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ABNORMAL PSYCHOLOGY SEVENTH EDITION

CHAPTER Five

Mood Disorders and Suicide


CHAPTER OUTLINE

• Symptoms

• Diagnosis

• Course and Outcome

• Frequency

• Causes

• Treatment

• Suicide


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OVERVIEW

• Major depression is the leading cause of disability worldwide (Moussavi et al., 2007).

• Depression accounts for 10% of all disability. • Emotion: the state of arousal defined by

subjective states of feeling – Sadness, anger, disgust

• Affect: pattern of observable behaviors – Facial expression, pitch of voice, body movements

• Mood: a pervasive and sustained emotional response that can color perception (APA, 2000)


OVERVIEW • Depression can refer to a mood or to a clinical

syndrome, a combination of emotional, cognitive, and behavioral symptoms.

• Clinical depression: depressed mood accompanied by other symptoms such as loss of energy, loss of pleasure, fatigue, changes in sleep and appetite

• Mania: flip side of depression – Disturbance of mood accompanied by euphoria,

grandiosity, decreased need for sleep, pressured speech


OVERVIEW

• Mood disorders are defined in terms of episodes, discrete periods of time in which the person’s behavior is dominated by either a depressed or manic mood.

• Unipolar mood disorder

– Experience of a depressive episode.

• Bipolar mood disorders

– Episodes of depression and mania.


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TABLE 5-2 Important Considerations in Distinguishing Clinical Depression from Normal Sadness

1. The mood change is pervasive across situations and persistent over time. The person’s mood does not improve, even temporarily, when he or she engages in activities that are usually experienced as pleasant.

2. The mood change may occur in the absence of any precipitating events, or it may be completely out of proportion to the person’s circumstances.

3. The depressed mood is accompanied by impaired ability to function in usual social and occupational roles. Even simple activities become overwhelmingly difficult.

4. The change in mood is accompanied by a cluster of additional signs and symptoms, including cognitive, somatic, and behavioral features.

5. The nature or quality of the mood change may be different from that associated with normal sadness. It may feel “strange,” like being engulfed by a black cloud or sunk in a dark hole.


SYMPTOMS

EMOTIONAL SYMPTOMS Depressed, or

dysphoric mood

Euphoria

Irritability

Anxiety

COGNITIVE SYMPTOMS

Slowed thinking

Guilt and worthlessness

Sped up thoughts

Grandiosity

Guilt

Suicidal thoughts


SYMPTOMS

SOMATIC SYMPTOMS

Aches and pains

Changes in sleep and appetite

Loss of sexual desire

BEHAVIORAL SYMPTOMS

Psychomotor retardation

Gregarious and energetic


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DIAGNOSIS

• Brief Historical perspective – The first widely accepted classification system was

proposed by Emil Kraepelin (1921). • Divided the major forms of mental disorder into

two categories: dementia praecox (schizophrenia) and manic-depressive psychosis

– Two primary issues: • Should disorders be defined in a broad or a narrow

fashion? • Heterogeneity – all patients do not have exactly the

same set of symptoms, the same pattern of onset, or the same course over time


DIAGNOSIS

• Contemporary Diagnostic Systems – Unipolar Disorders

• Includes two specific types:

–Major depressive disorder

–Dysthymia

»Differs from depression in terms of severity and duration

»Must have symptoms over a period of two years, exhibit depressed mood for most of the day on more days than not


DIAGNOSIS

• Bipolar Disorders – All three types of bipolar disorders involve manic

or hypomanic episodes. • Bipolar I: At least one manic episode • Bipolar II: At least one hypomanic episode, no

full blown manic episode • Cyclothymia: Bipolar equivalent of dysthymia

–Must experience numerous hypomanic and depressive episodes during a two-year period.


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DIAGNOSIS

• Further Descriptions and Subtypes

– Episode specifiers

• Melancholia: a particularly severe type of depression

• Psychotic features

• Postpartum

– Course specifiers

• Rapid cycling

• Seasonal pattern


COURSE AND OUTCOME

• Unipolar Disorders

– Average age of onset is 32 (Kessler et al., 2007)

– Length of episodes vary widely

– Minimum duration is two weeks

– Remission: a period of recovery

– Relapse: a return of active symptoms

– Approximately half of unipolar patients recover in six months


COURSE AND OUTCOME

• Bipolar Disorders

– Onset usually occurs between ages of 18 and 22 years.

