(精神病學(xué)課件)mood-disorder-and-suicide

1、Mood Disorders and SuicideBy Yixiao FuDepartment of PsychiatryMood Disorders and SuicideBy YOutlineMood disorders, depression and maniaDepressive disordersBipolar disordersCauses of mood disordersTreatment of mood disordersSuicideDepressive disorderMAJOROutlineMood disorders, depressMood disorders,

2、depression and maniaMood disordersGroup of disorders involving severe and enduring disturbances in emotion (mood) (prevalence in population between 8% and 19%)Major depressive episodeExtremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms (worthlessness, indecisive

3、ness) and physical symptoms (altered sleeping pattern, changes in appetite and weight, loss of energy)ManiaEpisode of joy and euphoria marked by individuals extreme pleasure in every activity, hyperactivity, little sleepHypomanialess severe version of a manic episode that does not cause marked impai

4、rment in social or occupational functioningDysphoric manic or mixed episodethe individual experiences both elation and depression or anxiety at the same timeMood disorders, depression and(精神病學(xué)課件)mood-disorder-and-suicide(精神病學(xué)課件)mood-disorder-and-suicideDepressive disordersMajor depressive disorder,

5、single episodeInvolves 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-BarbaraInvolves repeated major depressive episodes separated by a period of at least 2 months during

6、 which the individual was not depressedDysthymic disorderthe same symptoms as major depressive disorder but presented in milder form, the depressed mood continues for at least 2 yearsDouble depressionCombination of major depression episodes and dysthymic disorderDepressive disordersMajor depDepressi

7、ve disordersUsual onset is 25 years but is decreasingDepressive episodes last from 2 weeks up to yearsAdult patients with dysthymic disorder are more likely to commit suicide than patients with major depressive disorderDepression can result from griefPathological grief reaction involves psychotic fe

8、atures, suicidal ideation, severe loss of weight or energy that persists more than 2 monthsTherapy involves reexperiencing the trauma under supervision and finding meaning in the lossDepressive disordersUsual onsBipolar disordersBipolar I disorder Y-MaryDepressive episodes alternate with full manic

9、episodes (17% suicidal attempts) (onset at age 18)Bipolar II disorderDepressive episodes alternate with hypomanic episodes (24% suicidal attempts) (onset at age 22)Cyclothymic disorderChronic alternation of mood elevati+on and depression that does not reach the severity of manic or major depressive

10、episodesSeasonal 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)Bipolar disordersBipolar I diCauses of mood disordersbiological factorsif one twi

11、n 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 factorsstressful life events, hopelessness, negative cognitive styles - overgeneralizationsocial and cultural fa

12、ctorsmarital dissatisfaction70% of people suffering with major depressive disorder or dysthymia are womenCauses of mood disordersbioloCauses of mood disordersCauses of mood disordersTreatment of mood disordersMedicationsAntidepressants (number of side effects)Monoamine oxidase (MAO) inhibitors (nega

13、tive 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 ECTPsychosocial treatmentsCognitive therapyInterpersonal therapy

14、Combined treatments V-Bipolarin depression (medication and psychosocial treatments)in bipolar disorders (combining medication and family and/or CBT is crucial)Treatment of mood disordersMedSuicide8th leading cause of death in the USA (30 000 people a year) for people aged 25-34Among teenagers, suici

15、de is the 3rd leading cause of death The suicide rate for young men in the USA is the highest in the worldMales are four to five times more likely to commit suicide than females90% of suicides are committed by people suffering from psychological disorder60% are associated with mood disorders25%-50%

16、with alcohol use and abuse10% borderline personality disorderSuicide8th leading cause of deSuicideSuicidal attempt Suicidal ideation Types of suicide (formalized suicide altruistic suicide, egoistic suicide, fatalistic suicide etc.)Psychological autopsy (postmortem psychological profile of a suicide

17、 victim)Imitation of suicide (teenager or celebrity)Suicide preventioncognitive-behavioral problem-solving approachstrong social support and hopefulnesstreatment of psychiatric and personality disordersSuicideSuicidal attempt MAJORDEPRESSIVEDISORDERMAJOROne Thing in Common- DepressionGreat writer He

18、mingway Scientist DarwinArtist van goghPrime Minister ChurchillSuperstar Marilyn MonroeOne Thing in Common- DepressiDepression is CommonThe WHO identified depression as the fourth leading cause of worldwide disease in 1990, and depressive illness is projected to be the second leading cause of disabi

19、lity worldwide in 2020. Murray CJ, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, Mass.: Harvard University Press, 1996. Depression is CommonThe WHO idDepression is an

20、illness involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. It is not the same as unhappiness and is not a state people can snap out of. What is depression? Depression is an illness involDEPRESSIOND

21、EPRESSION(DSM-IV-TR):Major Depressive DisorderDiagnostic and Statistical Manual of Mental DisordersBy:American Psychiatric Association(ICD-10) :Depressive Episode International Statistical Classification of Diseases and Related Health ProblemsBy:World Health OrganizationDepression(informal)Scholar f

