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Mood disorders and suicide lecture
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Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Emotions
Cognitions
Behaviors
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.
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 shoulderfrom a coworker.
Coming home to slump into bed without eating dinner.Tossing and turning in bed, unable to sleep.Some difficulty concentrating.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Emotions
Cognitions
Behaviors
NormalMild
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.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Emotions
Cognitions
Behaviors
NormalMildModerate
Cycle of Major Depressive Disorder
Intense sadness and frequent crying. Daily feelings of “heaviness” and emptiness.
Thoughts about one’s personal deficiencies, strongpessimism about the future, and thoughts aboutharming oneself (with little intent to do so).
Inability to rise from bed many days, skippingclasses at school, and withdrawing fromcontact with others.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Emotions
Cognitions
Behaviors
NormalMildModerateDepression – Less Severe
Cycle of Major Depressive Disorder
Extreme sadness, very frequent crying, andfeelings of emptiness and loss. Strong sense of hopelessness.
Thoughts about suicide, funerals, andinstructions to others in case of one’s death.Strong intent to harm oneself.
Complete inability to interact with others or evenleave the house. Great changes in appetite andweight. Suicide attempt or completion.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Emotions
Cognitions
Behaviors
NormalMildModerateDepression – Less SevereDepression – More Severe
Cycle of Major Depressive Disorder
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
• Click below to see a one-minute video
• depressive episode
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Manic
Normal
Depressive
Cycle of Major Depressive Disorder
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
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
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Manic
Normal
Depressive
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Manic
Normal
Depressive
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Manic
Normal
Depressive
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Will to live
Feeling thoughts of death
Suicidalideation
Planningsuicidal
acts Suicideattempt
Suicidecompletion
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Note: These numbers reflect the fact that some people have more than one mood disorder.
Dis
ord
er
0 5 10 15 20 25
Percentage
Any mood disorder
Major depressive
disorder
Dysthymia
Bipolar I and II disorders
20.89.5
16.66.7
2.51.5
3.92.6
Lifetime prevalence rate (%) 12-month prevalence rate (%)
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
Ag
e a
t d
ea
th i
n y
ea
rs
30 35
1.20.3
17.13.0
31.14.0
21.36.2
65+
21.35.4
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Amygdala
Anterior cingulate cortex
Prefrontal cortex
Caudate nucleus, putamen
Basal gangalia
Hippocampus
Pons
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 fromothers, 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
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
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Assessment and Treatment
Hamilton Rating Scale for Depression
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Assessment and Treatment
• Elderly• Unmarried• White• Male• Living alone
Assesssociodemographicrisk factors
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 anxietyor 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 foralcohol 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.
Assessrisk of suicide
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Assessment and Treatment
• 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