Mood Disorders Lecture_jm_spr09_class

Mood Disorders Lecture_jm_spr09_class - Mood Disorders and...

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Unformatted text preview: Mood Disorders and Mood Disorders and Suicide Overview Overview What are mood disorders? Theoretical models of depression Treatment for mood disorders Suicide What is a mood disorder? What is a mood disorder? Depression Mania Unipolar vs. bipolar mood disorder Leading cause of disability worldwide DSM­IV­TR Mood Disorders: DSM­IV­TR Mood Disorders: Unipolar Major depressive disorder: occurrence of one or more major depressive episodes Dysthymic disorder: depression that is less severe but more chronic than a major depressive episode Major Depressive Disorder: Major Depressive Disorder: Statistics in the U.S. 25 20 Any 1 Time Women Men % 15 10 5 0 DSM Criteria DSM­IV­TR Criteria for DSM­IV­TR Criteria for Major Depression: > 5 of 9 Symptoms for > 2 Weeks Depressed mood most of the day nearly every day Markedly diminished interest/pleasure in all activities Significant weight loss without dieting Insomnia/hypersomnia nearly every day Psychomotor agitation/retardation Extreme feelings of worthlessness/guilt Diminished ability to concentrate/think Fatigue/loss of energy nearly every day Recurrent thoughts of death or suicide Some Specifiers of Major Some Specifiers of Major Depressive Episodes Mild, Moderate, Severe Chronic Catatonic features Melancholic features Psychotic features Atypical features With seasonal pattern Postpartum onset Dysthymia: Common Dysthymia: Common characteristics Gloomy Doesn’t enjoy things Humorless Pessimistic Low self esteem Tendency to brood Feels guilty DSM­IV­TR Criteria for DSM­IV­TR Criteria for Dysthymic Disorder: Depressed mood most of the day, more days than not, for at least 2 years > 2 of 6 Symptoms while depressed Poor appetite or overeating Insomnia or sleeping too much Low energy Low self­esteem Poor concentration or difficulty in making decisions Feelings of hopelessness Dysthymia Dysthymia Time course Gender differences Prevalence rates “Double depression” DSM­IV­TR Bipolar Disorders DSM­IV­TR Bipolar Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder DSM­IV­TR Criteria for DSM­IV­TR Criteria for Manic Episode Must last at least 1 week with > 3 symptoms: Inflated self­esteem or grandiosity Decreased need for sleep More talkative than usual Flight of ideas Distractibility Increase in goal­directed activity Excessive involvement in pleasurable, but risky activities Bipolar I Bipolar I Occurrence of a MANIC EPISODE Expected that person will have a major depressive episode MDD episode NOT needed for diagnosis! Small minority will never experience depression Bipolar II Bipolar II At least 1 episode of HYPOMANIA Has never been a manic episode At least 1 episode of Major Depression Presence or history of MDD Cyclothymia Cyclothymia Chronic mood disturbance > 2 years Includes both hypomanic episodes and frequent mild periods of depressed mood Risk Factors for Recurrence of Risk Factors for Recurrence of Manic Episodes Younger the age of first manic episode Lower stress level of event associated with first episode Close family members who have any DSM­IV disorder Mood Disorders: Comorbidity Mood Disorders: Comorbidity Alcoholism 40% of those dependent on alcohol have been depressed Etiology: the chicken or the egg? Family incidence studies: Eating disorders Anxiety disorders Theoretical Models of Depression: Theoretical Models of Depression: Causes and Treatments Biological Characteristics Social Factors: Stressful Life Events Psychological Vulnerabilities Biological Etiology of Biological Etiology of Depression Genetics or physiological malfunction ­ 5­HTT serotonin transporter gene ­ hippocampus Heritability is moderate for depression, strong for bipolar disorder Genetic and Family Studies Genetic and Family Studies Concordance for identical (MZ) and fraternal (DZ) twins ­ Unipolar ­ Bipolar Neurotransmitter Deficiencies Neurotransmitter Deficiencies and Depression Serotonin (5­HT) Norepinephrine (NE) Dopamine Social Factors: Stressful Life Social Factors: Stressful Life Events Unipolar Increased number of stressful life events Brown and Harris “Severe” L.E. → Higher rates of depression But, most people still do not develop depression. Who does? Bipolar Increased stressful LE prior to episode Psychological Factors Psychological Factors Cognitive vulnerability Beck’s cognitive triad Cognitive errors Interpersonal factors Social relationships Response styles and gender Biological Treatments Biological Treatments for Depression MAO Inhibitors Tricyclics Selective Serotonin Reuptake Inhibitors (SSRI) Who should take antidepressants? Medication vs. psychotherapy? ECT – when? Psychotherapy: The CBT Psychotherapy: The CBT Approach to Depression Behavioral activation Self­monitoring Activity scheduling Challenging cognitions Identify cognitive errors Challenge negative thoughts An Alternative Therapy: Physical An Alternative Therapy: Physical Activity Short­term and long­term antidepressant effects Why? What are some associations? Combination treatment may be best Biological Treatments for Biological Treatments for Bipolar Disorder Lithium Anticonvulsants First treatment of choice Depakote Tegretol Electroconvulsive Therapy Psychotherapy for Bipolar Psychotherapy for Bipolar Disorders In conjunction with medication CBT or IPT Address reactions to stressful life events Focus on social rhythms, medication compliance Suicide Suicide 11/100,000 deaths in US 15% of clinically depressed people will eventually commit suicide Few attempt without warning Timing of attempt somewhat surprising Suicide: Predictors & Facts Suicide: Predictors & Facts Best predictor: threat of suicide Other good predictors: previous attempts family history hopelessness/negative expectations perfectionism/ extremely high standards for self age sex differences twice as many women try it twice as many men “successful” Parasuicide Parasuicide “Successful” suiciders plan very carefully arranging not to be interrupted Parasuiciders act impulsively make sure of rescue? use methods that is slow to work or completely ineffective Treatment for Suicidal Ideation Treatment for Suicidal Ideation Medication Reduce lethality Negotiate agreement Provide support Replace tunnel vision What to do if you know What to do if you know someone Take it seriously! Do they have a plan? Encourage them to get help immediately: *WPIC Emergency: 412­624­2000 *Resolve Crisis Line: 1­888­7YOUCAN *Clinical Psychology Center: 412­624­8822 *Student Counseling: 412­648­7930 ...
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This note was uploaded on 02/17/2012 for the course PSY 1205 taught by Professor Staff during the Spring '08 term at Pittsburgh.

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