Psych 380 1st Edition Lecture 9 Current Lecture Chapter 5 Mood Disorders I Clinical Descriptions and Epidemiology of Mood Disorders II Etiology of Mood Disorders III Treatment of Mood Disorders IV Suicide Etiology of Mood Disorders Social Factors Lack of social support may be one reason a stressor triggers depression Interpersonal Difficulties High levels of expressed emotion by family member predicts relapse Marital conflict also predicts depression Etiology of Mood Disorders Psychosocial Factors Behavior of depressed people often leads to rejection by others Excessive reassurance seeking Few positive facial expressions Negative self disclosures Slow speech and long silences Neuroticism frequent mood swings easily bothered by things worry excessively Tendency to react with higher levels of negative affect Predicts onset of depression Jorm et al 2000 Etiology Mood disorders Cognitive theories o Beck s Theory Negative triad negative view of self world future Negative schema underlying tendency to see the world negatively Negative schema cause cognitive biases tendency to process information in negative ways o Attributional Style Stable and Global attributions can cause hopelessness Etiology of Mood Disorders Psychological Factors Cognitive theories Rumination Theory A specific way of thinking tendency to repetitively dwell on sad thoughts Nolen Hoeksema 1991 Most detrimental is to brood over causes of events Social and Psychological Factors in Bipolar Disorder Triggers of depressive episodes in bipolar disorder appear similar to the triggers of major depressive episodes Negative life events neuroticism negative cognitions expressed emotion and lack of social support Predictors of Mania Reward sensitivity Sleep disruption Mood disorders Treatment Psychotherapy Cognitive Behavioral therapy Interpersonal therapy Biomedical tricyclics SSRI Combinations Cognitive therapy Second Wave Psychological Treatment of Mood Disorders Assumptions Much of who you are is determined by your thoughts Your feelings and your experience are shaped by your thinking To change your feelings and your experience change your thinking As applied to depression Problem is maladaptive thoughts Monitor and identify automatic thoughts Replace negative thoughts with more neutral or positive thoughts Mindfulness based cognitive therapy MBCT Psychological Treatment of Mood Disorders Assumptions You are NOT your thoughts So stop taking them so seriously Short term Strategies including meditation to prevent relapse Witnessing Thought surfing Treatment of Mood Disorders Psychological treatment of bipolar disorder Psychoeducational approaches Provide information about symptoms course triggers and treatments next slide Family focused treatment FFT Educate family about disorder enhance family communication improve problem solving Electroconvulsive therapy ECT Treatment of Mood Disorders Reserved for treatment non responders Induce brain seizure and momentary unconsciousness Unilateral EC Uses series of brief high voltage electrical pulses about 60 to 70 pulses second for three to five seconds Seizures last 20 to 50 seconds Side effects Memory loss ECT more effective than medications Unclear how ECT works Pharmacological treatments for depression Assumption Problem is due to neurochemical imbalance solution is restore balance Biological Treatment of Mood Disorders Published studies may overestimate the effectiveness of medication Turner et al 2008 STAR D Rush et al 2006 Attempted to evaluate effectiveness of antidepressants in real world settings 3671 patients across 41 sites Only 33 achieved full symptom relief with citalopram the SSRI Celexa About 30 of non responders achieved remission with a different antidepressant Research Comparing Treatments for Major Depressive Disorder Combining psychotherapy and antidepressant medications increase odds of recovery over either alone by 10 20 Medications quicker therapy longer lasting effects Later studies Hollon DeRubeis 2003 CT as effective as medication for severe depression CT more effective than medication at preventing relapse Medications for Bipolar Disorder Lithium Up to 80 receive at least some relief with this mood stabilizer Potentially serious side effect Lithium toxicity Newer mood stabilizers Anticonvulsants Depakote Antipsychotics Zyprexa Both also have serious side effects Models of Suicide Psychological Disorders Half of suicide attempts are depressed Neurobiological Models Heritability of 48 for suicide attempts Low levels of serotonin Overly reactive HPA system Social Factors Economic recessions Media reports of suicide Social isolation and a lack of social belonging Psychological Models Problem solving deficit Hopelessness Life satisfaction Preventing Suicide Talk about suicide openly and matter of factly Most people are ambivalent about their suicidal intentions Treat the associated mental disorder Treat suicide directly Suicide prevention centers