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Mood disorders and suicide lecture

Mood disorders and suicide lecture

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  • Mood disorders refer to extreme emotional states of sadness or euphoria
  • A major depressive episode is a lengthy period of sad or empty mood, eating and sleeping problems, concentration difficulties, fatigue, sense of worthlessness, and suicidal thoughts or attempts. While it’s normal to have bad days or sometimes be in a sad mood, a depressive episode involves at least five serious symptoms of depression that last at least two weeks. Major depressive disorder involves at least one, and often several, depressive episodes
  • At the “normal” or symptom-free end of the spectrum, you have a good mood, no particularly sad thoughts, and are able to function fine.
  • At the mild end, we’re talking about a typical bad day or rough week. Might feel a bit sad, think about the negative, and have maybe less appetite or some difficulty sleeping
  • More moderate level of symptoms there might be more pervasive feelings of sadness, some pessimism, and maybe having a little trouble functioning adequately.
  • Once you merit a diagnosis of major depressive disorder, the episode includes more intense sadness every day, frequent crying, and often a feeling of “emptiness” or lack of interest in usual activities. May have the occasional thought about harming oneself, but don’t really intend to commit suicide.
  • At more severe levels you have more intense sadness, but also you see much more serious suicidal ideation. Also may at this level see someone stop getting out of bed altogether.
  • Click on link to see a one-minute video of a woman describing what a depressive episode is like for her.
  • Dysthymic disorder is a chronic feeling of depression for at least 2 years. Usually less severe than major depression, but also don’t see them ever really getting to normal levels.
  • A manic episode is a period of uncontrollable euphoria and potentially self-destructive behavior. People tend to feel GREAT, think and talk really fast, don’t need to sleep. BUT they can also get to the point where they stop making any sense when they talk, they have really inflated grandiose ideas. I have seen in my personal life, people in a manic episode take off on road trips with no planning, in one case she thought she was being pursued by aliens and took off across the country. A mixed episode involves symptoms of mania and depression for at least 1 week. Hypomanic episodes are similar to manic episodes but with less impaired functioning. You really don’t want mania, because it can be so destructive, but many people who only experience hypomania really see it as a positive thing.
  • Bipolar I disorder involves one or more manic or mixed episodes. You will see usually a longer depressive episode, which gradually gets better, passes through a normal period of functioning, the escalates into mania, before the person comes crashing back down into depression. Usually the depressive episodes will last about 2-3 months, then the manic episode will last anywhere from a week to a month. Once in a while you will have someone who is “rapid cycling”, where the mood fluctuations will occur faster than that, but that’s rare. When you meet someone who experiences rapid mood swings on a daily basis, chances are they do NOT have bipolar disorder. They may have depression, which can often have some periods of elevated mood interspersed with their typically low mood, or they may have a completely different problem like a personality disorder.
  • Bipolar II disorder refers to hypomanic episodes that alternate with major depressive episodes. So, the depressive episodes look the same as in Bipolar I, but the mania is not so extreme.
  • Cyclothymic disorder refers to symptoms of hypomania and depression that fluctuate over a long time. Depression is milder, mania is milder, and it lasts at least two years.
  • Suicide is commonly seen in people with mood disorders, especially among men, European Americans, nonmarried people, and the elderly. Suicidality can be viewed along a spectrum ranging from thoughts of suicide to completion of suicide. Important to keep in mind that thinking about death, fantasizing about being dead is on this spectrum, but at the mild end. Will talk in a few slides about how to assess for risk for actual suicide attempts.
  • Mood disorders are common in the general population and often occur with anxiety, personality, eating, and substance use disorders. Depression has been called the “common cold” of psychological problems. That’s a bit of an exaggeration, but with 1 in 5 people experiencing clinical depression at some point in their lives, it’s pretty common.
  • Across the lifespan, you’ll see males at higher risk for suicide than females. Females have higher rates of suicide attempts, but males have higher rates of completed suicides. This is attributed to males are more likely to choose a method of suicide that has higher lethality– like using a gun, while a female is more likely to try to overdose on pills. Also note, the age at highest risk for completed suicide is later in life. There is much more awareness these days that while teenagers have the highest rates of suicide attempts, the elderly have the highest rates of suicide completion. Think about it– why do you think older adults are at higher risk for suicide?
  • Biological risk factors for mood disorders include genetics, neurochemical and hormonal differences, sleep deficiencies, and brain changes. In particular, bipolar disorder seems to have a high genetic loading, such that if someone in your family has bipolar disorder you are at higher risk for both bipolar and major depressive disorder.
  • Evidence indicates that mood disorders result from a combination of (1) early biological factors and (2) environmental factors related to ability to cope, think rationally, and develop competent social and academic skills. These environmental factors could include have disengaged parents, high levels of family conflict, and cognitive factors such as developing a sense of general helplessness and hopelessness. Having a parent with depression puts a child at dual risk: not only do you get the genetics, but a depressed parent tends to be disengaged from the child, which is an additional risk factor for depression.
