{"id":4187,"date":"2018-09-18T17:11:49","date_gmt":"2018-09-18T21:11:49","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4187"},"modified":"2019-05-26T00:23:51","modified_gmt":"2019-05-26T04:23:51","slug":"epidemiology-of-mood-disorders","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/abnormal-psychology\/epidemiology-of-mood-disorders\/","title":{"rendered":"Epidemiology of Mood Disorders"},"content":{"rendered":"<p><strong>Clinical Descriptions and Epidemiology of Mood Disorders <\/strong><\/p>\n<ul>\n<li>2 broad types of mood disorders according to DSM-5: 1) Depressive, 2) Manic (bipolar)<\/li>\n<\/ul>\n<p>Depressive Disorders<\/p>\n<ul>\n<li>Cardinal symptoms: profound sadness, and\/or inability to experience pleasure<\/li>\n<li>Physical symptoms: fatigue, low energy, physical aches\/pains *convince individual they are suffering from serious medical conditions o Difficulty falling asleep, bland taste, change in appetite, disappearance in sexual interest, limbs feel heavy\n<ul>\n<li><strong>Psychomotor retardation<\/strong> = thoughts and movements slow<\/li>\n<li><strong>Psychomotor agitation<\/strong> = inability to sit still (pace, fidget, wring their hands) \uf0b7 <strong>Major Depressive Disorder (MDD):<\/strong><\/li>\n<li><strong>MDD<\/strong> \u2013 diagnosis requires 5 depressive symptoms to be present for at least <strong>2 weeks<\/strong>, must include either depressed mood or loss of interest and pleasure<\/li>\n<li>Additional symptoms must also be present: changes in sleep, appetite, concentration\/decision making, feelings of worthlessness, suicidality, psychomotor retardation\/agitation<\/li>\n<li><strong>Episodic disorder<\/strong> = symptoms tend to be present for a period of time and then clear o Untreated episode may stretch for 5 months+<\/li>\n<li>Episodes tend to <strong>reoccur<\/strong>, 2\/3 who experience 1 episode, will experience at least 1 more o Average: 4 episodes (with each new episode, chance of reoccurrence goes up 16%) \uf0a7 DSM-5 Criteria:\n<ul>\n<li>1) Sad mood or loss of pleasure in usual activities<\/li>\n<li>2) At least 5 symptoms (counting sad mood and loss of pleasure)<\/li>\n<\/ul>\n<\/li>\n<li>Sleeping too much\/too little<\/li>\n<li>Psychomotor retardation\/agitation<\/li>\n<li>Weight loss\/change in appetite<\/li>\n<li>Loss of energy<\/li>\n<li>Feelings of worthlessness\/excessive guilt<\/li>\n<li>Difficulty concentrating, thinking or making decisions<\/li>\n<li>Recurrent thoughts of death\/suicide<\/li>\n<li>3) Symptoms are present nearly every day, most of the day for at least 2 weeks<\/li>\n<li>4) Symptoms are distinct &amp; more severe than a normative response to significant loss o <strong>Sub-clinical depression<\/strong> = sadness plus 3 other symptoms for 10 days<\/li>\n<li>Significant impairments in functioning even though full diagnostic criteria are not met \uf0b7 <strong>Persistent Depressive Disorder (PDD):<\/strong><\/li>\n<li><strong>PDD<\/strong> \u2013chronically depressed, more than half of the time for at least <strong>2 years<\/strong>, have at least 2 of the other symptoms of depression<\/li>\n<li>Central feature: chronicity of symptoms o Similar to a DSM-IV-TR diagnosis of dysthymia\n<ul>\n<li>DSM-5 Criteria:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>1) Depressed mood for most of the day more than half of the time for 2 years (1 for children\/adolescents)<\/p>\n<p>2) At least 2 of the following during that time:<\/p>\n<p>\uf0b7 Poor appetite\/overeating, Sleeping too much\/too little, Low energy, Poor SE, Trouble concentrating\/making decisions, Feelings of hopelessness<\/p>\n<p>3) The symptoms do not clear for more than 2 months at a time<\/p>\n<p>4) Bipolar disorders are not present \uf0b7 Other DSM-5 Depressive Disorders:<\/p>\n<ul>\n<li><strong>Disruptive mood dysregulation disorder<\/strong> = newly defined depressive disorder, a diagnosis specific to children and adolescents<\/li>\n<li><strong>Premenstrual dysphoric disorder<\/strong> = moved from DSM-IV appendix to main diagnostic section \uf0b7 Epidemiology and Consequences of Depressive Disorders:<\/li>\n<li>MDD \u2013 one of the most common psyc disorders (16.2% US will meet criteria at some point)<\/li>\n<li>Chronic forms are rarer (PDD), about 2.5% US meet criteria for dysthymia (DSM-IV-TR) o Twice as