Chapter 6 Mood Disorders and Suicide
Cognitive symptoms:
feelings of worthlessness and indecisiveness; Loss of interest in things
Inherited Vulnerability
Familial and genetic influences
Permissive hypothesis
-When serotonin levels are low, other neurotransmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities, including depression. -Chronic stress also reduces dopamine and produces depressive-like behavior
Bipolar II Disorder
-Alternation of major depressive episode with hypomanic episodes (not full manic episodes) -As in the criteria set for major depressive disorder; for the manic episodes to be considered separate, there must be a symptom free period of at least 2 months.
Stress and Bipolar Disorder
-Negative stressful life events trigger depression, but a somewhat different, more positive, set of stressful life events seems to trigger mania -Experience associated with striving to achieve important goals (such as getting married) trigger mania in vulnerable individuals. -
Stress seems to initially trigger mania and depression
-Once the cycle begins, a psychological or pathophysiological process takes over and ensures the disorder will continue -Some precipitants of manic episodes related to loss of sleep
Is Suicide Contagious?: Why would anyone want to copy a suicide?
-Suicides are often romanticized in the media -Media accounts often describe in detail the methods -Little is reported on the side effects of the suicide attempt (brain damage)
Gene-environment correlation Model
-The association between stressful life events is not the usual arrangement where stress triggers depression but rather individuals vulnerable who are placing themselves in high-risk stressful environments -Stress triggers depression, and depressed individuals create or seek stressful events
Depressive Cognitive triad
-Thinking errors by depressed people negatively focused in three areas: themselves, their immediate world and the future. -Beck theorized that individuals may develop a deep-seated negative schema, an enduring negative cognitive belief system about some aspect of life
Electroconvulsive therapy
1. Biological treatment for severe, chronic depression involving the application of electrical impulses through the brain to produce seizures 2. Side effects are short-term memory loss
Treatment: Suicide
1. CBT2.Mental health professionals would look for signs that show a vulnerability or risk 3.There is a no-suicide contract with a promise not to do anything remotely connected with suicide without contacting the mental health professional 4. Suicide prevention programs
Cognitive Vulnerability for Depression: An Integration
1. Evidence suggests that depression is always associated with pessimistic explanatory style and negative cognitions 2. Evidence also exists that cognitive vulnerabilities predispose some people to view events in a negative way, putting them at risk for depression
Onset before 21 years old can be associated to 3 characteristics
1. Greater chronicity (it lasts longer) 2. Relatively poor prognosis {response to the treatment} 3. Stronger likelihood of the disorder to run in the family.
The endocrine system
1. Hormones that affect the brain and are increasingly the focus of study in psychopathology a. The cortisol (stress hormone) level is elevated in depressive patients. b. This hormone might be deathly to neurons. Making them to be less healthy and to stop the growing connections
Disruptive Mood Dysregulation Disorder
1. In children, a mental disorder characterized by recurrent temper outbursts occurring against a background of irritable mood. 2. The temper outbursts occur three or more times per week for at least one year. 3. Irriatability affects their functioning in three main settings (home, at school, with peers) 4. The diagnosis should not be made for the first time before age 6 or after age 18 years
Transcranial Magnetic Stimulation
1. It works by placing a magnetic coil over the individual's head to generate a precisely localized electromagnetic pulse. 2. Side effects: headaches
Hypomanic Episode
1. Less severe and less disruptive version a manic episode that is one for the criteria for several mood disorder 2. The episode does not cause marked impairment in social or occupational functioning 3. It need to last only 4 days
Neurotransmitter systems
1. Low levels of serotonin (regulate our emotional reactions) in the causes of mood disorders, but only in relation to other neurotransmitter, including norepinephrine (gets the body ready to react/body's alarm) and dopamine (happy) a. Low levels of serotonin= impulsive behavior and mood swings.
Psychological Treatments for Bipolar Disorder
1. Medications 2. Psychological treatment 3. Interpersonal and Social rhythm therapy
Persistent Depressive Disorder
1. Mood disorder characterized by two years or more of depressed or dysthymic mood (less severe depression) which may vary in severity 2. The patient cannot be symptoms free for more than 2 months 3.A prolonged major depressive episode is called chronic.
