chapter 7
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Chapter 7. Mood Disorders & Suicide. Unipolar Depression Symptoms. Anhedonia Psychomotor retardation/agitation In severe cases Hallucinations Delusions Major depression — acute Dysthymic disorder — chronic. Subtypes of Depression. Depression with Melancholic Features - PowerPoint PPT PresentationTRANSCRIPT
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Unipolar Depression Symptoms
Anhedonia Psychomotor retardation/agitation In severe cases
Hallucinations Delusions
Major depression—acute Dysthymic disorder—chronic
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Subtypes of Depression
Depression with Melancholic Features Depression with Psychotic Features Depression with Catatonic Features Depression with Atypical Features Depression with Postpartum Onset Depression with Seasonal Pattern (SAD)
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Symptoms of Depression Cognitive Poor concentration,
indecisiveness, poor self-esteem, hopelessness, suicidal thoughts, delusions
Physiological and Behavioral
Sleep or appetite disturbances, psychomotor problems, catatonia, fatigue, loss of memory
Emotional Sadness, depressed mood, anhedonia (loss of interest or pleasure in usual activities), irritability
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Major Depression
Dysthymic Disorder
Five or more symptoms including sadness or loss of interest or pleasure
Three or more symptoms including depressed mood
At least 2 weeks in duration
At least 2 years in duration
Num
ber
of
sym
ptom
sD
urat
ion
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Prevalence and Prognosis
Among adults, 18- to 29-year-olds are most likely to have had a major depressive episode in the past year.
Women are twice as likely to experience depressive symptoms as men.
Depression rates vary from 3% in Japan to 16% in the United States.
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Bipolar Disorder
Mania combined with depression Bipolar I
Elevated, expansive or irritable mood >1 week Three additional symptoms
Bipolar II Severe depression, but mild mania (hypomania)
that does not involve hallucinations, delusions, or interfere with daily functioning
Cyclothymic Less severe but more chronic bipolar condition
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Biologic Theories of Depression
Genetic Theory Genes predispose people to depression
Neurotransmitter Theories Dysregulation of neurotransmitters and their
receptors Brain Abnormalities
Altered brain-wave activities affect mood Neuroendocrine Factors
Hormonal dysregulation
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Psychological Theories of Depression Behavioral Theories
Lewinsohn’s theory Learned helplessness theory
Cognitive Theories Aaron Beck’s negative cognitive triad Reformulated learned helplessness theory Ruminative response style
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Psychological Theories of Depression, cont. Interpersonal Theories
Rejection sensitivity Excessive reassurance seeking
Sociocultural Theories Cohort effects Gender differences Ethnicity/race differences Cross-cultural differences
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Theories of Bipolar Disorders
Genetic Factors- strong linkage Brain Abnormalities Neurotransmitter Factors
Dysregulation of the dopamine system Psychological Contributors
Greater sensitivity to rewards Increased stress Disruptions in routines
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Drug therapy Tricyclics, monoamine oxidase inhibitors, mood
stabilizers, selective serotonin reuptake inhibitors –SSRI, selective serotonin-norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitor, anticonvulksant and atypical anticonvulsants
Electroconvulsive therapy (ECT) Repetitive transcranial magnetic stimulation
(rTMS) Vagus nerve stimulation Deep brain stimulation Light therapy for SAD
Biological Treatments
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Psychological Treatments for Mood Disorders
Behavior Therapy Increase positive reinforcers and decrease aversive events by
teaching the person new skills for managing interpersonal situations and the environment
Cognitive-Behavioral Therapy Challenge distorted thinking and help the person learn more
adaptive ways of thinking and new behavioral skills Interpersonal Therapy
Examines the interpersonal relationships Interpersonal & Social Rhythm Therapy (ISRT)
Enhanced interpersonal therapy for bipolar disorder Family Focused Therapy
Reduces the interpersonal stress for bipolar disorder
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Comparison of Treatments
Different therapies generally appear to be equally effective for the treatment of most people with depression
Combination of psychotherapy and drug therapy may be more effective than either type alone
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Suicide
“Death from injury, poisoning, or suffocation where there is evidence (either explicit or implicit) that the injury was self-inflicted and that the decedent intended to kill himself/herself.” Centers for Disease Control and Prevention (CDC)
Among the three leading causes of death worldwide among people 15 to 44 years of age. (World Health Organization [WHO], 2008)
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Gender Differences
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National Differences
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Understanding Suicide
Durkheim’s theory Egoistic suicide is committed by people who feel
alienated from others Anomic suicide is committed by those who
experience severe disorientation from society Altruistic suicide is committed by people who
believe that taking their own life will benefit society in some way.
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Psychological Disorders & Suicide
Over 90% of people who commit suicide have probably been suffering from a diagnosable mental disorder
Depression increases the odds of a suicide attempt by approximately 6 times and bipolar disorder increases the odds of a suicide attempt by 7 times
Best predictor of suicidal thought and behavior is past suicidal thought and behavior. Among adolescents, a history of a previous suicide attempt increases the odds of suicide by 30 times among boys and 3 times among girls
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Personality, Cognitive & Biological Factors Personality characteristic that seems best to predict
suicide is impulsivity Cognitive variable that most consistently predicts
suicide is hopelessness Children of parents who had attempted suicide were
6 times more likely to also attempt suicide than the children of parents who had a mood disorder but had not attempted suicide
Low serotonin levels are linked with suicidality even among people who are not depressed
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Treatment & Prevention
Community-based prevention– Crisis intervention programs, suicide hotlines
Drug treatments– Lithium, selective serotonin reuptake inhibitors
Psychological treatments– Dialectical behavior therapy, psychotherapy