– First onset can be depression or mania.

– Average duration of a manic episode runs between two and three months

– Long-term course is often intermittent (Cuellar, Johnson, & Winters, 2005)

– Long-term prognosis is mixed


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FREQUENCY

• Incidence and Prevalence

– Unipolar depression is one of the most common forms of psychopathology.

– 16% of NSC-R study (n = 9,000) suffered from depression.

– The lifetime risk of bipolar I and II disorders combined is close to 4%.

– The ratio of unipolar to bipolar disorders is at least 5:1 (Kessler & Wang, 2008).


FREQUENCY

• Risk for Mood Disorders Across the Lifespan – Mood disorders are most frequent among young

and middle-aged adults.

– Has the frequency of depression increased in recent years?

• YES

– People born after WWII seem to be more likely to develop mood disorders than people from previous generations.


FIGURE 5-2 Lifetime Prevalence of Mood Disorders by Age (NCS-R data)


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FREQUENCY

• Gender Differences – Women are two or three times more vulnerable to

depression than men (Kessler, 2006).

• Women are more likely than men to present for mental health services.

• It is more difficult for men to admit to subjective feelings of distress.

– Gender differences are not typically observed for bipolar mood disorders.


In what way are the symptoms of depression different in China?

• Depression is more likely to be described in somatic symptoms, such as sleeping problems, headaches, and loss of energy (Kleinman, 2004).


FREQUENCY

• Cross-Cultural Differences

– Each culture has its own ways of interpreting reality including expressing or communicating symptoms of physical and emotional disorder.

– Clinical depression is a universal phenomenon that is not limited to Western or urban societies.


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Do negative life events cause depression? Or does depression lead to negative events?

• A special class of circumstances — those involving major losses of important people or roles — seems to play a crucial role in precipitating unipolar depression.

• Depression is more likely to occur when life events are associated with feelings of humiliation, entrapment and defeat (Brown, 1998).


CAUSES

• Social Factors and Bipolar Disorders

– Less attention paid to bipolar disorders

– Some evidence indicate that weeks preceding the onset of a manic episode are marked by an increased frequency of stressful life events (Miklowitz & Johnson, 2009).

– Factors are different than from depression

–Schedule-disrupting events

–Goal attainment


CAUSES

• Psychological Factors: Cognitive Vulnerability – Humans are not only social but thinking

organisms. – Ways in which people perceive, think about, and

remember event influence feelings. – Negative thoughts about self and pessimistic view

of the environment maintain depression.


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Why do some people become depressed after stressful life events while others do not?

• Response Styles and Gender – Ruminative style (more likely in women) – Distracting Style (more likely in men)

• Interpersonal Factors and Social Behaviors – Some depressed people create difficult

circumstances that increase the level of stress.

• Integration of Cognitive and Interpersonal Factors – Vulnerability to depression is influenced by

childhood experiences.


BIOLOGICAL FACTORS • Genetics

– Twin Studies

• Genes play a more important role in bipolar disorders than unipolar disorders.

• Heritability (0–100): bipolar mood disorders have heritability of 80%

– Mode of Transmission and Linkage

• Polygenic

– Genetic Risk and Sensitivity to Stress

• Gender

• “s” allele of the 5-HTT Copyright © Pearson Education 2011

FIGURE 5-4

Combined Effects of Stress and Genetic Vulnerability on Risk for Depression


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FIGURE 5-5

The Hormonal System Known as the Hypothalamic- Pituitary-Adrenal (HPA) Axis


FIGURE 5-6

Areas of the Brain Involved in Depression


BIOLOGICAL FACTORS

• Neurotransmitters

– The development of antidepressant drugs stimulated research on several specific neurotransmitters.

• Serotonin, Norepinephrine, Dopamine

– There may be more than 100 different neurotransmitters in the CNS, and each neurotransmitter is associated with several type of postsynaptic receptors.


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TREATMENT: UNIPOLAR DISORDERS

COGNITIVE THERAPY

Focuses on helping patients replace self-defeating thoughts with more rational statements.

Current experiences

Effective for unipolar depression

INTERPERSONAL THERAPY

Focuses on current relationships, especially familial

Attempts to improve relationships by building communi-cation and problem-solving skills.