22、ield:Diagnostic criteria:(DSM-IV-TR):Major Depressive DMDD/DEPRESSIONMDD/DEPRESSION(精神病學(xué)課件)mood-disorder-and-suicide(精神病學(xué)課件)mood-disorder-and-suicideEpidemiologyThe lifetime risk is about 15%Out of very 100 people about 13 men and 21 women develop the disorder （MDD occurs more on woman ) Teenagers a

23、re most likely to develop MDD due to developing the symptoms of sadness, loneliness, stress.Up to 15% of people with MDD die by suicideEpidemiologyThe lifetime risk (精神病學(xué)課件)mood-disorder-and-suicide25genetic predispositionFamily and Twin studies show that MDD has a definite genetic component. the ri

24、sk rate among first-degree relatives of individuals suffering from MDD is about two to three times the risk in the general population. There is a higher concordance rate (about 40%) in monozygotic compared with dizygotic (about 11%） twins. No single major gene has yet been shown to be involved( poly

25、genic inheritance). Genes have not yet to be identifiedEtiology25genetic predispositionFamily26Social and Environmental Influences historical factors: early maternal death, parental neglect, a long period of separation from a parent during childhood, childhood sexual abuse experiencespersonalitycurr

26、ent factors（stress） unemployment,Disappointed In Love.（ loss life events） Etiology26Social and Environmental Inf27Biochemical factorsNeurotransmitterEtiology5-HTDANAACH27Biochemical factorsNeurotraEtiology; Bio-Psycho-SocialEtiology; Bio-Psycho-Social29.Etiology29.Etiology(精神病學(xué)課件)mood-disorder-and-s

27、uicideof MDD?What are the symptoms of MDD?What are the symptoms DSM-IV-TR1 DEPRESSED MOOD (SAD.HOPELESS)2 FATIGUE,ENERGY LOSS3 THOUGHTS OF DEATH/SUICIDE4 DIFFICULTY5LACK OF INTEREST6INSOMNIA(WAKING UP IN THE MIDDLE OF THE NIGHT/NOT BEING ABLE TO GO BACK TO SLEEP)7RETARDATION8UNINTENTIONAL WIGHT LOSS

28、/APPETITTE DECREASE OR INCREASE9DISTRESS/IMPAIRMENTClinical FeatureBiological symptomsCognitive symptoms Mood and motivation symptomsDSM-IV-TRClinical FeatureBioloMood and motivation symptoms(core feature) 1.Mood symptoms Sadness, anhedonia, unhappiness irritability Anxiety symptoms, panic attacks C

29、linical FeatureMood and motivation symptoms(cMood and motivation symptoms(cord feature)2. motivation symptoms loss of interest, low energy and social withdrawal(keep themselves in the room,low-esteem,have no confidence) Clinical FeatureMood and motivation symptoms(cBiological symptomsloss of appetit

30、e and weightloss of sex drive (libido)Sleep disturbance most days: either initial insomnia or early morning waking and being unable to get back to sleep.Diurnal variation of mood, such that mood is worse in the morning and slowly lifts in the evening.non-specific physical symptoms, such as tension h

31、eadache, back pain and atypical chest Psychomotor retardation (mute and stupor)Clinical FeatureBiological symptomsloss of appBiological symptomsLoss of appetite and weightBiological symptomsLoss of appLoss of sex drive Biological symptomsLoss of sex drive Biological sEarly morning wakingBiological s

32、ymptomsEarly morning wakingBiologicalDiurnal variation of mood123456789101112131415161718192021222324Biological symptomsDiurnal variation of moodBioloNon-specific physical symptomsBiological symptomsNon-specific physical symptomsPsychomotorsymptomsPsychomotorCognitive symptoms negative thoughts To t

33、he past( guilt, regrets and self-blame) To the present( low self-esteem, worthlessness) To the future (pessimism, hopelessness, thoughts of dying and suicidal ideas)Psychotic depression Delusions( persecutory , hypochondriacal , guilt ) hallucinations( Auditory) Clinical FeatureCognitive symptoms ne

34、gative thSuicideSuicideDEPRESSIONOccasional sadnessMental illnessDEPRESSIONOccasional sadnessMe(精神病學(xué)課件)mood-disorder-and-suicideDiagnoseDiagnoseDiagnoseCriteria for Major depressive Episode (DSM-) it includes four aspects: symptom criteria, course criteria severity criteria exclusion.these symptoms

35、must persist continuously for at least 2 weeks. Symptoms cause clinically impairment in social, occupational, or other important areas of functioningSymptoms are NOT due to the effects of a substance (e.g., drug of abuse, or medication) or a general medical condition (e.g., hyperthyroidism)5 or more

36、 of the total 9 symptoms must be met.at least 1 of those must be either depressed mood or loss of interest or pleasure.DiagnoseCriteria for Major de(精神病學(xué)課件)mood-disorder-and-suicideManagement1.Preparation2.Treament .Pharmacotherapy .Electroconvulsive therapyManagement1.Preparation 1.PreparationHisto

37、ry-taking will include alcohol and drug use and psychosocial history with evidence for supportive relationships. Suicidal risk assessment is important. Physical investigations will include eosinophil sedimentation rate (ESR) and thyroid function and, in older patients, chest X ray and computed tomographic(CT) scan. Management 1.PreparationManagement2.Treament.PharmacotherapyA. Major depression is usually treated with antidepressant drugs/medication Selective Sero