Psych 2510 – Trull Chapter 7: Mood Disorders and Suicide What are mood disorders?- Mood disorders involve extreme emotional states of sadness, euphoria (or irritability) Major Depressive Disorder- Major depressive episode: lengthy period of sad or empty mood, eating and sleeping problems, concentration difficulties,fatigue, sense of worthlessness, and suicidal thoughts or attemptso 2 months between episodes to be considered distinct episodes o Can occur with psychotic features - Major depressive disorder: involves several major depressive episodes- Video case study: Evelyn, a patient suffering from major depressive disorder. Dysthymic Disorder- Dysthymic disorder is a chronic feeling of depression for at least 2 years- Persistent depressive disorder- Relief from symptoms < 2 months Manic episode/Hypomanic episode- Symptoms of Manic episodeo Inflated self-esteem or grandiosity o Decreased need for sleep, such as feeling rested after only 3 hours of sleepo More talkative than usual or pressure to keep talkingo Distractibility - A manic episode is a period of uncontrollable euphoria and potentially self-destructive behavior. A mixed episode involvessymptoms of mania and depression for at least 1 week. - Hypomanic episodes are similar to manic episodes but with less impaired functioning. Bipolar Disorder- Hypomanic Episodes and Bipolar II Disordero Same symptoms as mania, but less severeo Does not cause the same level of impairment in daily functioning o Like bursts of energy, but last longer- Bipolar I disorder involves one or more manic or mixed episodes.- Bipolar II disorder refers to hypomanic episodes that alternate with major depressive episodes. - Video: Emilie, a patient suffering from bipolar disorder. Cyclothymic Disorder- Cyclothymic disorder refers to symptoms of hypomania and depression that fluctuate over a long time. - Do not have full-blown episodes of hypomania and depression- Lasts for at least a 2 year periodo Children – usually 1 year period - General symptoms of hypomania and depression cycle back and forthSuicide1Psych 2510 – Trull - Suicide ideationo Thoughts about death, killing oneself, funerals, an other morbid ideas - Suicide behavioro Self-harm or self destructive behavior- Suicide attempto Self-destructive behavior in which someone is trying to kill themselves - Suicide is commonly seen in people with mood disorders, especially among men, European Americans, non-married people, and the elderly.- Suicidality can be viewed along a spectrum ranging from thoughts of suicide to completion of suicide. Epidemiology of Mood Disorders- Mood disorders are common in the general population and often occur with anxiety, personality, eating, and substance use disorders.- An estimated 877,000 lives were lost due to suicide worldwide in 2002, varying in age.Risk Factors for Mood DisordersBiological Risk Factors - Geneticso Huge role with depression and bipolar disorderso Usually combination of multiple genes o Heritability Depression (37-50) and Bipolar (75-80)- Neurotransmitters o Depression: Serotonin norepinephrine, dopamine Motivation level and emotional stateo Bipolar: High norepinephrine, high dopamine - Sleep deficiencies- Hormones - Brain changeso Depression Reduced activity in prefrontal cortex Increased activity in amygdala o Bipolar Increased activity in anterior cingulate (associated with motor activity) Environmental Risk Factors - Stressful and uncontrollable life eventso Severity and meaning are important - Cognitive factors 2Psych 2510 – Trull o Cognitive distortions  Negative thought processes and misattributionso Negative cognitive triad  Feeling bad about self Self critical  Feeling negative about the future o Hopelessness o Helplessness  Learned helplessness theory - Dog shock test – eventually the dogs lay down and gave up - Problematic interpersonal relationshipso Poor social skills o Romantic conflict- Parent and family factors o Expressed emotion Highly critical, conflict, or over-involvement o Help create an unstable living environment for a childCultural and evolutionary factors may also be influentialEvidence indicates that mood disorders result from a combination of:- Early biological factors - Environmental factors related to ability to cope, think rationally, and develop competent social and academic skillsPrevention of Mood Disorders- Targeting (usually secondary prevention) o Coping skills o Social skills o Interpersonal problems o Medical issues o Low self-esteemo Hopelessness - Preventing mood disorders involves building one’s ability to control situations that might lead to depressiono Helping people declare their strengthso Manage stresso Change unrealistic thoughtso Solve problemso Develop friendshipso Reduce conflicto Enhance social skillo Maintain prescribed medication.- Example: the Resource Adolescent Program-Adolescents (RAP-A) involves an 11-step group approachAssessment of Mood DisordersPrimary methods to assess people with mood disorders include: - Interviews o Structured interviewso Unstructured interviews - Self-report questionnaires3Psych 2510 – Trull o Beck Depression inventoryo Automatic Thoughts Questionnaire - Self-monitoringo Mood, events, reactions - Observations and information from therapists, spouses, partners, children, parents, and others - Physiological measuremento Laboratory assessments for mood disorders  Dexamethasone test: people are injected with a corticosteroid to determine whether cortisol levels decline over time or remain highAssessing Suicide- Assess Sociodemographic risk factorso Elderlyo Unmarriedo Whiteo Maleo Living alone - Ask about stressorso How is family, home, work, etc.? - Screen for alcohol and substance abuse- Assess anxiety levels - Assessing risk of suicide o Focuses on detail of suicide plano Access to weaponso Support from otherso Ask about suicide of family members Treatment of Mood DisordersBiological treatment - Medicationso Selective serotonin reuptake inhibitors (SSRIs)o Tricyclicso Monoamine oxidase inhibitors (MAOIs)o Mood-stabilizing drugs Stabilize the highs and the lows  EX: lithium with bipolar disorders - Electroconvulsive therapy (ECT): deliberately inducing a brain seizure to improve very severe depressiono Can be effective – unilateral treatment o “Horror stories” come from bilateral and treating individuals who do not need it - Repetitive transcranial magnetic stimulation (rTMS): placing an