MoodDisorders7 edith

MoodDisorders7 edith - Mood Disorders Mood Types Depression...

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Unformatted text preview: Mood Disorders Mood Types: Depression and Bipolar Disorder 1. Unipolar depression = depressive episodes only 2. Bipolar disorder/manic-depressive disorder = cyclical patterns of mania & depressive episodes (diagnosed even without evidence of depression) Diagnosis of Mood Disorders Diagnosis A) Unipolar Depression 1. Major Depression = extremely debilitating episode of depression Could be single episode or recurrent 5 symptoms, 2 weeks or more a) emotional: sad, anhedonia, agitation b) lack of motivation: loss of interest in usual activities c) low activity level: low energy, slow, lack of affect (flat) Diagnosis of Mood Disorders Diagnosis [5 symptoms, 2 weeks or more] d) cognitive: negative self cognitions i.e., self blame, low self-esteem, low self image, sense of helplessness/hopelessness, confusion and poor concentration e) somatic complaints (vegetative signs): weight loss or gain sleep problems – too much or too little loss of sex drive other psychosomatic problems Differential diagnosis: anxiety, grief reaction Diagnosis of Mood Disorders Diagnosis 2) Dysthymia = milder depressive symptoms, less debilitating But, long standing (2 years or more) May be a predisposing factor for major depressive episode Diagnosis of Mood Disorders Diagnosis B) Manic-Depression 1) Bipolar Disorder = experience at least 1 major manic episode Symptoms in similar areas as depression, but opposite: a) elated emotions b) excessive drive and ambition c) grandiose cognitions: extreme self-worth, unrealistic optimism d) Hypermanic behaviors neologisms, clang expressions e) physically “never better” Diagnosis of Mood Disorders Diagnosis 2) Cyclothymia = opposite of dysthymia Bipolar, but less debilitating Long-standing and disruptive Prevalence of Mood Disorders Prevalence A) Unipolar – 6% of U.S. population (well over 10 million people) 2 times more likely in women – Why? B) Bipolar – less common, maybe 1% No gender differences Cognitive Model of Depression Cognitive Though episode may be triggered by an event or loss, it occurs most often for people who have depressive cognitive styles 1. Faulty schema = generalized beliefs about the world Include: expections attributions (negative: global, stable, internal) assumptions: “shoulds” (Ellis) 2. Automatic thoughts form the “cognitive triad” = negative view of (1) self, (2) experiences, (3) the future. 3. Dysfunctional cognitive processes (Beck) a) arbitrary inference b) selective abstraction c) overgeneralization d) magnification and minimization e) personalization Cognitive Model of Depression Cognitive 4. Learned Helplessness (Seligman) Animal studies = unreinforced effort leads to giving up Reformulated model: unsuccessful effort leads to depressotypic attributions Negative events are due to global, stable, and internal causes Some people are predisposed to this “attributional style” Cognitive Therapy for Depression Cognitive 1) First relieve mood - e.g., increase pleasant activities 2) Next, identify and challenge automatic thoughts and distorted cognitions - e.g., conduct experiments to dispute assumptions 3) Finally, address generalized attitudes and thinking styles to prevent recurrence. - e.g., alter attributional style Effectiveness: One of the most effect forms of psychotherapy 50-60% of clients have depression totally lift Works as well as medication May surpass medication in preventing relapse Depression and Grief Depression A) Loss – often triggers onset of depressive episode 1) actual loss: death, relationship, job - grief/despair is normal reaction 2) symbolic loss: esteem, self-worth, etc. Depression and Grief Depression B) Psychodynamic Formulation - Freud & Abraham 1) Not accepting loss/grief leads to regression to oral stage (basic dependency needs) 2) Introject loved one – take on characteristics i.e., symbolically become them to possess them 3) Experience feelings toward loved one as feelings toward self 4) Anger re: desertion now directed at self - creates self-hatred, self-blame 5) “oral dependent” personality (i.e., oral stage fixation) associated with propensity for depression Depression and Grief Depression Psychodynamic Model: Research support: Parental loss < 5yrs. old associated with depression Psychodynamic Psychotherapy (Analysis) - recognize anger re: loss - work-through oral dependency - not effective when low energy for analysis Interpersonal Psychotherapy for Depression Interpersonal 1) Recognize that depression occurs in interpersonal contexts –loss, loneliness, isolation - focus on the context and the specific problems that support the depression. 2) If grief: Work through loss and begin to replace it - “here and now” i.e., no focus on “changing oral dependence” 3) If relationship disputes: Work on dissatisfaction and distress in that relationship 4) If life change (job loss, birth of child): Help with new role demands and stressors 5) If skills deficits: teach relatioship skills, assertiveness, etc. to overcome isolation. Highly effective approach. Behavioral Treatment for Depression Behavioral Lewinsohn - Proposed that depression derives from imbalance of Lewinsohn negative versus reinforcing areas of life. negative Thus, identify sources of pleasure and increase these. Also, extinguish secondary gains for depressive behaviors. Pair with social skills training to improve interpersonal functioning. Biological Models of Depression Biological Catecholamine Theory = llow levels of neurotransmitter norepinephrine are ow responsible for major depression Idoleamine Theory = llow serotonin activation is responsible for ow major depression major (Both seem to be involved) Treatment: Medications Treatment: 1. MAO Inhibitors: inhibit activation of other chemicals that destroy 1. norepinephrine and serotonin. norepinephrine - somewhat dangerous – MAO controls BP 2. Tricyclics: Slow re-uptake of norepinephrine and serotonin in the 2. synapse. synapse. 3. 2nd generation antidepressants: increase sensitivity of 3. norepinephrine and serotonin receptors norepinephrine Medications alone as effective as Cognitive and Interpersonal Medications therapies. therapies. Slide 19 ECT ECT Electrical stimulation to increase neurotransmission in the brain neurotransmission - 6-9 sessions, 2-4 weeks. Bipolar Disorder Bipolar Explanations: 1. No accepted psychogenic theories 2. Biological mechanisms a) over supply of norepinephrine a) over b) but, under supply of serotonin b) under c) neural imbalance of sodium ions - causes excessive neural activity due to excessive causes transmission of impulses down the cell axon down d) can isolate specific chromosomes in families associated with phenotypic mania. associated Treatment of Bipolar Disorder Treatment 1. Lithium – a mineral salt 2. Adjunctive Therapy - increase awareness of nature of disorder - repair damage to relationships, job, etc. ...
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