common among women as among men o MDD is 3x as common among impoverished o Prevalence varies considerably across cultures<\/li>\n<li>Rates of winter depression (SAD) higher farther from the equator, days are shorter o Countries with more fish consumption have lower MDD\/bipolar rates o Child symptoms: stomach\/headache, Adult: distracted, forgetfulness o Adolescent males: irritability, anger<\/li>\n<li>Korea \u2013 less likely to describe sad mood\/suicidal thoughts o Latino culture \u2013 complaints of nerves\/headaches<\/li>\n<li>Asian culture \u2013 reports of weakness, fatigue, and poor concentration<\/li>\n<li>Smaller distance from equator and higher fish consumption associated w\/lower rates o Age of onset has become lower for each recent generation of people in US o Age of onset: late teens, early 20s<\/li>\n<li>60% who meet criteria for MDD will also meet criteria for anxiety o Other comorbidities: substance use, sexual dysfunction, personality disorders o MDD is a leading cause of disability in the world o 2\/3 will also meet criteria for anxiety disorder<\/li>\n<\/ul>\n<p>Bipolar Disorders<\/p>\n<ul>\n<li>3 forms (DSM-5): bipolar-I, bipolar-II, cyclothymic disorder<\/li>\n<li>Manic symptoms are the defining feature (most also experience depression)<\/li>\n<li>Episode of depression is not required for bipolar-I, it is required for bipolar-II<\/li>\n<li><strong>Mania<\/strong> = a state of intense elation, irritability, or activation accompanied by other symptoms<\/li>\n<li><strong>Flight of ideas<\/strong> = difficult to interrupt, shifting rapidly from topic to topic<\/li>\n<li>Stop sleeping, extremely self-confident, incredibly energetic<\/li>\n<li>Risky sexual activities, overspending, reckless driving<\/li>\n<li><strong>Hypomania<\/strong> = less extreme than mania (under mania), does not involve significant impairment, involves a change in functioning that does not cause serious problems \uf0b7 <strong>Bipolar I Disorder:<\/strong>\n<ul>\n<li>Formerly known as manic-depressive disorder<\/li>\n<li>Diagnosis: includes a single episode of mania during the course of a person\u2019s life o Bipolar episodes tend to recur<\/li>\n<li>More than 50% experience 4+ episodes during their life time o Toughest to diagnose<\/li>\n<\/ul>\n<\/li>\n<li><strong>Bipolar II Disorder:<\/strong>\n<ul>\n<li>Midler form<\/li>\n<li>Must experience at least one major depressive episode and at least one episode of hypomania (and no lifetime episode of mania) \uf0b7 <strong>Cyclothymic Disorder:<\/strong><\/li>\n<li>Aka cyclothymia \u2013 a second chronic mood disorder (like PDD)<\/li>\n<li>Symptoms must be present of at least 2 years among adults (1 year in children) o Frequent, but mild symptoms of depression, alternating with mild symptoms of mania o Symptoms don\u2019t clear for more than 2 months at a time \uf0b7 Epidemiology and Consequences of Bipolar Disorders:<\/li>\n<li>1% prevalence in USA, 0.6% worldwide (Bipolar I), 0.4% Bipolar II, 4% cyclothymia o Bipolar I is much rarer than MDD o More than 50% report onset prior to age 25<\/li>\n<li>Being seen with increased frequency among adolescents and children o Occurs equally often in women and men o Women diagnosed experience more depression than men o 2\/3 diagnosed meet diagnosis for comorbid anxiety o Many report a history of substance abuse o Bipolar I is one of the most severe psyc disorders o Suicide rates high for bipolar I and II<\/li>\n<li>People hospitalized for bipolar I 2x as likely to die from medical illnesses in a given year compared to people without mood disorders <strong>DSM-5 Criteria<\/strong> for Manic and Hypomanic Episodes: \uf0b7 Distinctly elevated or irritable mood<\/li>\n<\/ul>\n<\/li>\n<li>Abnormally increased activity or energy<\/li>\n<li>At least 3 of the following are noticeably changed from baseline (4 if irritable mood):\n<ul>\n<li>Increase in goal-directed activity or psychomotor agitation o Unusual talkativeness \u2013 rapid speech<\/li>\n<li>Flight of ideas or subjective impression that thoughts are racing o Decreased need for sleep<\/li>\n<li>Increased SE, belief that one has special talents, powers, or abilities o Distractibility, attention easily diverted<\/li>\n<li>Excessive involvement in activities that are likely to have painful consequences, such as reckless spending, sexual