additional Facts and Statistics (continued) Fundamentally similar in children and adults Prevalence of depression seems to be similar across subcultures Relation between anxiety and depression – negative affect ▫ Most depressed persons are anxious ▫ Not all anxious persons are depressed

15 Mood Disorders: Familial and Genetic Influences Family studies ▫ Rate is high in relatives of probands ▫ Relatives of bipolar probands tend to have unipolar depression Adoption studies – data are mixed

16 Mood Disorders: Familial and Genetic Influences (continued) Twin studies ▫ Concordance rates are high in identical twins ▫ Severe mood disorders have a strong genetic contribution ▫ Heritability rates are higher for females compared to males ▫ Vulnerability for unipolar or bipolar disorder  Appears to be inherited separately

17 Mood Disorders: Neurobiological Influences Neurotransmitter systems ▫ Serotonin and its relation to other neurotransmitters ▫ Mood disorders are related to low levels of serotonin ▫ Permissive hypothesis The endocrine system Sleep disturbance

18 Mood Disorders: Psychological Dimensions (Stress) Stressful life events ▫ Stress is strongly related to mood disorders  Poorer response to treatment  Longer time before remission ▫ The relation between context of life events and mood  What’s good for you may not be good for others The learned helplessness theory of depression ▫ Lack of perceived control over life events

19 Mood Disorders: Psychological Dimensions (Cognitive Theory) Negative coping styles ▫ Depressed persons engage in cognitive errors ▫ Tendency to interpret life events negatively Types of cognitive errors ▫ Arbitrary inference – overemphasize the negative ▫ Overgeneralization – negatives apply to all situations Cognitive errors and the depressive cognitive triad ▫ Think negatively about oneself ▫ Think negatively about the world ▫ Think negatively about the future

20 Mood Disorders: Social and Cultural Dimensions Marital relations ▫ Marital dissatisfaction is strongly related to depression ▫ This relation is particularly strong in males Mood disorders in women ▫ Females over males ▫ Except bipolar disorders ▫ Gender imbalance likely due to socialization

21 Mood Disorders: Social and Cultural Dimensions (continued) Social support ▫ Extent of social support is related to depression ▫ Lack of social support predicts late onset depression ▫ Substantial social support predicts recovery from depression

22 An Integrative Theory Shared biological vulnerability ▫ Overactive neurobiological response to stress Exposure to stress ▫ Activates hormones that affect neurotransmitter systems ▫ Turns on certain genes ▫ Affects circadian rhythms ▫ Activates dormant psychological vulnerabilities ▫ Contributes to sense of uncontrollability ▫ Fosters a sense of helplessness and hopelessness Social and interpersonal relationships/support are moderators

23 Treatment of Mood Disorders Tricyclic Medications Monoamine Oxidase (MAO) Inhibitors Selective Serotonergic Reuptake Inhibitors (SSRIs) Lithium Electroconvulsive Therapy (ECT)

24 Psychosocial Treatments Cognitive therapy ▫ Addresses cognitive errors in thinking ▫ Also includes behavioral components Interpersonal psychotherapy ▫ Focuses on problematic interpersonal relationships

25 The Nature of Suicide: Facts and Statistics Eighth leading cause of death in the United States Overwhelmingly a white and Native American phenomenon Suicide rates are increasing, particularly in the young

26 The Nature of Suicide: Facts and Statistics (continued) Gender differences ▫ Males are more successful at committing suicide than females ▫ Females attempt suicide more often than males

27 The Nature of Suicide: Risk Factors Suicide in the family Low serotonin levels Preexisting psychological disorder Alcohol use and abuse Past suicidal behavior Experience of a shameful/humiliating stressor Publicity about suicide and media coverage

28 Summary of Mood Disorders All mood disorders share ▫ Gross deviations in mood ▫ Common biological and psychological vulnerability Occur in children, adults, and the elderly Onset, maintenance, and treatment are affected by ▫ Stress ▫ Social support

29 Summary (continued) Suicide is an increasing problem ▫ Not unique to mood disorders Medications and psychotherapy produce comparable results High rates of relapse


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