2621 mood disorders and suicide moods –enduring states of feeling that color our psychological...
TRANSCRIPT
2621 Mood Disorders and Suicide• Moods
– Enduring states of feeling that color our psychological lives.
• Mood disorders– Are disturbances in mood that impair
functioning.
Major Depression
• Must exhibit 5 or more features and one of the features must be either depressed mood/loss of interest for most of the day.
• Major depressive disorder is based on the occurrence of one or more major depressive episodes in the absence of manic or hypomanic episodes.
Other features
• Significant weight gain or loss• insomnia/hypersomnia• agitation/slowed movement• fatigue/loss of energy• sense of worthlessness/guilt• decreased concentration• suicidal thoughts
• Affects 1 in 5 adults (17%) in the U.S. at some point in their life.
• The “common cold” of psychological problems.
Risk factors
• Age (younger more likely to develop than older)
• SES• marital status• gender (women more likely than
men)
Cont. risk factors
• sociocultural (Af-A less likely to be depressed than whites/hispanics)– multinational study shows that rates of
depression are rising. Lowest rates of depression in Taiwan; highest rates in Beirut.
– Increases in depression may be due to increasing urbanization and fragmentation of the family, exposure to war and increased incidence of violence.
• Reactive depression – Depression linked to negative events while
• Endogenous depression is born from within
• To distinguish between reactive/ endogenous, endogenous exhibits more physical symptoms (weight loss, insomnia) while reactive exhibits less physical symptoms.
Seasonal Affective Disorder• Features
– fatigue– excessive sleep– craving for carbohydrates– weight gain
• Affects women more than men
Cont. SAD features
• Most common among young adults though half of those with SAD report episodes beginning in childhood or adolescence.
• Treatment involves exposure to 2 to 3 hours of artificial light (phototherapy)
Postpartum Depression
• Postpartum blues– occurs fairly frequently and lasts a couple of
days. (normal)
• Postpartum Depression– may persist for months or even a year or more.
• Features– disturbance in appetite/sleep– low self-esteem– difficulty concentrating
Dysthymic Disorder
• Milder but chronic• Affects about 3% of the adult
population at some point in their life.• It is more common in women than in
men• A person may experience Major
Depression along with dysthymia: Double Depression.
Features
• Pessimism• self-pity• inactivity• feelings of inadequacy• low self-esteem
Bipolar Disorder
• Mood swings between mania/depression
• First episode may be either mania or depression
• Mania may last from a few weeks to several months but are shorter in duration and end more abruptly
Cont. bipolar
• Bipolar I (Mixed type): one or more manic episodes
• Bipolar II: one or more depressive episode and one hypomania (a milder form of mania) episode but never a full blown manic episode.
• Relatively uncommon affecting .4% to 1.6% for bipolar d/o and .5% for bipolar II d/o
• Affects men and women at the same rate.
Features of mania
• Sudden elevation of mood• unusually cheerful• boundless energy• pressured speech • distractible • rapid flight of ideas• inflated sense of self• show poor judgment• become argumentative
Cyclothymic Disorder
• Means Circle/spirit• individual experiences mild mood
swings for at least 2 years• hypomania is a period of elevated
mood; not as severe as manic episode
• depressed mood is not as severe as Major Depression.
Theoretical Perspectives
• Stress and Mood d/o– stressors such as
• loss of loved one• unemployment• physical illness• marital discord• poverty• pressure at work • prejudice/discrimination have been contributed to
depression
– Relationship between stress/depression may be moderated by coping styles/social support.
Psychodynamic
• Depression represents anger directed inward rather than against others.
• In bereavement where there is ambivalent feelings, this can create rage/guilt. To preserve the lost object, people introject (bring inward) their mental representations of the other person into themselves. This causes the rage/guilt to turn inward resulting in depression.
Cont. Psychodynamic
• For bipolar d/o, there is a shifting dominance over the personality by ego/superego: in depression, superego is dominant producing exaggerated notions of guilt/wrong. After a time, ego rebounds/asserts supremacy, produces feelings of elation/self-confidence = manic.
Humanistic/Existential
• Depression = no meaning• Lose self-esteem when lose
friends/family
Learning
• Focus on situational factors such as the loss of positive reinforcement.
• Depression equals too little reinforcement from environment.
• Then less activity deplete opportunity/less reinforcement encourages withdrawal. Depression may also become a reinforcer.
Cognitive
• Beck’s cognitive triad equals negative beliefs about self, environment, future.
• Typical cognitive distortions:– all or nothing – emotional reasoning– overgeneralization – should statement– mental filter – labeling/mislabeling– disqualifying the positive – personalization– jumping to conclusions– magnification/minimization
Cognitive-specificity hypothesis• Depressive thoughts center on
loss, self-depreciation, pessimism.• Anxiety centers on physical
danger, threats.
Learned Helplessness
• A combination of behavioral/cognitive: situational factors foster attitudes that lead to depression. Shock dogs/attributional style– internal/external– global/specific– stable/unstable
Biological
• Genetic – Stronger for bipolar than unipolar– Uncertain what is inherited.
• Biochemical– Neurotransmitters involved
• deficiencies in norepinephrine = depression• excess in norepinephrine = mania• serotonine, acetylcholine deficiencies• thyroid hormones
Treatment
• Psychodynamic– Helps people understand their
ambivalent feelings toward the lost object.
Cont. Treatment
• Humanistic/Existential– Become aware of authentic feelings– need self-actualization– living according to one’s own
values/choices
Cont. Treatment
• Behavioral– Depression is learned/ therefore
unlearn it.
• Cognitive– Identify distorted, self-defeating
thoughts/substitute more rational thoughts.
Cont. Treatment
• Biological– antidepressants– tricyclics– monoamine oxidase inhibitors (MAO
inhibitors)– serotonin-reuptake inhibitors (SSRI)
Side Effects of tricyclics, MAO Inhibitors• Dry mouth• constipation,• blurred vision• confusion• delirium
Side Effects of Serotonin
• Upset stomach• headaches• agitation• insomnia• sexual problems
Lithium side-effects
• Potential toxic effects• impair memory• slow people down
Electro-convulsive therapy
• Used to treat major depression when antidepressants don’t work.
• Don’t know why it works.• Controversy over memory loss as
side effect.
Suicide
• Who?– More Whites than Af-A– More women attempt; more men
succeed– Elderly more likely than teens.
Cont. suicide
• Why?– People think there is a narrow range
of options available. Connected to stress.
Cont. Suicide
• Theoretical– Psychodynamic
• anger turned murderous or motivated by death instinct- a tendency to return to tension-free state before birth.
– Humanistic/existentials• Suicide is a perception that life is
meaningless/ hopeless.
– Sociocultural: alienation in today’s society
Cont. Suicide
• Learning– Reinforcement of previous attempts/
effects of stress
• Cognitive: positive outcome expectancies
• Social-learning - modeling• Biological - genetic
Predicting Suicide
• Hopelessness• Sudden sorting of affairs• Sudden peace/calm interpreted as
hope.