indiscretions, or unwise business investments<\/li>\n<li>Symptoms are present most of the day, nearly everyday \uf0b7 For a <strong>manic episode<\/strong>:<\/li>\n<li>Symptoms last 1 week, require hospitalization, or include psychosis o Symptoms cause significant distress or functional impairment \uf0b7 For a <strong>hypomanic episode<\/strong>:<\/li>\n<li>Symptoms last at least 4 days<\/li>\n<li>Clear changes in functioning are observable to others, but impairment is not marked o No psychotic symptoms are present<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Subtypes of Depressive Disorders and Bipolar Disorders<\/p>\n<ul>\n<li>Mood disorders are highly heterogeneous \u2013 people diagnosed with the same disorder may show very different symptoms<\/li>\n<li><strong>Rapid cycling<\/strong> = pattern of episodes over time (aka seasonal specifier) *for bipolar only<\/li>\n<li><strong>Melancholic<\/strong> = episode specifier specific to depression<\/li>\n<\/ul>\n<p><strong>Etiology of Mood Disorders <\/strong><\/p>\n<ul>\n<li>Etiology studies tend to focus on MDD and bipolar-I<\/li>\n<\/ul>\n<p>Genetic Factors<\/p>\n<ul>\n<li>Heritability estimate of 37% for MDD (twin studies) *higher estimate when studying more severe samples<\/li>\n<li>Bipolar is among the most heritable disorders \u2013 heritability estimate of 93%<\/li>\n<li>Unlikely that there is a single gene that explains mood disorders \u2013 due to high heterogeneity<\/li>\n<li>GWAS studies for responsible genes have been inconclusive o DRD 4.2 gene influences dopamine function, related to MDD<\/li>\n<li>Have identified several genetic polymorphisms related to bipolar disorder<\/li>\n<li>Polymorphism of serotonin transporter gene is related to MDD o Greater risk for depression after a stressful life event with this polymorphism o Having at least one short allele associated with elevated reactivity to stress \uf0b7 Neurotransmitters:\n<ul>\n<li>Norepinephrine, dopamine and serotonin are related to mood disorders<\/li>\n<li>People with depression are less responsive than others to drugs that increase dopamine levels<\/li>\n<li>It is thought that the functioning of dopamine might be lowered in depression o Dopamine is involved in the <strong>reward system<\/strong> of the brain = guides pleasure, motivation, and energy in the context of opportunities to obtain rewards<\/li>\n<li>Drugs that increase dopamine levels are found to trigger manic symptoms in bipolar individuals *overly sensitive dopamine receptors<\/li>\n<li>To lower serotonin levels, deplete levels of <strong>tryptophan<\/strong> *major precursor or serotonin\n<ul>\n<li>Causes temporary depressive symptoms in those with family history for depression or depressive symptoms<\/li>\n<\/ul>\n<\/li>\n<li>Bipolar disorder may be related to diminished sensitivity of serotonin receptors o Medication alters levels immediately but takes 2-3 weeks for relief o New modes focus on sensitivity of post-synaptic receptors<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Brain Function: Regions Involved in Emotion<\/p>\n<ul>\n<li>5 primary brain structures most studied in depression: amygdala, anterior cingulate, dorsolateral prefrontal cortex, hippocampus, and the striatum<\/li>\n<li><strong>Amygdala<\/strong> \u2013 helps assess how salient\/emotionally important a stimulus is o People with MDD have more intense reactions to stimuli with emotion<\/li>\n<li>MDD associated with greater activation of <strong>anterior cingulate<\/strong> and diminished activation of the <strong>hippocampus<\/strong> &amp; <strong>dorsolateral prefrontal cortex<\/strong> when viewing negative stimuli<\/li>\n<li>MDD \u2013 diminished activation of <strong>striatum<\/strong> \u2013 specifically when receiving positive feedback o <strong>Nucleus accumbens<\/strong> \u2013 central component of rewards system, plays a key role in motivation to pursue rewards<\/li>\n<li>Bipolar I \u2013 elevated responsiveness in the amygdala, increased activity of anterior cingulate, diminished activity of hippocampus and dorsolateral prefrontal cortex o High activation of striatum***<\/li>\n<\/ul>\n<p>The Neuroendocrine System: Cortisol Dysregulation<\/p>\n<ul>\n<li>HPA axis overactive during MDD *stress reactivity **overactive amygdala<\/li>\n<li>Overactive amygdala sends signals to HPA