Major Depressive Episode
1. Mood disorder involving one major depressive episode. 2. It last at least 2 weeks.
After identifying the dispute, the next step is to bring it to a resolution
1. Negotiation Stage 2. Impasse Stage 3. Resolution Stage
Selective Serotonin Reuptake: Side effects
1. Physical agitation 2. Sexual dysfunction 3. Lower sexual desire 4. Insomnia 5. Gastrointestinal upset
Mixed Reuptake Inhibitors: Side effects
1. Risk of damage to the cardiovascular system 2. Sexual Dysfunction 3. Nausea
Treatment of Mood Disorder: Four types of antidepressants
1. Selective Serotonin Reuptake 2. Monoamine Oxidase (MAO) inhibitors 3. Mixed Reuptake Inhibitors 4. Tricyclic antidepressants
Double Depression
1. Severe mood disorder typified by major depressive episodes superimposed over a background of dysthymic disorder (persistent depressive disorder) 2. Typically, a few depressive symptoms develop first, perhaps at an early age, and then one or more major depressive episodes occur later only to revert to the underlying pattern of depression once the major depressive episode has run its course
Onset and Duration for Mood Disordes
1. The mean age of onset for major depressive episode is 30 years old but 10% of the population developed major depressive episode at 55+ years old. 2. The length of depressive episodes is variable (2 weeks to several years). The typical duration of the first episode is 2 to 9 months. 3. The onset duration for persistent depressive episode is 20 to 30 years
Psychological Treatments of Depression [CBT]
1. Treatment approach that involved identifying and altering negative thinking styles related to psychological disorders and replacing them with more positive beliefs and attitudes and, ultimately, more adaptive behavior and coping styles. 2. Treatment involved correcting cognitive errors and substituting less depressing and more realistic thoughts and appraisals 3. Avoiding environmental cues and exercise might help to reduce depression
Mood Disorder in Women
1.Almost 70% of depressed people are women 2.The gender differences are strongly influenced by perceptions of uncontrollability. 3 Women tend to place greater value on intimate relationships than men, which can be protective if social networks are strong, but may also put them at risk. 5.In adolescent girls, aggression and rejection may contribute to develop depressive episodes 6.Women tend to ruminate more and blame themselves for being depressed. 7.
Tricyclic antidepressants: Side effects
1.Blurred vision 2.Dry mouth 3.Constipation 4.Difficulty urinating 5.Drowsiness 6.Weight gain 7.Sexual dysfunction -It is lethal in excessive doses
Lithium
1.It is effective in preventing and treating manic episodes. a.Mood-stabilizing drug i.A medication used in the treatment of mood disorders, particularly bipolar disorder, that is effective in preventing and treating pathological shifts in mood
Marital Relations
1.Marital dissatisfaction and depression including bipolar disorder are strongly related 2.Depression and bipolar disorder if continues may lead to substantial deterioration in marital relationships 3.Depression seems to cause men to withdraw or disrupt the relationship 4.For women, problems in the relationship most often cause depression
Premenstrual Dysphoric Disorder: At least five of the following symptoms should be present
1.Marked affective lability (mood swings) 2.Marked irritability or anger 3.Marked Depressed mood 4.Marked anxiety and tension 5.Decreased interest in usual activities 6.Difficulty in concentration 7.Lethargy (a lack of energy and enthusiasm), fatigability, lack of energy 8.Hypersomnia or insomnia 9.Marked change in appetite: a sense of food cravings 10.Sense of being overwhelmed 11.Physical symptoms: weight gain and breast tenderness
Manic Episode: Symptoms
1.Period of abnormally excessive elation or euphoria associated with some mood disorders 2.extreme pleasure in every activity 3.extraordinarily active (hyperactive) 4.little sleep 5.develop grandiose plans, believing they can accomplish anything 6.Speech is typically rapid and may become incoherent, because the individual is attempting to express so many exciting ideas at once [flight of ideas]
Three other important indices of suicidal behavior
1.Suicidal ideation-Thinking seriously about suicide 2. Suicidal plans- The formulation of a specific method for killing oneself 3. Suicidal attempts- Effort made to kill oneself
Prevention
1.Universal Programs, which are applied to everyone 2.Selected interventions, which target individuals at risk for depression because of factors 3.Indicated interventions, in which the individual is already showing mild symptoms of depression
Mood disorders
A group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression.
Premenstrual Dysphoric Disorder
A mood disorder in women characterized by marked depressive, anxious or irritable symptoms, regularly occurring around the time of the menstruation.
Complicated grie
A reaction to loss characterized by persistent intense grief and persistent or impairing concerns about the consequences or circumstances of the loss.
Integrated grief
A stage of grieving at which the finality of death and the meaning of the loss are acknowledged and appreciated
Cyclothymic Disorder
Chronic (at least 2 years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes.
Bipolar I Disorder
Alternation of major depressive episode with full manic episodes
Altruistic suicide
An individual who brought dishonor to himself or his family was expected to impale himself on a sword (ancient Japan)
Classified the cognitive errors
Arbitrary inference- When a depressed individual emphasizes the negative rather that the positive aspects of the situation Overgeneralization- Making a very broad conclusion based on a single incident or a single piece of evidence
Mixed Reuptake Inhibitors
Best known: Effexor -Block reuptake of norepinephrine as well as serotonin
Causes of Mood Disorder
Biological Dimension, Psychological Dimension and Sociocultural Dimension
Maintenance treatment
Combination of continued psychosocial treatment, medication, or both designed to prevent relapse following therapy
Interpersonal psychotherapy
Brief treatment approach that emphasizes resolution of interpersonal problems and stressors, such as role disputes in marital conflict, forming relationships in marriages, or a new job. It has demonstrated effectiveness for such problems as depression
Depression and Crying
Crying is not an indicator of depression; Research suggests that depressed and non-depressed individuals cry in equally amounts
Negative Cognitive Styles
Depression may result from a tendency to interpret everyday events in a negative ways
Depression and anxiety
Evidence supports the assumptions that anxiety, depression, and panic are closely related.
