Transcript Durand and Barlow Chapter 6: Mood Disorders and Suicide

Chapter 7
Mood Disorders and
Suicide
Amber Gilewski
Tompkins Cortland Community College
Major Depressive Episode
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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
Mania and Hypomania
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Symptoms
-elated joy, euphoria
-excessive or extraordinary activity
-rapid speech
*Criteria for manic episode
-duration of 1 week
-irritability towards the end
-anxiousness and depression
-if left untreated, lasts 3-6 months
*Hypomanic episodes – less severe
Depressive Disorders
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Major Depressive Disorder
• Single episode – Highly unusual
• Recurrent episodes – More common
• Median # of episodes = 4 with duration of
4-5 month
• Mean age of onset = 25-29 years old
• Age appears to be decreasing
Persistent Depressive Disorder
(Dysthymia)
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Symptoms are milder than major depression
Persists for at least 2 years (1 year for children &
adolescents)
No more than 2 months symptom free
Symptoms can persist unchanged over long periods
(≥ 20 years)
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Late onset – Typically in the early 20s
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Early onset – Before age 21
• Greater chronicity
• Poorer prognosis
“Double Depression”
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Major depressive episodes AND dysthymia
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Dysthymic disorder often develops first
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Associated with severe psychopathology
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Associated with a problematic future course
Bipolar I Disorder
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Alternations between full manic episodes &
depressive episodes
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Average age on onset is 18 years
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Can begin in childhood
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Tends to be chronic
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Suicide is a common consequence
Bipolar II Disorder
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Alternations between major depressive &
hypomanic episodes
Average age on onset is between 19 - 22
years
Can begin in childhood
10 to 13% of cases progress to full bipolar I
disorder
Tends to be chronic
Cyclothymic Disorder
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Chronic version of bipolar disorder
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Manic & major depressive episodes are less severe
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Manic or depressive mood states persist for long
periods
Must last for at least 2 years (1 year for children &
adolescents)
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Average age on onset is 12 to 14 years
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Most are female
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High risk for developing bipolar I or II disorder
Prevalence of Mood Disorders
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16% lifetime prevalency for Major Depression
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Females are twice as likely to have major depression
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Bipolar disorders equally affect males and females
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High rates amongst Native Americans
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Most depressed persons are anxious
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Not all anxious persons are depressed
Causes of Mood Disorders:
Biological dimensions
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Family & twin studies – runs in families
Mood disorders are related to low levels of
serotonin
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Endocrine system – cortisol
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Sleep disturbances/circadian rhythms
Mood Disorders:
Psychological Dimensions
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Stress is strongly related to mood disorders
The relation between context of life events
and mood
Reciprocal-gene environment model:
depressed persons putting themselves in high
risk situations
Beck proposed cognitive errors
Treatment of Mood Disorders:
Tricyclic Medications
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Widely used (e.g., Tofranil, Elavil)
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Block reuptake of NE and serotonin
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Therapeutic effects can take 2-8 weeks
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Negative side effects are common
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May be lethal in excessive doses
Treatment of Mood Disorders:
MAO Inhibitors
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Monoamine oxidase (MAO)
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Block Monoamine Oxidase
This enzyme breaks down
serotonin/norepinephrine
Slightly more effective than tricyclics
Must Avoid Foods Containing Tyramine
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Examples include beer, red wine, cheese
Treatment of Mood Disorders:
SSRIs
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Specifically block reuptake of
serotonin
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Fluoxetine (Prozac) is the
most popular SSRI
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Negative side effects are
common
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SSRIs pose no unique risk of
suicide or violence
www.londonstimes.us/toons/index_medical.html
Treatment of Mood Disorders:
St John’s Wort
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www.jadeandpearl.com/.../jp0040St,John.jpg
Herbal solution for
depression
Works as well as low doses
of other antidepressants
Alters serotonin function
Few side effects
No prescription needed in
the U.S.
Treatment of Mood Disorders:
Lithium
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Lithium Is a Common Salt
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Primary drug of choice for bipolar disorders
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Can be toxic
Side Effects May Be Severe
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Dosage must be carefully monitored
Why Lithium Works Remains Unclear
Psychological Treatments
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Cognitive Therapy
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Addresses cognitive errors in thinking
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Also includes behavioral components
Interpersonal Psychotherapy
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Focuses on problematic interpersonal
relationships
Therapy and medication may be equally effective
The Nature of Suicide:
Facts and Statistics
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11th Leading Cause of Death in the United States
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Overwhelmingly a White and Native American
Phenomenon
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Suicide Rates Are Increasing, Particularly in the Young
and Elderly
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Gender Differences
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Males complete suicide more often than females
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Females attempt suicide more often than males
Suicide:
Risk Factors, Prevention, & Treatment
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Suicide in the Family
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Low Serotonin Levels
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Preexisting Psychological
Disorder
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Alcohol Use and Abuse
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Past Suicidal Behavior
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Experience of a
Shameful/Humiliating
Stressor
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Predicting suicide:
difficult, but ask
appropriate questions
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Prevention measures
-Suicide contract: may
help prevent suicide
-Curriculum based
programs: education &
prevention
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Treatments for those at
risk: problem solving,
CBT, coping, etc.