axis, triggers release of cortisol (stress hormone)<\/li>\n<li>Cortisol increases immune system activity to help body prepare for threats<\/li>\n<li><strong>Cushing\u2019s syndrome<\/strong> = causes over-secretion of cortisol, frequent depressive symptoms<\/li>\n<li>80% of people hospitalized for depression show poor regulation of HPA system<\/li>\n<\/ul>\n<p>Social Factors in Depression: Childhood Adversity, Life Events, and Interpersonal Difficulties<\/p>\n<ul>\n<li>Often interpersonal factors precede onset of depression<\/li>\n<li>Childhood adversity: parental death, physical abuse, sexual abuse increases risk that later the individual will develop depression *depressive symptoms likely will be chronic<\/li>\n<li>Child abuse linked to anxiety even more strongly than to depression<\/li>\n<li>Common stressful life events for triggering depressive symptoms include: losing a job, a key friendship or a romantic relationship<\/li>\n<li>Lack of social support is common amongst depressed individuals *lessens ability to handle stress<\/li>\n<li><strong>Expressed emotion<\/strong> = a family member\u2019s critical or hostile comments toward or emotional overinvolvement with the person with depression o High EE strongly predicts relapse in depression<\/li>\n<li>Excessive need for reassurance has been found to be predictive of depression<\/li>\n<li>Low social competence among elementary school children is a predictor of depression, poorinterpersonal problem solving skills among adolescents<\/li>\n<li>Marital conflict can predict depression<\/li>\n<\/ul>\n<p>Psychological Factors in Depression \uf0b7 Neuroticism:<\/p>\n<ul>\n<li><strong>Neuroticism<\/strong> = a personality trait that involves the tendency to experience frequent and intense negative affect *predicts the onset of depression<\/li>\n<li>Explains part of genetic vulnerability to depression o Also associated with anxiety \uf0b7 Cognitive Theories:<\/li>\n<li>Pessimistic and self-critical thoughts are major causes of depression o Beck\u2019s Theory:\n<ul>\n<li>Depression is associated with a <strong>negative triad<\/strong> = negative views of the self, their world, and the future (hopelessness)<\/li>\n<li>In childhood, people with depression acquired negative schemas through experiences<\/li>\n<li>Negative schema is activated whenever the person encounters situations similar to those that originally caused the schema to form<\/li>\n<li>Cause <strong>cognitive biases<\/strong> = tendencies to process info in certain negative ways<\/li>\n<li>Depression associated with a tendency to stay focused on negative info once it is initially noticed<\/li>\n<\/ul>\n<\/li>\n<li>Hopelessness Theory:\n<ul>\n<li><strong>Hopelessness theory<\/strong> = most important trigger of depression is hopelessness *the belief that desirable outcomes will not occur and that there is nothing a person can do to change this<\/li>\n<li><strong>Attributions <\/strong>= the explanations a person forms about why a stressor has occurred:<\/li>\n<\/ul>\n<\/li>\n<li>1) Stable (permanent) vs. unstable (temporary) causes<\/li>\n<li>2) Global vs. specific causes<\/li>\n<li>Stable and global <strong>Attributional style<\/strong> more likely linked to depression\n<ul>\n<li>Rumination Theory:\n<ul>\n<li><strong>Rumination<\/strong> = tendency to repetitively dwell on sad experiences and thoughts, or to chew on material again and again<\/li>\n<li>Most detrimental form: to brood regretfully about why a sad event happened<\/li>\n<li>Tendencies to ruminate have been found to predict onset of MD episodes<\/li>\n<li>Women tend to ruminate more than men<\/li>\n<li>Rumination increases negative moods, particularly when people focus on negative aspects of their mood and their self<\/li>\n<li>Evolutionarily adaptive to focus on negative events in order to solve problems<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Social and Psychological Factors in Bipolar Disorder<\/p>\n<ul>\n<li>Most people who experience a manic episode will also experience a major depressive episode \uf0b7 Depression in Bipolar Disorders:\n<ul>\n<li>Triggers of depression in bipolar disorder are similar to those of MDD<\/li>\n<li>Negative life events are important triggers, neuroticism, negative cognitive styles, expressed emotion, lack of social support \uf0b7 Predictors of