Mood Disorders and Suicide

1. Mood Disorders and Suicide Chapter 6

2. Outline • Mood disorders, depression and mania • Depressive disorders • Bipolar disorders • Causes of mood disorders • Treatment of mood disorders • Suicide

3. Mood disorders, depression and mania • Mood disorders • Group of disorders involving severe and enduring disturbances in emotion (mood) (prevalence in population between 8% and 19%) • Major depressive episode • Extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms (worthlessness, indecisiveness) and physical symptoms (altered sleeping pattern, changes in appetite and weight, loss of energy) • Mania • Episode of joy and euphoria marked by individual’s extreme pleasure in every activity, hyperactivity, little sleep • Hypomania • less severe version of a manic episode that does not cause marked impairment in social or occupational functioning • Dysphoric manic or mixed episode • the individual experiences both elation and depression or anxiety at the same time

4. Mood disorders, depression and mania • Unipolar mood disorder • Individuals experience either depression or mania but not both • Bipolar mood disorder • Individuals alternate between depression and mania

5. Mood disorders • Additional statistics • 32% of children with ADHD also met criteria for major depression • 18% to 20% of nursing home residents may experience major depressive episodes • 20% of a group of famous American poets exhibited bipolar disorders • There seems to be significant overlap between anxiety and depression with respect to causes and occurrence

6. Depressive disorders • Major depressive disorder, single episode • Involves only one major depressive episode in lifetime (very rare – 85% of single episodes are followed by repeated episodes) (12% suicidal attempts) • Major depressive disorder, recurrent Y-Barbara • Involves repeated major depressive episodes separated by a period of at least 2 months during which the individual was not depressed • Dysthymic disorder • the same symptoms as major depressive disorder but presented in milder form, the depressed mood continues for at least 2 years • Double depression • Combination of major depression episodes and dysthymic disorder

7. Depressive disorders • Usual onset is 25 years but is decreasing • Depressive episodes last from 2 weeks up to years • Adult patients with dysthymic disorder are more likely to commit suicide than patients with major depressive disorder • Depression can result from grief • Pathological grief reaction involves psychotic features, suicidal ideation, severe loss of weight or energy that persists more than 2 months • Therapy involves reexperiencing the trauma under supervision and finding meaning in the loss

8. Bipolar disorders • Bipolar I disorder  Y-Mary • Depressive episodes alternate with full manic episodes (17% suicidal attempts) (onset at age 18) • Bipolar II disorder • Depressive episodes alternate with hypomanic episodes (24% suicidal attempts) (onset at age 22) • Cyclothymic disorder • Chronic alternation of mood elevati+on and depression that does not reach the severity of manic or major depressive episodes • Seasonal affective disorder (SAD) • Mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring in the winter (10% in New Hampshire and 2% in Florida)

9. Causes of mood disorders • biological factors • if one twin presents with a mood disorder, an identical twin is approximately three times more likely than a fraternal twin to have a mood disorder (heritability approx. 40% for women) • psychological factors • stressful life events, hopelessness, negative cognitive styles - overgeneralization • social and cultural factors • marital dissatisfaction • 70% of people suffering with major depressive disorder or dysthymia are women

10. Causes of mood disorders

11. Treatment of mood disorders • Medications • Antidepressants (number of side effects) • Monoamine oxidase (MAO) inhibitors (negative interactions with tyramine) • Selective serotonergic reuptake inhibitors (SSRIs) (side effects) • Lithium (weight gain, danger of poisoning) • Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) as an alternative to ECT • Psychosocial treatments • Cognitive therapy • Interpersonal therapy • Combined treatments  V-Bipolar • in depression (medication and psychosocial treatments) • in bipolar disorders (combining medication and family and/or CBT is crucial)

12. Suicide • 8th leading cause of death in the USA (30 000 people a year) for people aged 25-34 • Among teenagers, suicide is the 3rdleading cause of death • The suicide rate for young men in the USA is the highest in the world • Males are four to five times more likely to commit suicide than females • 90% of suicides are committed by people suffering from psychological disorder • 60% are associated with mood disorders • 25%-50% with alcohol use and abuse • 10% borderline personality disorder

13. Suicide • Suicidal attempt • Suicidal ideation • Types of suicide (‘formalized’ suicide – altruistic suicide, egoistic suicide, fatalistic suicide etc.) • Psychological autopsy (postmortem psychological profile of a suicide victim) • Imitation of suicide (teenager or celebrity) • Suicide prevention • cognitive-behavioral problem-solving approach • strong social support and hopefulness • treatment of psychiatric and personality disorders