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Mood Disorders

Mood Disorders. Video – Out of the Shadows. Handout with questions – Descriptions Contributing factors Treatments Your curiosity. Recognizing signs of depression and mania. Consider various domains-handout Varying degrees of severity. Mood Episodes. Major Depressive Episode

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Mood Disorders

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  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 • Major Depressive Disorder • Major depressive episode • Not better accounted for… • No history of manic, mixed or hypomanic episode • Specifiers

  6. 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 • Bipolar Disorder NOS • Mood Disorder due to general medical condition. • Substance-induced Mood Disorder 7. Mood Disorder NOS

  10. Etiology • Exogenous • Endogenous • 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 • Typically used in tx for depressive disorders and substance use disorders alone. • Match the tx to the stage of change or treatment stage: • CBT is most useful during active treatment and relapse prevention.

  12. 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 • Recognize risk factors and respond appropriately • 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. 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 • Read the scenario. • Identify problem behavior. • What are probable antecedents to the bx? • What are the consequences to the bx? • How might you and Melody work with the antecedents or consequences to help her resolve the problem behavior?

  22. Identify problem behavior. • Explore the likely feelings that occur prior to the behavior. • Explore the likely thoughts that occur prior to the feelings. • Challenge these thoughts: are they rational? Accurate? Constructive? Destructive? • 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

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