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
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 Bipolar II disorder
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 ( people a year) for people aged 25-34
Among teenagers, suicide is the 3rd leading 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