Presentation on theme: "Mood Disorders M Anne Washington Derry (1927) Oil on canvas"— Presentation transcript:
1Mood Disorders M Anne Washington Derry (1927) Oil on canvas by Laura Wheeler Waring( )
2Mood Disorders Depressive Disorders Bipolar Spectrum Disorder Cyclothymiacs DisorderMood Disorder duo to GMCSubstance induced mood disorder.
3Depressive Disorders Major Depressive Disorder (single, recurrent) [Major Depressive Disorder: Postpartum onset]**Dysthymic DisorderDouble Depression**Postpartum depression will also be a specifier for bipolar disorder.
4Major Depressive Disorder: Diagnostic Criteria 5 of following symptoms, must include one of first two, occurred almost every day for two weeks lead to dysfunctionDepressed moodPleasure or interest/ LossAppetiteSleep disturbance, too much or too littleAgitation or retardationFatigue or loss of energyFeelings of worthlessness or guiltDifficulty concentrating or decidingRecurrent thoughts of death or suicidal thought
8Other Classification Melancholic Atypical Chronic(more than 2 yr) With seasonal pattern.Post partum onsetWith CatatoniaDouble depressionSub clinical depression(Minor depression)With psychotic feature
9Dysthymic Disorder: Symptoms Depressed/irritable moodPresence of two of the following:Appetite disturbanceSleep disturbanceLow energy/fatiguePoor concentration of difficulties making decisionFeelings of hopelessnessC. Present for two year period (one year in children and adolescents)D. No evidence of a Major Depressive Epidsode during the first two years (one year for children)E. No manic or hypomanic episodeF. No chronic psychotic disorderG. Not related to organic factors
10Dysthymic Disorder Early Onset: before 21 year old Late Onset : after 21 year oldWith or Withought Atypical feature.
11“Double Depression” Not a diagnosis Meet diagnostic criteria for both MDD and Dysthymic Disorder
12Manic Episode: Diagnostic Criteria A distinct period of abnormally and persistently elevated, expansive, or irritable moodMood disturbance plus three of the following symptoms (four if the mood is only irritable):Inflated self esteem or grandiosityDecreased need for sleepMore talkative than usual or pressure to keep talkingFlight of ideas, or racing thoughtsDistractibilityIncrease in goal directed activityExcessive involvement in pleasurable activitiesMarked impairmentNo psychosisNot organic
13Hypomania: Diagnostic Criteria All the criteria of a Manic episode except criterion C (marked impairment)
14Bipolar Disorder Bipolar I Alternation of full manic and depressive episodesAverage onset is 18 yearsTends to be chronicHigh risk for suicideBipolar IIAlternation of Major Depression with hypomaniaAverage onset is 22 yearsTends to be chronic10% progess to full biploar I disorder
15CyclothymiaFor at least two years (one year for children and adolescents) presence of numerous hypomanic episodes and numerous periods with depressed mood or loss of interest or pleasure that did not meet criterion A (5 symptoms) of Major DepressionDuring a two-year period (1 year in children and teens) of disturbance, never without hypomanic or depressive symptoms for more than tow months at a timeNo evidence of MDD or Manic episode during the first two years of disturbanceNo psychotic disorderNo organic cause
16Mood Disorders: Summary Depressive DisordersMajor Depressive Disorder (single, recurrent)[Major Depressive Disorder: Postpartum onset]**Dysthymic DisorderBipolar DisordersBipolar I DisorderBipolar II DisorderCyclothymic Disorder
17Mood Disorders: Prevalence Life Time Major DepressionDysthymiaBipolar IBipolar IIMDD (Postpartum)Prevalencemale: 5 – 12 %Female : %6%0.8%- 1.6%0.5%13%
18Epidemiology Life time prevalence : High(10-25%) Gender: Female more than Male(2, times)
19Differential Diagnosis Mood Disorder due to GMC (Hypothyroidism)Substance Induced Mood Disorder (Amphetamine , Steroids ,…)SchizophreniaGriefPersonality DisorderAdjustment Disorder
20Prognosis 50% attempt Suicide Un treated depression get 10 mo or more to recover75% have recurrence.5 Episode occurs long life50% full recovery.30% partial remission.20% tend to be Chronic20%-30% of Dystymic Disorder go to MDD or BMD
21Major Depressive Disorder: Etiological Theories Biological (genetic, brain structures, neurotransmitters)Behavior and cognitionEmotionSocial and cultural factorsDevelopmental factors
22Major Depression: Genetics Family studies:Relatives of those with a mood disorder are two to three times more likely to have a mood disorder (usually major depression)Twin studies:If one identical twin has a mood disorder the othe twin is 3 times more likely than a fraternal twin to have a mood disorder (particulrly for bipolar disorder)
23Major Depression: Genetics Severe mood disorders may have stronger genetic contribution than less severe disordersHeritability rates are higer for females
24Major Depression: Neurotransmitters Low levels of serotonin deregulates the activity of other neurotransmitters such as Dopamine & NE.Imbalance in cortisole & TSH
26Learned HelplessnessAttribution of lack of control over stress leads to anxiety and depressionDepressive attributional style is internal, stable, and global
27Negative Cognitive Styles Aaron Beck Depression is the result of negative interpretations (wearing gray instead of rose colored glasses, e.g. Eyore in Winnie the Pooh)Key Components of Negative InterpretationsMaladaptive attitudes (negative schema)Automatic thoughtsCognitive triadErrors in thinking
28Seligman and Beck Seligman Attributions are: Internal Stable Global I am inadequate (internal) at everything (global) and I always will be (stable).“Dark glasses about why things are bad”Interpretation (theory)BeckNegative interpretations about:ThemselvesImmediate world (their place)Future (their place)I am not good at school (self). I hate this campus (world). Things are not going to go well in college (future).“Dark glasses about what is going on”Description
29Major Depression: Social and Cultural Factors Stressful life eventsSocial support (marital relationship) (see chart)GenderCulture (see chart)
31Ethnicity and Prevalence of MDD Percentage by Ethnicity
32Treatment Major Depression: Overview Biological TreatmentsMedicationECTSpecial note about antidepressants and childrenPsychological TreatmentsCognitive TherapiesInterpersonal Psychotherapy (IPT)NIMH Collaborative Treatment Study
34Antidepressant Medication with Children The effectiveness of antidepressant medication with children is questionable.December 2003 British drug regulators told physicians to stop writing perscriptions for all but one of the newer generation of antideressant drugs to treat children under 18.Benefit did not outweigh the risks (including suicidal thoughts and behavior and agression)Prozac was exempted.
