Download Disorders Related to Emotional State or Mood

Disorders Related to
Emotional State or Mood
Assessment and Diagnosis
SW 593
Introduction
• The term “mood” refers to an internally
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experienced emotional state that influences an
individual’s thinking and behavior.
The term “affect” refers, more specifically to the
external demonstration of one’s mood or
emotions.
This distinction is important because affect and
mood may differ; people do not always display
accurately in their affect what their mood
actually is.
Introduction
• This section of DSM is generally organized
around four different types of episodes (a
period of time during which a client
evidences a particular set of symptoms;
experiences a pronounced alteration in
mood)
• Functioning in social, interpersonal, and
vocational arenas is affected.
Introduction
• Two diagnoses are determined by the etiological
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factors relevant to the mood disorder (Mood
Disorder due to a General Medical Condition;
Substance-Induced Mood Disorder).
The most disruptive disorders include Major
Depression, Bipolar I and Bipolar II.
Each is based on the number and pattern of
episodes the individual has experienced in their
lifetime.
Introduction
• In the coding of each disorder, attention is given
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to the severity of symptoms, the overall number
of episodes and specific characteristics of the
most recent episode.
The Mood disorder section of DSM includes a
comparatively large number of specifiers,
including some that are reflected in the fourth
and fifth digit of the numeric coding.
Assessment
• Particular attention will be focused on the
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person’s emotional functioning when assessing
for a mood disorder.
Someone with a history of psychiatric treatment
may fear rehospitalization and deliberately
minimize symptoms.
Often it is helpful to gather data from collateral
sources such as close friends or relatives,
employers, or other professionals to specify both
the timing and severity of symptoms.
Assessment
• Assessment Instruments:
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Beck Depression Inventory II
Hamilton Rating Scale for Depression
Geriatric Depression Scale
Hopelessness Scale for Children
• For mania:
– Internal State Scale
– Self Report Manic Inventory
– Young Mania Rating Scale
Emergency Considerations
• People experiencing the more severe mood
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disorders may constitute a danger for
themselves or others.
Thoughts about self-destruction are among the
criteria for determining the presence of a major
depressive episode and are not at all
uncommon.
An assessment of suicide risks is of great
importance both at the time of initial contact
and on a consistent ongoing basis throughout
treatment.
Emergency Considerations
• In some major depressive episodes and in
most manic episodes some degree of
psychosis is present.
• Practitioners must attend to issues about
the client’s safety and secure whatever
level of supervision and treatment is
necessary.
Cultural Considerations
• Some cultures are more likely to express
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emotional states in somatic terms.
This may be related to a fear that emotions like
depression or anxiety will be interpreted as weak
or “crazy”.
In some cultures it is more acceptable to
complain of a variety of physical symptoms
rather than acknowledge negative moods.
Cultural Considerations
• Complaints of “nerves” or “headaches” may
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relate to negative moods among Latino clients.
Bilingual clients may appear to have more or
less symptomatology depending on the
language of the practitioner.
Another caution about misdiagnosis relates to
the tendency for minority group members to
receive more serious or more stigmatizing
psychiatric labels.
Cultural Considerations
• Caucasians are more likely to be
diagnosed with Bipolar I Disorder while
minority clients with the same symptom
presentation are diagnosed with
Schizophrenic Disorders.
Social Support Systems
• Conflicts between family, friends, and the person
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with the disorder can arise due to disruptive
thoughts, behaviors and extreme mood swings
on the part of the symptomatic individual.
An assessment of the person’s family or friends
is important for the practitioner to obtain to get
a clear picture of the support available to the
person coping with the illness.
Social Support Systems
• Family members and friends need to have
accurate information about the disorder
including where to obtain help in times of
a crisis.
• Psychoeducational groups for individuals
with similar problems may be an
additional source of support for the person
suffering from a mood disorder.