TREATMENT • Unipolar Disorders

• Antidepressant Medications

– Four general categories

• Selective Serotonin Reuptake Inhibitors (SSRIs),Tricyclics, Monoamine Oxidase Inhibitors (MOA-Is), Other

– Improvement typically in four to six weeks

– Current episode is often resolved within 12 weeks (DePaulo & Horvitz, 2002; Schulberg et al.,1999).

– Continued 6 to 12 months after the patient has entered remission


TREATMENT: UNIPOLAR DISORDERS

SSRIs Most frequently used

antidepressant Easier to use than

other antidepressants Fewer side effects Sexual dysfunction,

weight gain Less dangerous in

event of overdose

TRICYCLICS (TCAs)

• Imipramine and amitriptyline

• More side effects:

– Constipation, drowsiness, drop in BP, blurred vision

• Equal in efficacy to SSRIs


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TREATMENT

Unipolar Disorders

MAO-Is: Phenelzine (Nardil)

– Not as effective as tricyclics

– Side effects: consuming foods with tyramine (cheese and chocolate) often increases BP.

• Can be used safely when foods such as cheese, beer, and red wine are avoided

– Used in treatment of anxiety disorders, particularly agoraphobia and panic.


TREATMENT: BIPOLAR DISORDERS

Lithium

• Effective treatment in alleviation of manic symptoms

• 40% of patients do not improve

• Non-compliance with drug due to side effects

Anticonvulsants

• Tegretol and Depakene

• More than 50% responds to these drugs

• Used to treat rapid cycling

• Side effects



Psychotherapy • Can be effective supplement to biological

intervention

• Cognitive therapy

• Interpersonal therapy

• Combination of psychotherapy and medication is more beneficial than medication alone.


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Electroconvulsant Therapy (ECT) • Effective for unipolar and bipolar disorders

• Given three times a week for 2 to 7 weeks

• Electrodes placed on skull

• Used when medication and therapy have not been effective


SEASONAL MOOD DISORDERS

• Changes in seasons can bring about mood disorders

• Jean Esquirol (1772-1840)

• Light therapy is exposure to bright broad-spectrum light for one to two hours everyday

• Combination of cognitive therapy and light therapy is preferred


SUICIDE

• The highest rate in the U.S. is among white males over the age of 50.

• Within this group, men who have been occupationally successful are more likely to commit suicide, especially if that success is threatened.

• There is a strong relationship between depression and self-destructive acts.

• 15 to 20% of all patients with mood disorders will eventually kill themselves. Copyright © Pearson Education 2011

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SUICIDE

• Classification of Suicide

– Emile Durkheim: social factors; social integration and regulation

• Egoistic suicide

• Altruistic suicide

• Anomic suicide

• Fatalistic suicide

– Different types of suicide overlap


SUICIDE

• Classification of Suicide

– Nonsuicidal Self-Injury

• Deliberate self-harm without desire for suicide: cutting, burning, scratching the skin

• The pain serves a useful purpose

–To punish the self and is a reflection of frustration and anger

–Maladaptive way to regulate intense, negative emotional states


FIGURE 5-7 Suicide rates across the lifespan


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SUICIDE • Causes of Suicide

– Psychological Factors

• Psychological pain: social isolation, feelings of being a burden, previous attempts

– Biological Factors

• Reduced levels of serotonin: poor impulse control; violent and aggressive behaviors

• Potential for genetic predisposition

– Social Factors

• Availability of guns, media, social integrations and regulation


SUICIDE

• Treatment of Suicidal People

– Crisis Centers and Hotlines

• Primarily suicide prevention

• Efficacy for “saving lives” not demonstrated

• People with most lethal ideations will not call

• Offers valuable assistance to people in distress

– Psychotherapy

• Reduce lethality


SUICIDE

• Treatment of Suicidal People

– Psychotherapy (continued)

• Negotiate agreements

• Provide support

• Replace tunnel vision with a broader perspective

– Medication

• SSRI use in treating depression lowers suicide rates

• Involuntary hospitalization Copyright © Pearson Education 2011

Documents

Abnormal Psychology Fifth Edition - Coming soonfac.hsu.edu › ahmada › 3 Courses › 9 Abnormal Psychology... · 2013-07-08 · ABNORMAL PSYCHOLOGY SEVENTH EDITION CHAPTER Five