Mood disorders & suicideAxis I (mood disorders): requires presence (or absence) of mood episodes such as 1. Major depressive episode: has at least 5 of the following symptoms- depressed mood, anhedonia, appetite/weight change, sleep issue, psychomotor changes, energy loss, inappropriate guilt/worthlessness, concentration problems, suicidality 2. Manic episode: distinct period of elevated or irritable mood, plus at least 3 of the following symptoms- inflated self-esteem, decreased sleep, more talkative, flight of ideas, distractibility, increase goal directed activity, excessive pleasurable activity3. Hypomanic episode: distinct period of elevated mood or irritability for at least 4 days, plus at least 3 of the following- inflated self-esteem, decreased sleep, more talkative, flight of ideas, distractibility, increase goal directed activity, excessive pleasurable activity• Unipolar:o Major depression: Major depressive disorder: presence of major depressive episode, not better accounted for by other disorder, and no history of manic/mixed/hypomanic episodeo Dysthymia: Less severe/more chronic At least 2 of the following for at least 2 years: appetite problem, sleep problem, low energy/self-esteem, poor concentration, feeling of hopelessness • Depression facts:o 16% lifetime prevalence, long lasting/recurrent, 2 X more common in woman than meno Ages 15-29 depression peaks, then declines, and then peaks again at age 85o Lowest rates in people around 60 due to difficulties in diagnoses and adaptive coping skillso Biological theories of depression: Genetic link- difference in serotonin transporter gene Problem with production/regulation of serotonin & norepinephrine (decreased synthesis, abnormalities in transport, impaired release/reuptake, receptor abnormalities) Brain abnormalities in prefrontal cortex, anterior cingulate, hippocampus, or amygdala Neuroendocrine factors (HPA)o Psychological theories of depression: Behavioral: stress reduces positive reinforcement, learned helplessness (belief of no control) Cognitive: Negative Cognitive Triad by Beck (negative thinking about self, world, & future) & Reformulated Learned Helplessness Theory (causal attribution error- negative event is stable, internal, & global)o Interpersonal theories of depression: Rejection sensitivity: easily perceive rejection by others Excessive reassurance seeking from others that they are accepted/lovedo Biological treatments for depression: MAOI’s drug: can be fatal if slight OD or mix, can cause liver damage Tricyclic antidepressant drug: many side effects, can be fatal if slight OD SSRI (selective serotonin reuptake inhibitor): most common, quick relief, less severe side effects/dangers SSNRI (selective serotonin & norepinephrine reuptake inhibitor): similar to SSRI but more stimulant effect ECT (electroconvulsive therapy): for patients that don’t respond to meds, effective but 85% relapse rate VNS (vagus nerve stimulation): 30/40% relief rTMS (repetitive transcranial magnetic stimulation): few side effects, patients remain awakeo Psychological treatment for depression: Cognitive behavioral therapy: change negative thinking/increase positive reinforcement Interpersonal therapy: identify & address 1-4 interpersonal sources of depression• Bipolar Disorder: o Bipolar I Disorder: full manic episode, and possible major depressive/hypomanic episodes .4-1.6% lifetime prevalence o Bipolar II Disorder: major depressive episode, hypomanic episode, no manic episode .5% lifetime prevalence o Cyclothymic disorder: less severe, more chronic form (at least 2 years), cycles between hypomanic and moderate depressive episodes• Biological theories of bipolar disorder: o Genetic factorso Brain abnormalities in prefrontal cortex, striatum, and structure/function of amygdalao Neurotransmitter dopamine• Psychosocial theories of bipolar disorder:o Greater sensitivity to rewardo Stressful life events (may be trigger for new episodes)o Changes in bodily rhythms/unusual routines• Biological treatment for bipolar disorder:o Mood stabilizers: Lithiumo Anticonvulsants o Atypical antipsychotics o Treated as chronic condition: patients remain on medication throughout life • Psychological treatment for bipolar disorder: o Interpersonal & social rhythm therapy: combine interpersonal & behavioral techniques to help maintain routine o Family-focused therapy: focus on interpersonal stress (within context of family)o Cognitive behavior therapy: address problematic cognitions to reduce vulnerability to depression/maniaSuicidal behavior:• Based on 2 dimensions: outcome vs. intent• 1,000,000 lives are lost to suicide each year (33,000 Americans)• Males are 4 times more likely to die from attempted suicide, but females are 3 times more likely to attempt suicide• Suicide is most common in white men• Common myths: suicide is by “whim”, people wanting to commit suicide can’t be stopped, it is cry for help (empathy helps) • Difficult to study/understand cause of suicide because it is rare, relies on family for information, and most don’t leave note• Durkheim’s theory: 3 types of suicide- egoistic (related to alienation), anomic (disorientation due to major change), or altruistic (belief that world is better without them)• Risk factors: hopelessness, impulsivity, elderly, male, social isolation, family history of suicide, divorce, aggression, etc.• Perspectives on suicide: o Mental disorder: depression, bipolar, substance abuse, etc.o Impulsivity: impulsive tendencieso Cognitive theories: hopelessnesso Biological theories: genetics or neurotransmitterso Interpersonal: mix between thwarted belongingness, perceived burdensome, and capability for suicide• Treatment: o Decrease burdensome and increase belongingness through interpersonal coping skills, challenging distorted beliefs, activities that foster connectedness/feeling of self-efficiencyo Crisis intervention: hospitalization, suicide hotlines, medicationo Dialectical behavior therapy: focus on increasing problem solving skills• Could assessing suicide risk be dangerous? – Gould et al (no, not dangerous)• Social issues: gun control is most common method of controlling suicide • How to help: be aware, direct, supportive, non-judgemental, proactive, and get helpSubstance use & disorders:• Substance: any natural or synthesized product that has psychoactive effects (changes
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