1. Mood Disorders

2. Video – Out of the Shadows Handout with questions – –Descriptions –Contributing factors –Treatments –Your curiosity

3. Recognizing signs of depression and mania Consider various domains-handout Varying degrees of severity

4. Mood Episodes Major Depressive Episode Manic Episode Mixed Episode Hypomanic Episode Episodes describe sets of sx The pattern of the episodes defines the disorder

5. Depressive Disorders 1.Major Depressive Disorder Major depressive episode Not better accounted for… No history of manic, mixed or hypomanic episode Specifiers

6. 2.Dysthymic Disorder Two year duration (one year in kids) Depressed most of the time At least 2 specific sx <2 months free of sx during 2 or 1 year period No major depressive episode during first 2 or 1 year period No evidence of manic, mixed, hypomanic episodes or cyclothymic d/o Doesn’t occur exclusively during a psychotic d/o Not better accounted for by substance or medical condition Clinically significant distress and/or impairment in functioning Specifier-atypical 3. Depressive Disorder NOS

7. Bipolar Disorders 1. Bipolar I Presence of a manic episode Not better explained by schizoaffective d/o or a part of another psychotic disorder. A variety of specifiers 2. Bipolar II Major depressive episode Hypomanic episode No manic or mixed episode Not better accounted for by…

8. 3. Cyclothymic 2 years of numerous periods with hypomanic sx. and depressive sx, but no major depressive episode. Sx-free no more than two months. No major dep., manic or mixed episode during first two years. Not better accounted for… Not due to substance or medical condition.

9. Others 4.Bipolar Disorder NOS 5.Mood Disorder due to general medical condition. 6.Substance-induced Mood Disorder 7. Mood Disorder NOS

10. Etiology 1.Exogenous 2.Endogenous 3.Vulnerability-Stress model Biological vulnerability Cognitive vulnerability Hopelessness theory Beck’s cognitive distortions Learned helplessness

11. Treatment for depression and s-r d/o-Cognitive-Behavioral Therapy 1.Typically used in tx for depressive disorders and substance use disorders alone. 2.Match the tx to the stage of change or treatment stage: CBT is most useful during active treatment and relapse prevention.

12. 3.Analyze and work with the ABCs of problem behavior. Antecedent-(thoughts, events, people, places, etc.) Behavior Consequence

13. 4. Event to behavior sequence model- Identify the sequence Evaluate thoughts Challenge rationality of thoughts Identify positive alternative thoughts

14. Role playing with “Jim,” pg. 379 Identify cognitive distortions and their consequent feelings. Explain event to behavior sequence model to client. Challenge the thoughts. Help cx develop constructive thoughts.

15. Issues Specific to Mood Disorders Distinguishing mood d/o from substance, medication or medical induced sx is tricky. Assessment includes self-report, along with observation and collateral information. Recognize how common sx of depression are as a consequence of substance use. Suicide risk should be assessed.

16. Bipolar and suicidality Most likely during transition for cx with bipolar S/I=80% S/A=25% S/C=7-19% Intoxication increases impulsivity and impairs judgment, putting person at greater risk.

17. A mnemonic: IS PATH WARM ideation substance abuse purposelessness anxiety trapped hopelessness withdrawal anger recklessness mood changes

18. Your role 1.Recognize risk factors and respond appropriately 2.Assess seriousness of risk-Fig. D-1, pg 330 What is wrong? Why now? How? Where and when? When and with what in the past? Who is involved? Why not now?

19. 3. Consider appropriate responses-low level of risk Talking about it Address particular triggers Contracting Obtaining support from friends/family Identify and plan use of crisis services Explore reasons for not killing self Refer to medication provider-ARNP or psychiatrist

20. 4.Responses with higher level of risk Schedule additional sessions Eliminate potential methods, e.g. weapons, meds, etc. Explore option of voluntary hospitalization Contact CDMHPs for involuntary outpatient or commitment evaluation-206-461-3222 72 hours, 14 days, 90 days inpatient 90 (adult) or 180 (youth) days of outpatient

21. A scenario 1.Read the scenario. 2.Identify problem behavior. 3.What are probable antecedents to the bx? 4.What are the consequences to the bx? 5.How might you and Melody work with the antecedents or consequences to help her resolve the problem behavior?

22. 1.Identify problem behavior. 2.Explore the likely feelings that occur prior to the behavior. 3.Explore the likely thoughts that occur prior to the feelings. 4.Challenge these thoughts: are they rational? Accurate? Constructive? Destructive? 5.Identify positive alternative thoughts.

23. Test Review Stages of change Substance-related disorders: –know the difference between use and induced disorders –be able to describe abuse and dependence Medications: –Important terms –Stepwise treatment –Your role re: meds –Reasons why clients discontinue meds Mood Disorders –Mood episodes –Depressive disorders and Bipolar disorders –Cognitive-behavioral theory – event to behavior sequence model and cognitive distortions