Tricyclic antidepressants
Examples: Tofranil and Elavil -They block the reuptake of certain neurotransmitters, allowing them to pool in the synapse and desensitize or down-regulate the transmission
Risk Factors: Family History
If a family member committed suicide, there is an increased risk that someone else in the family will also commit suicide
Risk Factors: Psychological autopsy
Postmortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death
Anhedonia
Inability to experience any pleasure from life
Unipolar Mood Disorder
Individuals who experience either depression or mania.
Manic Episode: Duration
It has to last at least 1 week, but the duration of untreated is typically 3 to 4 months
Integrative Model
It would understand the causes of depression based on the three dimensions: biological, psychological and sociocultural.
Risk Factors: Neurobiology
Low levels of serotonin may be associated with suicide and with violent suicide attempts
Learned Helplessness
Martin Seligman's theory that people become anxious and depressed when they make an attribution that they have no control over the stress in their lives (whether or not they actually have control)
Risk Factors: Psychological Disorder
More than 80% of people who kill themselves suffer from a psychological disorder, usually mood, substance abuse, or impulse control disorder (borderline personality disorder)
Major Depressive Disorder
Presence of at least one major depressive episode and the absence of manic or hypomanic episodes before or during the disorder.
Interpersonal and Social rhythm therapy
Psychological treatment that regulates circadian rhythms by helping patients regulate their eating and sleep cycles and other daily schedules as well as cope more effectively with stressful life
Stress and Depression
Stressful events should be analyzed based on the context and meaning of the situation i.Research shows that some situations might lead to depression as a breakup of a relationship ii.Scientists have confirmed that humiliation, loss, and social rejection are the most potent stressful life events
Mixed Features
Term for experiencing depressive symptoms during a manic or hypomanic episode, or experiencing manic symptoms during a depressive episode
Onset and duration: Bipolar Disorder
The average age: a. Bipolar I disorder is 15-18 b. Bipolar II disorder is 19-22 Chronic course Suicide range from 12% to 48%
Bipolar Mood Disorder
The individual travels from depression-elation continuum to the other and back again
Fatalistic suicide
The loss of control over one's own destiny
Egoistic suicide
The loss of social support
Risk Factors: Stressful life events
The most important risk factor for suicide is a severe, stressful event experienced as shameful or humiliating, such as a failure or bullying
Anomic suicide
The result of marked disruptions, such as the loss of a high-prestige job
Social Support
The risk of depression for people who live alone is almost 80% higher than people who live with others.
From Grief to Depression
Usually the natural grieving process has peaked within the first 6 months, although some people grieve for a year or longer
Four interpersonal problems
a.Dealing with interpersonal role disputes (marital conflict) b.Adjusting to the loss of a relationship (grief) c.Acquiring new relationships d.Identifying and correcting deficits in social skills
The depression attributional style
a.Internal (the individual attributes negative events to personal failings) b.Stable (even after a particular negative event passes, the attribution that "additional bad things will always be my fault" remains) c.Global (the attributions extend across a variety of issues)
Suicide: Statistics
a.Suicide is the 11th leading cause of death in the US b.Suicide causes more deaths per year than homicide and HIV/AIDS c.It is overwhelmingly a white phenomenon. Most minority groups, African Americans and Hispanics, seldom resort to suicide. d.The suicide rate for Native Americans is extremely high. e.For teenagers, suicide was the third cause of death f.Around males are four times more likely to commit suicide than females except in China
Physical functions
central indicator of a major depressive episode 1. Altered sleeping patterns 2. Significant changes in appetite and weight 3. A notable loss of energy
Selective Serotonin Reuptake
i. First choice in drug treatment for depression. ii.It seems to have an effect on the serotonin neurotransmitter system 1. Block the presynaptic reuptake of serotonin iii. Examples: Prozac
Prevalence of Mood Disorder
i. Women are twice as likely to have mood disorders as men iv. Women are more likely than men to experience rapid cycling, anxiety, and to be in a depressive phase rather than a manic phase. v. Depression lower among blacks than among whites vi. Depressive disorder rises dramatically in adolescence and is largely a female disorder. x. Bipolar disorder seemed to occur at about the same rate in childhood and adolescence (1%) xi. Children of depressed mothers may show depressive behavior at less than a year old xii. It is often difficult to diagnose depression in older adults (65+) because its symptoms are similar to those of medical ailments or dementia. Less elderly diagnosed with depression than general population.
Monoamine Oxidase (MAO) inhibitors
i.The block the enzyme MAO that breaks down norepinephrine and serotonin, leading to a down-regulation ii.Potentially consequences 1.Eating and drinking foods and beverages containing tyramine, such as cheese, red wine, or beer, can lead to severe hypertensive episodes and, occasionally, death
The duration of major depressive episode
if untreated, is approximately 4 to 9 months
Major Depressive Disorder: Recurrent
term used to characterize mood episodes divided by periods of full or partial remission -If two major depressive episodes occurred and were separated by at least 2 months during which the individual was not depressed, the major depressive episode is noted as recurrent. -The median duration of recurrent depressive episodes is 4 to 5 months.