Mania:<\/li>\n<li>Reward sensitivity:\n<ul>\n<li>Disturbance in reward system of the brain<\/li>\n<li>Highly responsive to rewards<\/li>\n<li>Life events involving success may trigger cognitive changes in confidence<\/li>\n<li>Then spirals into excessive goal pursuit, which helps trigger manic symptoms o Sleep deprivation:<\/li>\n<li>Sleep deprivation can precede onset of manic episodes<\/li>\n<li>Protecting sleep can help reduce symptoms of bipolar disorder<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Treatment of Mood Disorders<\/strong><\/p>\n<ul>\n<li>About 50% of people who meet diagnostic criteria for major depression do not receive care<\/li>\n<\/ul>\n<p>Psychological Treatment of Depression<\/p>\n<ul>\n<li><strong>Interpersonal Psychotherapy<\/strong> (IPT):\n<ul>\n<li>Builds on the idea that depression is closely tied to interpersonal problems o Examine major interpersonal problems<\/li>\n<li>Focus on 1 or 2 issues with the goal of helping the person identify his feelings about these issues, make important decisions and effect changes to resolve problems related to these issues<\/li>\n<li>Typically brief treatment (16 sessions)<\/li>\n<li>Techniques: discussing interpersonal problems, exploring negative feelings and encouraging their expression, improving verbal\/nonverbal communications\/problem solving<\/li>\n<li>Effective in relieving MDD and prevents relapse when continued after recovery o 1) Short-term psychodynamic theory 2) Focus on current relationships \uf0b7 <strong>Cognitive Therapy<\/strong> (CT):<\/li>\n<li>Depression is caused by negative schema and cognitive biases o Aims to alter maladaptive thought patterns o Client taught to understand how powerfully our thoughts can influence our moods o Help client change his opinions of himself<\/li>\n<li>Teaches client to challenge negative beliefs and to learn strategies that promote making realistic\/positive assumptions<\/li>\n<li>Thought-monitoring homework ***emphasis on <strong>cognitive restructuring<\/strong><\/li>\n<li><strong>Behavioural activation<\/strong> (BA) \u2013 people are encouraged to engage in pleasant activities that might bolster positive thoughts about one\u2019s self and life<\/li>\n<li><strong>Mindfulness-based cognitive therapy <\/strong>(MBCT) = focuses on preventing relapse after successful treatment\n<ul>\n<li>Based on the assumption that a person becomes vulnerable to relapse because of repeated associations between sad mood and patterns of self-devaluing, hopeless thinking during MD episodes<\/li>\n<li>Goal: teach people to reorganize when they start to become depressed and to try adopting a <strong>decentered perspective<\/strong><\/li>\n<\/ul>\n<\/li>\n<li>= Viewing their thoughts as mental events rather than as core aspects of the self or accurate reflections of reality<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>\uf0a7 Detached relationship to depression-related thoughts\/feelings o Monitor and identify automatic thoughts, replace negative with neutral\/positive \uf0b7 <strong>Behavioural Activation Therapy<\/strong> (BA):<\/p>\n<ul>\n<li>Originally developed as a standalone treatment<\/li>\n<li>Based on idea that many risk factors for depression interfere with receiving positive reinforcement<\/li>\n<li>Goal: to increase participation in positively reinforcing activities to disrupt depression \uf0b7 <strong>Behavioural Couples Therapy<\/strong>:<\/li>\n<li>Depression is often tied to relationship problems<\/li>\n<li>Researchers work with both members of a couple to improve communication and relationship satisfaction<\/li>\n<\/ul>\n<p>Psychological Treatment of Bipolar Disorder<\/p>\n<ul>\n<li>Medication is a necessary component, can have psychological treatment as a supplement<\/li>\n<li>Psychotherapy can also help reduce bipolar\u2019s depressive symptoms<\/li>\n<li><strong>Psychoeducational approaches<\/strong> = help people learn about the symptoms of the disorder, expected time course of symptoms, biological\/psychological triggers for symptoms, and treatment strategies<\/li>\n<li>Can help people adhere to treatment with medications (e.g. lithium)<\/li>\n<li>Half of patients on medication for bipolar do not take medication consistently<\/li>\n<li>Psycho-ed helps patients understand rationale for taking medication<\/li>\n<li>CT and family-focused