  • Preventing mood disorders involves building one’s ability to control situations that might lead to depression. This may involve helping people learn to manage stress, change unrealistic thoughts, solve problems, and enhance their social support. For example, the Resource Adolescent Program-Adolescents (RAP-A) involves an 11-step group approach, shown here.
  • Assessing people with mood disorders often includes structured and unstructured interviews and self-report questionnaires. Observations and information from therapists, spouses, partners, children, parents, and others are also important for assessing mood disorders.
  • Assessing risk of suicide is critical in mood disorders and often focuses on detail of suicide plan, access to weapons, and support from others. What do you do if you are concerned about someone you know? ASK if they are thinking about killing themselves. Not going to increase their risk, and may reduce it. Primarily, you’re looking for whether they have a plan, if that plan is realistic, and if they have any good reason not to kill themselves.
  • Biological treatment of mood disorders includes selective serotonin reuptake inhibitors (SSRIs), tricyclics, monoamine oxidase inhibitors (MAOIs), and mood-stabilizing drugs. Electroconvulsive therapy (ECT) involves deliberately inducing a brain seizure to improve very severe depression. Repetitive transcranial magnetic stimulation (rTMS) involves placing an electromagnetic coil on a person’s scalp and introducing a current to relieve mood disorder symptoms. Light therapy is often used for people with seasonal affective disorder.
  • Psychological treatment of mood disorders includes behavioral approaches to increase activity. Often called “follow your feet”, just getting up and starting to do things even though they aren’t fun, can make a person start to feel better. Cognitive therapy is also a main staple for mood disorders and may be linked to mindfulness. Interpersonal and marital and family therapists concentrate on improving a person’s relationships with others to alleviate symptoms of mood disorders.
  • Transcript

    • 1. Features and Epidemiology Causes and Prevention Assessment and Treatment
    • 2. Features and Epidemiology Causes and Prevention Assessment and Treatment
    • 3. Features and Epidemiology Causes and Prevention Assessment and Treatment Emotions Cognitions Behaviors Cycle of Major Depressive Disorder Normal Good mood. Thoughts about what one has to do that day. Thoughts about how to plan and organize the day. Rising from bed, getting ready for the day, and going to school or work.
    • 4. Features and Epidemiology Causes and Prevention Assessment and Treatment Emotions Cognitions Behaviors Cycle of Major Depressive Disorder Feeling upset and sad, perhaps becoming a bit teary-eyed. Dwelling on the negative aspects of the day, such as a couple of mistakes on a test or a cold shoulder from a coworker. Coming home to slump into bed without eating dinner. Tossing and turning in bed, unable to sleep. Some difficulty concentrating. Normal Mild
    • 5. Features and Epidemiology Causes and Prevention Assessment and Treatment Emotions Cognitions Behaviors Cycle of Major Depressive Disorder Mild discomfort about the day, feeling a bit irritable or down. Thoughts about the difficult of the day. Concern that something will go wrong. Taking a little longer than usual to rise from bed. Slightly less concentration at school or work. Normal Mild Moderate
    • 6. Features and Epidemiology Causes and Prevention Assessment and Treatment Emotions Cognitions Behaviors Cycle of Major Depressive Disorder Intense sadness and frequent crying. Daily feelings of “heaviness” and emptiness. Thoughts about one’s personal deficiencies, strong pessimism about the future, and thoughts about harming oneself (with little intent to do so). Inability to rise from bed many days, skipping classes at school, and withdrawing from contact with others. Normal Mild Moderate Depression – Less Severe
    • 7. Features and Epidemiology Causes and Prevention Assessment and Treatment Emotions Cognitions Behaviors Cycle of Major Depressive Disorder Extreme sadness, very frequent crying, and feelings of emptiness and loss. Strong sense of hopelessness. Thoughts about suicide, funerals, and instructions to others in case of one’s death. Strong intent to harm oneself. Complete inability to interact with others or even leave the house. Great changes in appetite and weight. Suicide attempt or completion. Normal Mild Moderate Depression – Less Severe Depression – More Severe
    • 8.