35Controversy Pro Medication Cost of untreated depression is high Depression itself is lethal (particularly in teens)Indisputable proof that it works in their own clientsQuestioned the adequacy of the studiesAnti MedicationReview of 11 studies of effects of medication in children revealed that the risks outweigh the benefitsEvidence based practice is guided by the results of research not clinician’s opinions
38Depression Collaborative Research Program Many Controversial Issues Treatment GroupsCognitive TherapyInterpersonal PsychotherapyMedicationImipriminePlacebo & Clinical ManagementOutcome MeasuresDepressive SymptomsOverall symptomotology and life functioningFunctioning in treatment specific domainsProcedures16 weeks of treatmentExtensive Assessment:TResultsFollow-up-18 monthsEquivalent success in three active treatmentsOnly 20 to 30% of recovered patients were still wellPatients in IPT report more satisfaction with treatmentIPT and CBT patients more likely to report that treatment affected capacity to establish and maintain relationships and to understand source of their depressionResults:Post-TreatmentEquivalent success in three active treatments over placeboMedication was fasterIPT better than CBT for more severely depressed patientsParticular treatments effected change in expected domainsMany Controversial Issues
39Childhood Onset Depression Special Topic 1Childhood Onset Depression
40Childhood Onset Depression: Historical Aspects Initial ViewPsychoanalytic: developmentally children could not experience depressionSadness results from loss of valued object/personSadness results in hostility and aggressionDepression is result of inward hostilityChildren lack superego development to direct aggression toward self
46Suicide 8th leading cause of death in the U.S. Overwhelmingly white phenomenaSuicide rates also quite high in Native AmericanRate of suicide is increasing in adolescents and elderlyMales are more likely to commit suicideFemales are more likely to attempt suicide (except China)
47Suicide: A Sociological Typology Emile Durkeim Formalized or altruistic suicideEgoistic suicideAnomic suicidesFatalistic suicideSanctioned suicideDisintegration of social supportMajor disruptionLoss of control of one’s destiny (mass suicide’s)
485 Myths and Facts About Suicide People who talk about killing themselves rarely commit suicide.Fact:Most people who commit suicide have given some verbal clues or warnings of their intentions
495 Myths and Facts About Suicide The suicidal person wants to die and feels there is no turning back.Fact:Suicidal people are usually ambivalent about dying; they may desperately want to live but can not see alternatives to problems.
505 Myths and Facts About Suicide If you ask someone about their suicidal intentions, you will only encourage them to kill themselves.Fact:The opposite is true. Asking lowers their anxiety and helps deter suicidal behavior. Discussion of suicidal feelings allow for accurate risk assessment.
515 Myths and Facts About Suicide All suicidal people are deeply depressed.Fact:Although depression is usually associated with depression, not all suicidal people are obviously depressed. Once they make the decision, they may appear happier/carefree.
525 Myths and Facts About Suicide Suicidal people rarely seek medical attention.Fact:75% of suicidal individuals will visit a physician within the month before they kill themselves.
53Sociodemographic Risk Factors Male> 60 yearsWidowed or DivorcedWhite or Native AmericanLiving alone (social isolation)Unemployed (financial difficulties)Recent adverse life eventsChronic Illness
54Clinical Risk Factors Previous Attempts Clinical depression or schizophreniaSubstance AbuseFeelings of hopelessnessSevere anxiety, particularly with depressionSevere loss of interest in usual activitiesImpaired thought processImpulsivity
55Assessing Risk and Planning Intervention LevelSpecificPlanRisk FactorsSeverityIntentInterven.LowNoFewNoneSafety PlanMod.VaguePlan/low lethalIncreasedSeverelethal planRemove Lethal ItemsExtremeSpecific lethal planIntent to dieHospitalize
56Clinical Considerations of Suicide Assessment For those who are reluctant to assess suicide:Asking questions may feel intrusive but not asking has dangerous consequencesA calm and genuinely concerned approach is effective