Chapter 5 Mood Disorders and Suicide Copyright © 2006 Pearson Education Canada Inc

Chapter 5Mood Disorders and Suicide

Copyright © 2006 Pearson Education Canada Inc.

Copyright © 2006 Pearson Education Canada Inc. 2

Overview

Several terms to describe problems associated with emotional response systems

– Emotion– Affect– Mood– Clinical Syndrome


Overview

Emotion - refers to a state of arousal that is defined by subjective states of feelings, such as sadness, anger, and happiness.

Affect - refers to pattern of observable behaviours associated with emotions (e.g. facial expression, voice pitch).

Mood - refers to a pervasive and sustained emotional response that can influence a person’s perception of the world (e.g. depressed mood).

Clinical Syndrome - is a combination of emotional, cognitive, and behavioural symptoms associated with a depressed mood (e.g. clinical depression).


Overview

How can we differentiate between normal sadness & clinical depression?

1. The mood change is pervasive across situations and persistent over time.

2. The mood change may occur in the absence of any precipitating events.

3. The depressed mood impairs social and occupational functioning.

4. The change in mood is accompanied symptoms that include cognitive, somatic, and behavioral features.

5. The nature of the mood change is different than normal sadness.


Overview

Mood disorders - are defined in terms of episodes

– discreet periods of time in which the person’s behaviour dominated by depressed or manic mood or both.


Symptoms & Features

emotional symptoms

cognitive symptoms

somatic symptoms

behavioural symptoms


Emotional Symptoms

brief negative emotions serve a useful communicating function

prolonged, intense emotions become problematic to our daily functioning

dysphoric mood (e.g. feeling gloomy), anxiety In mania there is euphoria, elation, as well as irritability


Cognitive Symptoms

changes in the way people think unrealistic expectations preoccupations and cognitive distortions thinking slowed down or sped up memory difficulties self-blame Suicidal ideation


Somatic Symptoms

Clinically significant changes in:

– fatigue– aches & pains– sleep patterns– appetite – hygiene – Sexual drive


Behavioural Symptoms

apparent lack of caring for others changes in the things people do and how

they do them psychomotor retardation in depressed

individuals sped up, impulsive behaviour in mania


Contemporary Perspective

Unipolar Disorders– dysthymia – major depressive disorder

Bipolar Disorders– bipolar I– bipolar II– cyclothymic disorder– Mixed episode



Dysthymia

Represents a chronic mild depressive condition that has been present for many years (i.e., at least 2)- depressed mood most of the day on more days than not,

plus 2 or more of the following:

– Poor appetite or overeating– Insomnia or hypersomnia– Low energy– Low self-esteem– Poor concentration or difficulty making decisions– Feelings of hopelessness




Bipolar II

A person who has experienced at least one major depressive episode, at least one hypomanic episode, and no full blown manic episodes.

Hypomania - episodes of increased energy that is not as severe as full blown mania.

Cyclothymia - numerous hypomanic episodes and numerous periods of depression during a 2 year period.

Mixed Episode – The criteria is met for a manic and major depressive episode for 1 week period.


Subtypes and Descriptors

episode specifiers– Early vs. late onset– psychotic– post-partum onset– melancholia

severe form of depression possible different etiology biological treatments successful

course specifiers– seasonal affective disorder– rapid cycling

denotes poor prognosis for bipolar disorder


Course and Outcome

Unipolar Disorders– onset generally in middle age, average age is mid 40s – 10% have depression for 2 years– 50% will recover within 6 months – of those, 50% will relapse in 3 years

Bipolar Disorders– onset typically between 28-33 yrs - 1% of population– could start as manic or depressive– average duration of an episode: 2-3 months– Onset is gradual - 5 - 15% will be rapid cyclers


Comorbidity

– 40% of alcohol dependent people are alcohol dependent

– Anxiety disorder and depression is closely linked

– Psychotic features


Epidemiology

incidence/prevalence– difficult to measure as many people do not seek treatment– Approximately 30% seek treatment

gender– women are far more vulnerable to depression– 12% women and 7% males

culture– depression is a universal phenomena – Higher in some cultures (e.g., Aboriginal Canadians)


Epidemiology

Lifespan Risk– most frequent among young and middle-aged

adults– Elderly is hard to diagnose

Cross-Generational Comparisons– People born after WW II more likely to develop a

mood disorder then previous generations


Etiological Considerations

Social Factors– Depression: Stressful life events– Bipolar: goal-attainment events

Psychological factors– Cognitive vulnerability


Etiological Considerations: Cognitive Theory

Beck’s theories:– distortions leading to and sustaining depression– depressive triad (demeaning sense of self, world, others)– negative schema formation– ABCD Model

hopelessness– refers to the person’s negative expectations about future

events and the associated belief that these events cannot be controlled

– depressogenic attributional style


Etiological Considerations: Interpersonal Factors

certain people create difficult circumstances that increase stress

self-critical people elicit criticism and rejection from others

person’s own behaviour causes negative life events


Specific Interpersonal Factors

A) social relationships– negative effects on others’ moods– negative interactions– smaller social networks

B) response styles & gender– ruminative vs. distracting style


Biological Factors: Genetics

family studies twin studies

– heritability of depression: 52% – 80% for bipolar disorder

genetic risk/sensitivity to stress– predisposition to coping ability

mode of transmission & linkage studies– single-gene vs. polygenic– chromosome 18: bipolar


Twin study

DANISH STUDY: Bertelson (1977)

bipolar probands MZ 69 %

DZ 19 %

unipolar probands MZ 54 %

DZ 24 %


Biological Factors: Neurotransmitters

catecholamine hypothesis (not enough norepinephrine)

SSRIs (selective serotonin reuptake inhibitors)– block re-uptake of serotonin– 6-8 weeks for optimal effectiveness– Prozac, Paxil, Zoloft– Side effects are less severe, however, the side effects are weight gain,

headaches, sexual dysfunction


Treatment: Unipolar Disorders

Cognitive Therapy– alter maladaptive schemas

Interpersonal Therapy– focus on relationships

Antidepressant medications– SSRIs– TCAs (dopamine, norepinepherine)– MAOIs


Depression Medications

40-50% improve 20-30 improve partially20-25 do not respond at all


Treatment: Bipolar Disorders

Lithium – 75% success rateanticonvulsant medications – 60%

success ratepsychotherapy


Electroconvulsive Therapy (ECT)

severe cases/last resort Unilateral vs. bilateral 2-3 sessions per week, 6-8 session overall reason for effectiveness not understood ethics of ECT controversial Pervasive and persistant Memory losss


Suicide

15-20% of mood disordered patients commit suicide 50% of completed suicides occur as a result of a

mood disorder Suicide rates among Canadian adolescents have

doubled over the past 30 years Ratio of attempted suicides to completed suicides

are 10:1 More women than men attempt suicide, however,

men are 4x more likely to kill themselves


Suicide: Durkheim’s Classification

egoistic– sense of meaninglessness

altruistic– sacrifice self for the group

anomic– social crisis

fatalistic– traumatic conditions


Treatment of Suicidal Individuals:

crisis centres/hot lines medication involuntary hospitalization psychotherapy

– reduce lethality– negotiate agreements– offer support– expand perspective

Documents

Chapter 5 Mood Disorders and Suicide Copyright © 2006 Pearson Education Canada Inc