      • Click below to see a one-minute video
      • depressive episode
      Features and Epidemiology Causes and Prevention Assessment and Treatment
    • 9. Features and Epidemiology Causes and Prevention Assessment and Treatment Manic Normal Depressive Cycle of Major Depressive Disorder
    • 10. Features and Epidemiology Causes and Prevention Assessment and Treatment
      • Symptoms of a Manic Episode
        • Inflated self-esteem or grandiosity
        • Decreased need for sleep, such as feeling rested after only 3 hours of sleep
        • More talkative than usual or pressure to keep talking
        • Subjective experience that one’s thoughts are racing,
        • or flight of ideas
        • Distractibility
    • 11. Mania in video
      • Click below for two one-minute videos:
        • mania-grandiosity
        • mania-inappropriate affect
      • If you’re interested, a one-minute video of the same individual in the midst of a depressive episode:
        • bipolar-depressive episode
    • 12. Features and Epidemiology Causes and Prevention Assessment and Treatment Manic Normal Depressive
    • 13. Features and Epidemiology Causes and Prevention Assessment and Treatment Manic Normal Depressive
    • 14. Features and Epidemiology Causes and Prevention Assessment and Treatment Manic Normal Depressive
    • 15. Features and Epidemiology Causes and Prevention Assessment and Treatment Will to live Feeling thoughts of death Suicidal ideation Planning suicidal acts Suicide attempt Suicide completion
    • 16. Features and Epidemiology Causes and Prevention Assessment and Treatment Note: These numbers reflect the fact that some people have more than one mood disorder. Disorder 0 Any mood disorder Major depressive disorder Dysthymia Bipolar I and II disorders 20.8 9.5 16.6 6.7 2.5 1.5 3.9 2.6 Lifetime prevalence rate (%) 12-month prevalence rate (%) 5 10 15 20 25 Percentage
    • 17. Features and Epidemiology Causes and Prevention Assessment and Treatment 0 5 10 15 20 25 Prevalence 5-14 15-24 25-44 45-64 Male Female Age at death in years 30 35 1.2 0.3 17.1 3.0 31.1 4.0 21.3 6.2 65+ 21.3 5.4
    • 18. Features and Epidemiology Causes and Prevention Assessment and Treatment Amygdala Anterior cingulate cortex Prefrontal cortex Caudate nucleus, putamen Basal gangalia Hippocampus Pons
    • 19. Features and Epidemiology Causes and Prevention Assessment and Treatment Features and Epidemiology Assessment and Treatment Biological vulnerabilities/early predispositions: Genetic contributions, neurochemical and hormonal changes, brain changes Early family problems: Poor attachment, disengaged parents, expressed emotion, modeling of parental depression Stressful life events: Family conflict, alienation from others, academic and other challenges Cognitive-stress and behavioral vulnerabilities: Sense of learned helplessness and hopelessness, intense negative emotions and arousal, escape-oriented behavior, lack of social support Possible mood disorder
    • 20. Features and Epidemiology Causes and Prevention Assessment and Treatment Features and Epidemiology Assessment and Treatment
      • RAP-A teaches adolescents to:
        • Declare existing strengths
        • Manage stress
        • Modify negative and irrational thoughts
        • Solve problems efficiently
        • Develop and use social support networks
        • Enhance social skill and recognize other perspectives
    • 21. Features and Epidemiology Causes and Prevention Assessment and Treatment Features and Epidemiology Assessment and Treatment Hamilton Rating Scale for Depression
    • 22. Features and Epidemiology Causes and Prevention Assessment and Treatment Features and Epidemiology Assessment and Treatment Assess sociodemographic risk factors
      • Elderly
      • Unmarried
      • White
      • Male
      • Living alone
      How are things going in your marriage, in your family, at home, at work?” (Cover health, financial, marital, family, legal, and occupational factors)
      • “ Have you experienced sad, blue, or empty feelings and at least two of the following in the past two weeks?”
        • Trouble falling or staying asleep
        • Feeling tired or having little energy
        • Poor appetite or overeating
        • Little interest or pleasure in doing things
        • Feeling bad about yourself
        • Trouble concentrating
        • Feeling fidgety, restless, or unable to sit still
      • “ Have you felt nervous, anxious, or on edge?”
      • “ Have you had anxiety or panic attacks recently?”
      Ask about stressors Screen for depression and associated anxiety or agitation “ Have you ever felt you should cut down on your drinking?” “ Have people annoyed you by criticizing your drinking?” “ Have you ever felt bad or guilty about your drinking?” “ Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?” Yes to two or more means probable alcohol abuse. Screen for alcohol abuse
      • “ Have you had thoughts about death, or about killing yourself?” If yes, ask:
        • “ Do you have a plan for how you would do this?”
        • “ Are there means available (e.g., a gun and bullets or poison)?”
        • “ Have you actually rehearsed or practiced how you would kill yourself?”
        • “ Do you tend to be impulsive?”
        • “ How strong is your intent to do this?”
        • “ Can you resist the impulse to do this?”
        • “ Have you heard voices telling you to hurt or kill yourself?”
      • Ask about previous attempts, especially the
      • degree of intent.
      • Ask about suicide of family members.
      Assess risk of suicide
    • 23.
      • Medication:
        • Selective serotonin reuptake inhibitors (SSRIs)
        • Tricyclics
        • Mood stabilizers
      • Electroconvulsive therapy
      • Transcranial magnetic stimulation
      Features and Epidemiology Causes and Prevention Assessment and Treatment Features and Epidemiology Assessment and Treatment
    • 24. Features and Epidemiology Causes and Prevention Assessment and Treatment Features and Epidemiology Assessment and Treatment

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