Abnormal Psychology 30 3/11/09

Chapter 6 - Mood Disorders and Suicide

Mood Disorders: Familial and Genetic Influences

o Family Studies
o Rate is 2-3x higher in relatives of probands
o Relatives of bipolar probands tend to have unipolar depression
o Severe mood disorders may have a stronger genetic contribution than less severe disorders
o Heritability for depression is higher for females than males
o Twin Studies
o Identical twins are 3X more likely than a fraternal twin to have a mood disorder
o Unipolar and bipolar disorder are inherited separately

Mood Disorders: Biological Influences

o Neurotransmitter Systems
o Serotonin (5HT) and its relation to other neurotransmitters
o Mood disorders related to low levels of 5HT
o Regulates norepinephrine and dopamine systems
o Permissive hypothesis
o Low 5HT means others become dysregulated leading to mood irregularities
o The Endocrine System
o Stress elevates cortisol
o May interfere with neurogenesis, especially in hippocampus (memory processes)þ
o Brain Wave Activity
o Different EEG values have been reported in the two hemispheres of brains of depressed persons
o This type of brain function may be an indicator of a biological vulnerability for depression
o Sleep Disturbance (a hallmark of most mood disorders)
o Move into REM more quickly and intensely
o Depriving depressed persons of sleep improves their depression.
o Show diminished slow wave sleep (deepest, most restful stage)þ
o Bipolar persons and their kids show increased sensitivity to light (greater suppression of melatonin
when exposed to light at night)

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Mood Disorders: Psychological Dimensions

o Stress is strongly related to mood disorders and leads to poorer response to treatment and longer time before
remission
o Reciprocal-gene environment model –

o Diathesis Stress Model –

o Learned helplessness theory of depression –

o A depressive attributional style may also lead to depression

o This style of thinking is threefold

o Internal Attribution - negative events are their fault

o Stable Attribution - future negative events will be their fault

o Global Attribution is global - negative events will influence many life activities

o CBT proposes that depression results from a tendency to interpret life events in a negative way

o Negative Coping Styles

o Depressed persons engage in cognitive errors
o Tendency to interpret life events negatively
o Often engage in several cognitive errors and think the worst of everything

o Types of Cognitive Errors

o Arbritary inference - magnifying negative details

o Polarized thinking - black or white thinking

o Overgeneralization - general conclusions based on a single incident

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o Catastrophizing - expecting disasters

o Personalization -everything people do or say is some kind of reaction to you

o These beliefs may comprise a negative schema – or an automatic and enduring cognitive bias about aspects of
life
o Its represented by the Depressive Cognitive Triad
Think negatively about oneself
o Think negatively about the world
o Think negatively about the future

Mood Disorders: Social and Cultural Dimensions

o Marital Relations
o Marital dissatisfaction is strongly related to depression
o This relation is particularly strong in males
o Gender Imbalances occur across mood disorder (except Bipolar Disorder)þ
o Females over males is likely due to socialization
o Perceptions of uncontrollability
o More emphasis on intimacy
o More self-deprecating during stress
o More social problems
o Social Support
o Extent of social support is related to depression
o Lack of social support predicts late onset depression
o Substantial social support predicts recovery from depression
An Integrative Theory
o Shared Biological Vulnerability
o Overactive neurobiological response to stress
o Exposure to Stress
o Activates hormones that affect neurotransmitter systems
o Turns on certain genes
o Affects circadian rhythms
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o Activates dormant psychological vulnerabilities
o Contributes to sense of uncontrollability
o Fosters a sense of helplessness and hopelessness
o Social and Interpersonal Relationships/Support are Moderators
Treatment of Mood Disorders: Biological Treatments
o Tricyclic Medications -

o
o Block Reuptake of Norepinephrine and other neurotransmitters

o Widely Used (e.g., Tofranil, Elavil)þ

o Therapeutic Effects
o Can take up 2 to 8 weeks
o Feel worse before they get better
o Negative Side Effects Are Common

o May be Lethal in Excessive Doses

o Monoamine oxidase (MAO) Inhibitors -

o
o Block Monoamine Oxidase – enzyme that breaks down serotonin and norepinephrine
o Slightly more effective than tricyclics with fewer side-effects
o Only prescribed when tricyclics are ineffective
o SSRIs (Selective Serotogenic Reuptake Inhibitors) -

o Fluoxetine (Prozac) is the most popular SSRI

o SSRIs Pose No Unique Risk of Suicide or Violence

o Negative Side Effects Are Common

o Lithium -

o Primary drug of choice for bipolar disorders

o Can be toxic – small boundary between ED and TD
o Side Effects May Be Severe
o Dosage must be carefully monitored
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o Why Lithium Works Remains Unclear

o Electroconvulsive Therapy (ECT) -

o ECT Is Effective for Cases of Severe Depression

o Side Effects Are Few

o Include Short-Term Memory Loss

o Relapse Is Common

o Transcranial magnetic stimulation (TMS)

o Related to ECT but uses magnetic field

Treatment of Mood Disorders: Psychosocial Treatments

o Beck's Cognitive Therapy
o Addresses cognitive errors in thinking
o Also includes behavioral components
o Interpersonal Psychotherapy
o Focuses on problematic interpersonal relationships
o Outcomes with Psychological Treatments
o Comparable to Medications
o Research does not suggest advantage for combined treatment

The Nature of Suicide: Facts and Statistics

o Eighth Leading Cause of Death in the United States

o Overwhelmingly a White and Native American Phenomenon

o Suicide Rates Are Increasing, Particularly in the Young

The Nature of Suicide: Important Terms
o Suicide ideation – serious contemplation of suicide

o Formalized or altruistic – socially sanctioned (seppuku)þ

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o Egoistic – caused by disintegration of social support (common in elderly)þ

o Anomic – followed by some major disruption (anomie - lost and confused)þ

o Fatalistic – loss of control over one's destiny (Heaven's Gate cult)þ

The Nature of Suicide: Facts and Statistics

o Gender Differences
o Males are more successful at committing suicide than females
o Females attempt suicide more often than males
o Except in China females tend to commit suicide than men, perhaps because of absence of stigma
The Nature of Suicide: Risk Factors
o Suicide in the Family

o Low Serotonin Levels

o Pre - existing Psychological Disorder

o Alcohol Use and Abuse

o Past Suicidal Behavior

o Experience of a Shameful/Humiliating Stressor

o Publicity About Suicide and Media Coverage

Avoiding Depression
o New research indicates that taking part in rewarding behaviors can stave off depression
o Increases perception of control over environment
o Anticipation fuels activity in pleasure centers

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o Nucleus accumbens- critical interface between emotions and actions
o Likely stimulates neurogenesis

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