Download Mood Disorders

Mood Disorders
I. DEPRESSION
Symptoms: 5+ over 2 weeks
• sadness
• guilt/remorse/worthlessness
• suicidal thoughts
• anhedonia (lack of pleasure)
• fatigue/lethargy
• sleep/appetite change
• psychomotor retardation/agitation
• impaired cognition (eg, concentration, memory)
Many mimicking illnesses
- Fatigue/slowness (schizophrenia)
use own reaction
- Cognition (Alzheimer’s)
medications
Dysthymia - low-grade depression
• 2+ years
• Can still function
• Feel bad (sleep/appetite, hopelessness,
fatigue, concentration, self-esteem)
Possible Causes
Psychodynamic Theory = “Anger in”
• Anger at others (loss) turned inward
• New model = excess focus on negative
aspects of self
Cognitive
• Cognitive errors & helplessness
• Triad: self, world, future
vs.: Depressive realism
Humanistic = lack of identity/purpose
• when not living authentically, life loses
meaning
• From lack of unconditional positive regard
Learning/Behavioral
• Lack of adequate reinforcers
- Lose reinforcers -> depression
- Depression -> reduce other reinforcers
- Friends pull back, reducing reinforcement
Biological
1.Genetic basis (diathesis-stress)
2.Deficiency of 1+ neurotransmitter(s)
• “catecholamine” & “indolamine” H1s
(norepinephrine) (serotonin)
• Treatment = increase
Explanation is inadequate
• Neurotransmitters interact
• Difference in time to increase vs. to not feel
depressed
Current = “permissive hypothesis"
• Serotonin regulates other neurotransmitters
• Low serotonin = other neurotransmitters
fluctuate more widely
Integrative Theory
Biological Vulnerability
Psychological Vulnerability/Poor Coping
Stressful Life Event
Biological
Activate
hormones
w/effects on
neurotransmitters
Cognitive
Negative
attributions
Cognitive errors
Hopelessness
Mood Disorder
Social
Interpersonal
problems &
poor social
support
Treatment
General
• High recovery rate, even w/o treatment
• 6-18 months
Exercise - link between regular exercise &
reduction in depression
• Increase endorphins?
• Increase personal mastery?
Psychotherapy
• Provides support
• Helps make changes
- Uncover anger towards others
- See own interaction style
- Find meaning & pleasure
• Therapy -> most lasting effects
Antidepressant Medication
• Extremely effective
• 2-3 weeks for effects
• May have to try several
• Likely relapse if just medication
Increase SE, NE, DA
• MAOIs = monoamine oxydase inhibitors
- prevent breakdown of SE, NE, DA
• Tricyclics
- block reuptake of SE, & esp. NE
• SSRIs = selective serotonin-reuptake
inhibitors
- block reuptake of SE
• Current: use SSRIs & other new drugs
• MAOIs: toxicity
=> dietary restrictions
• Tricyclics = danger of overdose
Electroconvulsive Therapy (ECT)
• Last resort
• Can work dramatically
• Induces seizure
• Memory loss, but usually transient
II. Bipolar Disorder
Description - “Manic-depressive illness”
Mania
• Euphoric or irritable mood
3+ over 1 week
• Inflated self-esteem - even psychotic
• Less sleep (high energy, restless)
• Talkative: speech = rapid, pressured, loud
• Thoughts: “flight of ideas”; clang assocs
• Distractible
• Agitation or goal-directed behavior
• Judgment: poor, low inhibitions
(sex, spending, gambling, reckless driving)
Cyclothymic Disorder
= cycles of dysthymia & hypomania
Hypomania
• High energy, low sleep
• Good leaders/high achievers
usually lifelong
• Considered “moody,” “high-strung”
• Bipolar I = mania +/- depression
• Bipolar II = hypomania + depression
- impulsivity & poor judgment
Misdiagnosis
• Mania is hard to sustain -> irritability
- Like unipolar depression
• Psychotic aspect => schizophrenia?
• Also, some bipolars respond to
antipsychotic medication
To distinguish bipolar from schizophrenia
1.Bipolar = periods of normal fx & depression
Schizophrenia = chronic, gradually
deteriorating
2.Bipolar = gregarious
Schizophrenia = solitary
Possible Causes
Psychodynamic
• Mania as defense mechanism
• Depression = superego overworking
• Mania counterbalances low self-esteem of
depression
• Superego (depression) & ego (mania) shift
dominance of personality
Biological - strong genetic basis
• Risk is for general mood disorder
not necessarily Bipolar Disorder
• Requires environmental precipitant
• Excess of norepinephrine?
• Insomnia may trigger manic episodes
-> bodily (circadian) rhythms involved
Treatment
Medication - Lithium carbonate
• Therapeutic level is close to toxic level
• SSRIs can induce mania
Problems
1.Mania can feel good
-> quit medication
-> deny illness & not seek treatment
2.Sometimes responds to antipsychotics
-> increases misdiagnosis
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Psychotherapy
Treat interpersonal/practical problems
Insure adherence to lithium
Psychotherapy alone not tested
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Good effects of psychotherapy + lithium
Family tx + lithium 56% recovered
Lithium alone
20% recovered
Goals = reduce inter-family conflict,
increase support & appropriate behavior
III. SUICIDE
Myth or reality?
1. People who threaten won’t really do it
2. People commit suicide when they are at
the bottom of depression
3. Talking about suicide can give them the
idea
4.People who attempt suicide are crazy
5.People who commit suicide really want to
die
6.People who attempt suicide just want
attention
Risk Factors
Sex
• More women attempt
• More men succeed
Age
• Attempts as young as 2
• Teens (2nd or 3rd leading cause)
• Elderly are most likely
Ethnicity
• Caucasian
• Fewer African/Hispanic Americans
• More Native Americans
Family history
• Genetic basis of depression
• Social learning
Neurobiology
• Low levels of serotonin
-> impulsivity, instability
Psychological disorders
• >90% suicides
• Alcohol abuse
Signs of Suicide Risk
Aspects of Depression
1. Lost ability to concentrate
2. Lack of interest in friends (anhedonia)
3. Change in personality
4. Change in sleep & loss of appetite
Reckless with own life
5. Sexual promiscuity
6. Alcohol or drug abuse
Other
7.Recent loss
8.Giving away of prized possessions (making
will)
9.Writing or talking about death
10. Any mention of suicide (or previous
attempt)
Intervention & Treatment
1. Talk openly -- MOST IMPORTANT
2. Assess the risk
- plan (lethal?)
- means
- time
plan, lethal means, time set -> high risk
3. Make contract
or Involuntary hospitalization
Positive:
crisis often passes
glad they’ve survived
Negative: not their own decision
can’t stop suicide, only delay
4. Treatment - after the crisis
- Deal with precipitating stressor
- Develop better coping
- Build social support
- Treatment for underlying disorder