therapy (FFT) have received strong support<\/li>\n<li>FFT educates the family about the illness, enhances family communication and develop problemsolving skills<\/li>\n<\/ul>\n<p>Biological Treatment of Mood Disorders<\/p>\n<ul>\n<li>Electroconvulsive Therapy for Depression (ECT):\n<ul>\n<li>Only used to treat MDD that has not responded to medication o Induces a momentary seizure<\/li>\n<li><strong>Bilateral ECT<\/strong> = electrodes placed on each side of the forehead<\/li>\n<li><strong>Unilateral ECT<\/strong> = currents passes only through the non-dominant (typically right) cerebral hemisphere *less pronounced side effects<\/li>\n<li>Patient is now given a muscle relaxant prior to ECT so they sleep through it o Receive 6-12 treatments typically<\/li>\n<li>More powerful than antidepressant medication especially when there are psychotic features o Associated deficiencies in cognitive functioning \uf0b7 Medications for Depressive Disorders:<\/li>\n<li>Most commonly used and best-researched treatments for depression o 75% of treated depression patients are prescribed antidepressants o 3 categories of antidepressants:\n<ul>\n<li>Monoamine oxidase inhibitors (MAOIs)<\/li>\n<li>Tricyclic antidepressants<\/li>\n<li>Selective serotonin reuptake inhibitors (SSRIs) o Recommended treatment for at least 6 months after an episode ends o Concern: may not be more affective than placebos for mild\/moderate symptoms of MDD o 40% of patients on antidepressants stop taking them after the 1<sup>st<\/sup> month *tough side effects o MAOIs have possible life threatening side effects if combined with certain foods o SSRIs are most common<\/li>\n<\/ul>\n<\/li>\n<li>Transcranial Magnetic Stimulation (TMS) for Depression:\n<ul>\n<li>Allowed for patients who have failed to respond to a first antidepressant but not yet tried a second<\/li>\n<li>Electromagnetic coil placed against scalp, pulses of magnetic energy used to increase activity in dorsolateral prefrontal cortex (30 mins, for 5-10 days)<\/li>\n<li>Can help relieve treatment resistant depression<\/li>\n<li>Star-D sequenced treatment alternatives to relieve depression \uf0b7 Comparing Treatments for Major Depressive Disorder:<\/li>\n<li>Combining psychotherapy and antidepressant use raises odds of recovery by 10-20% o Antidepressants work more quickly than psychotherapy \uf0b7 Medications for Bipolar Disorder:<\/li>\n<li><strong>Mood-stabilizing medications<\/strong> = medications that reduce manic symptoms o <strong>Lithium<\/strong> = naturally occurring chemical element, first mood stabilizer identified o Most medicated patients still experience mild manic\/depressive symptoms o 40% of people relapsed while taking lithium, 60% while taking a placebo o Lithium levels are toxic if too high *ingestions requires regular blood tests o 2 other types of medications for acute mania: *also help relieve depression\n<ul>\n<li>Anticonvulsant (antiseizure) medication (divalproex sodium)<\/li>\n<li>Antipsychotic medication (olanzapine)<\/li>\n<li>Recommended for those who don\u2019t respond to lithium o Patients often begin with lithium alongside psychotherapy (lithium takes a long time to start working)<\/li>\n<\/ul>\n<\/li>\n<li>A final note on treatment:\n<ul>\n<li><strong>Deep brain stimulation<\/strong> = involves implanting electrodes into the brain, applying small current to the electrodes, can manipulate activity to those brain regions<\/li>\n<li>Studies done with patients who have not responded to other forms of treatment o 10-20% better chance at recovery when combining medication w\/therapy o Medication takes 2-3 weeks to kick in<\/li>\n<li>CT can be as effective as medications for severe depression, more effective than medication at preventing relapse <strong>Suicide<\/strong><\/li>\n<\/ul>\n<\/li>\n<li><strong>Suicidal ideation<\/strong> = thoughts of killing oneself, more common than attempted\/completed suicide<\/li>\n<li>Most suicide attempts do not result in death<\/li>\n<li><strong>Suicide attempt<\/strong> = behaviour intended to kill oneself<\/li>\n<li><strong>Suicide<\/strong> = involves behaviours that are intended to cause death and actually do so<\/li>\n<li><strong>Non-suicidal self injury<\/strong> = involves behaviours meant to cause immediate bodily harm but are not intended to cause