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Mood Disorders

Mood Disorders. I. DEPRESSION Symptoms : 5+ over 2 weeks sadness guilt/remorse/worthlessness suicidal thoughts anhedonia (lack of pleasure) fatigue/lethargy sleep/appetite change psychomotor retardation/agitation impaired cognition (eg, concentration, memory). Many mimicking illnesses

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Mood Disorders

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  1. Mood Disorders I. DEPRESSION Symptoms: 5+ over 2 weeks • sadness • guilt/remorse/worthlessness • suicidal thoughts • anhedonia (lack of pleasure) • fatigue/lethargy • sleep/appetite change • psychomotor retardation/agitation • impaired cognition (eg, concentration, memory)

  2. Many mimicking illnesses • Fatigue/slowness (schizophrenia) use own reaction - Cognition (Alzheimer’s) medications

  3. Dysthymia - low-grade depression • 2+ years • Can still function • Feel bad (sleep/appetite, hopelessness, fatigue, concentration, self-esteem)

  4. Possible Causes Psychodynamic Theory = “Anger in” • Anger at others (loss) turned inward • New model = excess focus on negative aspects of self

  5. Cognitive • Cognitive errors & helplessness • Triad: self, world, future vs.: Depressive realism

  6. Humanistic = lack of identity/purpose • when not living authentically, life loses meaning • From lack of unconditional positive regard

  7. Learning/Behavioral • Lack of adequate reinforcers - Lose reinforcers -> depression - Depression -> reduce other reinforcers - Friends pull back, reducing reinforcement

  8. Biological 1. Genetic basis (diathesis-stress) 2. Deficiency of 1+ neurotransmitter(s) • “catecholamine” & “indolamine” H1s (norepinephrine) (serotonin) • Treatment = increase

  9. Explanation is inadequate • Neurotransmitters interact • Difference in time to increase vs. to not feel depressed

  10. Current = “permissive hypothesis" • Serotonin regulates other neurotransmitters • Low serotonin = other neurotransmitters fluctuate more widely

  11. Integrative TheoryBiological VulnerabilityPsychological Vulnerability/Poor CopingStressful Life Event Biological Cognitive Social Activate Negative Interpersonal hormones attributions problems & w/effects on Cognitive errors poor social neurotransmitters Hopelessness support Mood Disorder

  12. Treatment General • High recovery rate, even w/o treatment • 6-18 months Exercise - link between regular exercise & reduction in depression • Increase endorphins? • Increase personal mastery?

  13. Psychotherapy • Provides support • Helps make changes - Uncover anger towards others - See own interaction style - Find meaning & pleasure • Therapy -> most lasting effects

  14. Antidepressant Medication • Extremely effective • 2-3 weeks for effects • May have to try several • Likely relapse if just medication

  15. Increase SE, NE, DA • MAOIs = monoamine oxydase inhibitors - prevent breakdown of SE, NE, DA • Tricyclics - block reuptake of SE, & esp. NE • SSRIs = selective serotonin-reuptake inhibitors - block reuptake of SE

  16. Current: use SSRIs & other new drugs • MAOIs: toxicity => dietary restrictions • Tricyclics = danger of overdose

  17. Electroconvulsive Therapy (ECT) • Last resort • Can work dramatically • Induces seizure • Memory loss, but usually transient

  18. II. Bipolar Disorder Description - “Manic-depressive illness” Mania • Euphoric or irritable mood

  19. 3+ over 1 week • Inflated self-esteem - even psychotic • Less sleep (high energy, restless) • Talkative: speech = rapid, pressured, loud • Thoughts: “flight of ideas”; clang assocs • Distractible • Agitation or goal-directed behavior • Judgment: poor, low inhibitions(sex, spending, gambling, reckless driving)

  20. Cyclothymic Disorder = cycles of dysthymia & hypomania Hypomania • High energy, low sleep • Good leaders/high achievers usually lifelong • Considered “moody,” “high-strung”

  21. Bipolar I = mania +/- depression • Bipolar II = hypomania + depression - impulsivity & poor judgment

  22. Misdiagnosis • Mania is hard to sustain -> irritability - Like unipolar depression • Psychotic aspect => schizophrenia? • Also, some bipolars respond to antipsychotic medication

  23. To distinguish bipolar from schizophrenia 1. Bipolar = periods of normal fx & depression Schizophrenia = chronic, gradually deteriorating 2. Bipolar = gregarious Schizophrenia = solitary

  24. Possible Causes Psychodynamic • Mania as defense mechanism • Depression = superego overworking • Mania counterbalances low self-esteem of depression • Superego (depression) & ego (mania) shift dominance of personality

  25. Biological - strong genetic basis • Risk is for general mood disorder not necessarily Bipolar Disorder • Requires environmental precipitant • Excess of norepinephrine? • Insomnia may trigger manic episodes -> bodily (circadian) rhythms involved

  26. Treatment Medication - Lithium carbonate • Therapeutic level is close to toxic level • SSRIs can induce mania

  27. Problems 1. Mania can feel good -> quit medication -> deny illness & not seek treatment 2. Sometimes responds to antipsychotics -> increases misdiagnosis

  28. Psychotherapy • Treat interpersonal/practical problems • Insure adherence to lithium • Psychotherapy alone not tested

  29. Good effects of psychotherapy + lithium • Family tx + lithium 56% recovered • Lithium alone 20% recovered • Goals = reduce inter-family conflict, increase support & appropriate behavior

  30. III. SUICIDE Myth or reality? 1. People who threaten won’t really do it 2. People commit suicide when they are at the bottom of depression 3. Talking about suicide can give them the idea

  31. 4. People who attempt suicide are crazy 5. People who commit suicide really want to die 6. People who attempt suicide just want attention

  32. Risk Factors Sex • More women attempt • More men succeed Age • Attempts as young as 2 • Teens (2nd or 3rd leading cause) • Elderly are most likely

  33. Ethnicity • Caucasian • Fewer African/Hispanic Americans • More Native Americans Family history • Genetic basis of depression • Social learning

  34. Neurobiology • Low levels of serotonin -> impulsivity, instability Psychological disorders • >90% suicides • Alcohol abuse

  35. Signs of Suicide Risk Aspects of Depression 1. Lost ability to concentrate 2. Lack of interest in friends (anhedonia) • Change in personality • Change in sleep & loss of appetite

  36. Reckless with own life 5. Sexual promiscuity 6. Alcohol or drug abuse

  37. Other 7. Recent loss 8. Giving away of prized possessions (making will) 9. Writing or talking about death 10. Any mention of suicide (or previous attempt)

  38. Intervention & Treatment 1. Talk openly -- MOST IMPORTANT • Assess the risk - plan (lethal?) - means - time plan, lethal means, time set -> high risk

  39. Make contract or Involuntary hospitalization Positive: crisis often passes glad they’ve survived Negative: not their own decision can’t stop suicide, only delay

  40. Treatment - after the crisis - Deal with precipitating stressor - Develop better coping - Build social support - Treatment for underlying disorder

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