Lecture 9 Current Lecture Chapter 5: Mood DisordersI. Clinical Descriptions and Epidemiology of Mood DisordersII. Etiology of Mood DisordersIII. Treatment of Mood DisordersIV. SuicideEtiology 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 depressionEtiology 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 theorieso 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 wayso Attributional Style Stable and Global attributions can cause hopelessnessEtiology of Mood Disorders: Psychological Factors Cognitive theories• Rumination Theory A specific way of thinking: tendency to repetitively dwell on sad thoughts (Nolen-Hoeksema, 1991)Psych 380 1st EditionMost detrimental is to brood over causes of eventsSocial 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• PsychotherapyCognitive Behavioral therapyInterpersonal therapy• Biomedical (tricyclics, SSRI)• CombinationsCognitive therapy Second Wave Psychological Treatment of Mood DisordersAssumptions 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 thoughtsMindfulness-based cognitive therapy (MBCT) Psychological Treatment of Mood DisordersAssumptions You are NOT your thoughts So, stop taking them so seriously Short-term Strategies, including meditation, to prevent relapse Witnessing Thought surfingTreatment of Mood Disorders Psychological treatment of bipolar disorder• Psychoeducational approachesProvide 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 worksPharmacological treatments for depression Assumption: Problem is due to neurochemical imbalance, solution is restore balanceBiological 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 settings3671 patients across 41 sitesOnly 33% achieved full symptom relief with citalopram (the SSRI Celexa)About 30% of non-responders achieved remission with a different anti-depressantResearch 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 relapseMedications for Bipolar Disorder Lithium• Up to 80% receive at least some relief with this mood stabilizer• Potentially serious side effectLithium toxicity Newer mood stabilizers• Anticonvulsants Depakote• AntipsychoticsZyprexa• Both also have serious side effectsModels 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 satisfactionPreventing 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
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