death<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Epidemiology of Suicide and Suicide Attempts<\/p>\n<ul>\n<li>9% report ideation (worldwide), 2.5% have made at least 1 attempt<\/li>\n<li>Suicide rates are underestimated \u2013 often circumstances of some deaths are ambiguous<\/li>\n<li>Every 20 minutes someone in the US dies from suicide<\/li>\n<li>Men (adolescent males especially) are 4 times more likely to kill themselves than women<\/li>\n<li>Women are more likely to make suicidal attempts that do not result in death<\/li>\n<li>Men choose to shoot\/hang themselves, women are more likely to use pills<\/li>\n<li>Suicide rate increases in old age *white males over 50 have highest rate in US<\/li>\n<li>Being divorced or widowed increased risk 4 or 5 fold<\/li>\n<li>6% of undergrads, 4% grad students seriously contemplate attempting o 1 in 12 make a plan, \u00bd don\u2019t tell anyone<\/li>\n<\/ul>\n<p>Risk Factors for Suicide<\/p>\n<ul>\n<li>Psychological Disorders:\n<ul>\n<li>Many individuals with mood disorders have suicidal thoughts o More than 50% of those who attempt, are depressed at the time o 15% of those hospitalized with depression end up killing themselves o 90% of attempts are suffering from some psyc disorder\n<ul>\n<li>5-7% bipolar, 5% schizophrenia, impulse control disorders, substance use disorders,<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>PTSD, borderline personality disorder, panic disorders, eating disorders<\/p>\n<ul>\n<li>Most likely when a person is experiencing comorbid depression o Most people with psyc disorders do not die from suicide \uf0b7 Neurobiological Factors:<\/li>\n<li>Heritability accounts for 48% of suicide attempts o Serotonin (violent suicide) and cortisol are important factors<\/li>\n<\/ul>\n<ul>\n<li>Social Factors:\n<ul>\n<li>Suicide rates have increased over the past 100 years (economic recession) o Major effect from media reports on suicide (e.g. after Marilyn Monroe\u2019s suicide) o Social isolation and lack of social belonging are powerful predictors \uf0b7 Psychological Factors:<\/li>\n<li>Related to poor problem solving skills<\/li>\n<li>Difficulty solving problems leads to increased vulnerability to hopelessness *strongly tied to suicidality<\/li>\n<li>Many think about suicide, only few act on those thoughts **impulsivity<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Preventing Suicide<\/p>\n<ul>\n<li>Talking about suicide might help relieve a sense of isolation \uf0b7 Treating the Associated Psychological Disorder:\n<ul>\n<li>Most people who kill themselves are suffering from a psyc disorder o Decrease in psyc disorder symptoms also decreases risk of suicide<\/li>\n<li>Many antidepressants and other medications for mood disorders reduce risk of suicide \uf0b7 Treating Suicidality Directly:<\/li>\n<li>Cognitive behavioural approaches are most promising<\/li>\n<li>Reduce risk of future attempt by 50% in those who have already attempted\/failed o Also reduce suicidal ideation<\/li>\n<\/ul>\n<\/li>\n<li>Broader Approaches to Suicide Prevention:\n<ul>\n<li>Rates of suicide are much higher in the military *use this setting to conduct research on prevention methods<\/li>\n<li>Public health prevention tries to make it more difficult to access means used for suicide<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Clinical Descriptions and Epidemiology of Mood Disorders 2 broad types of mood disorders according to DSM-5: 1) Depressive, 2) Manic (bipolar) Depressive Disorders Cardinal symptoms: profound sadness, and\/or inability&hellip; <a class=\"continue\" href=\"https:\/\/www.amyork.ca\/academic\/zz\/abnormal-psychology\/epidemiology-of-mood-disorders\/\">Continue Reading<span> Epidemiology of Mood Disorders<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[104],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4187"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4187"}],"version-history":[{"count":2,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4187\/revisions"}],"predecessor-version":[{"id":4910,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4187\/revisions\/4910"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4187"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4187"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4187"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}