Survey of Modern Psychology

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Survey of Modern Psychology

• Mood Disorders

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The Mood Disorders

• Major Depressive Disorder
• Dysthymic Disorder
• Bipolar
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder
• The mood disorders are built from the presence
  and combinations of mood episodes

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Mood Episodes

• Major Depressive Episode
• Manic Episode
• Hypomanic Episode
• Mixed Episode

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Mood Disorders

• Major Depressive Disorder
• Dysthymic Disorder
• Bipolar Disorder
• Bipolar I
• Bipolar II
• Cyclothymic Disorder

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Major Depressive Disorder

• Lifetime risk
• Women 10 - 25
• Men 5 - 9
• Point prevalence
• Women 5 - 9
• Men 2 - 3

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Major Depressive Disorder Course

• Can begin at any age, but the average is in the
  mid 20s
• The average age of onset has been decreasing
• At least 60 of people who have one Major
  Depressive Episode will have a second
• 70 of people who have had 2 episodes will have a
  third
• 90 of people who have had 3 episodes will have a
  fourth
• 5 - 10 of people with MDD who have one Major
  Depressive Episode develop a Manic Episode

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Depression Treatment

• Therapy
• Traditional talk therapy
• Cognitive behavioral therapy
• Medication
• Most effective in combination with therapy
• Depression is thought to be caused by a shortage
  of serotonin and dopamine circulating in the
  brain
• In severe cases, ECT may be used

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Antidepressants

• MAOIs
• Side effects can include

Eldepryl Marplan
Nardil Parnate
Dizziness Headaches Drowsiness
Insomnia Fatigue Tremors
Twitching Convulsions Constipation
Dry mouth Weight gain Skin irritation
Blurred vision High blood pressure
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Antidepressants

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Side effects include
• These are among the most popular used

Celexa Luvox Paxil
Prozac Zoloft
Decrease in sex drive Fatigue
agitation
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Antidepressants

• Other commonly used antidepressants include
• Wellbutrin
• Ludiomil
• Remerone
• Effexor

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Bipolar I Disorder

• Variations
• Bipolar I Disorder, Single Manic Episode
• Bipolar I Disorder, Most Recent Episode Hypomanic
• There has been at least 1 Manic Episode or Mixed
  Episode in the past
• Bipolar I Disorder, Most Recent Episode Manic
• Bipolar I Disorder, Most Recent Episode Mixed
• Bipolar I Disorder, Most Recent Episode Depressed

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Bipolar II Disorder

• Defined by recurrent Major Depressive Episodes
  with Hypomanic Episodes
• There are no Manic or Mixed Episodes

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Bipolar II Disorder Notes

• Lifetime prevalence is approximately .5
• 60 - 70 of Hypomanic Episodes in Bipolar II
  occur immediately before or after a Major
  Depressive Episode
• The interval between episodes tends to decrease
  with age
• 10 - 15 have rapid cycling
• Over 5 years, approximately 5 - 15 of people
  with Bipolar II will develop a Manic Episode
  (hence new diagnosis of Bipolar I)

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Bipolar Disorders Treatment

• Bipolar disorder is thought to be caused by an
  imbalance of serotonin, dopamine, and
  norepinephrine
• Bipolar Disorder is generally treated with a
  combination of medications and therapy
• Some people with Bipolar Disorder may need to
  take medications for all or most of their lives

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Bipolar Disorders Treatment Mood Stabilizers

• Lithium based medications
• Eskalith
• Lithobid
• Lithonate
• A downside of these medications is that lithium
  levels in the bloodstream need to be carefully
  monitored

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Bipolar Disorders Treatment Mood Stabilizers
Tegretol Neurontin Lamictal
Topamax Depakote

• Side effects include

Gastrointestinal distress Weight gain Decrease in cognition/memory
Nausea Vomiting Tremors
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Bipolar Disorder Treatment

• Antipsychotic medications may also be used,
  particularly to treat mania
• Antidepressants are used sometimes, but may set
  off manic episodes

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Mood Disorder Specifiers

• Mild, Moderate, Severe Without Psychotic Features
• Based on the severity of the symptoms, number of
  symptoms, and impairment
• Severe With Psychotic Features includes delusions
  and/or hallucinations (typically auditory) during
  the episode
• Mood congruent guilt, punishment, somatic
  sensations of death, auditory hallucination of a
  voice berating the person
• Mood incongruent

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Mood Disorder Specifiers

• Full Remission at least 2 months in which there
  are no significant symptoms of depression
• Partial Remission
• Some symptoms are still present, but full
  criteria are no longer met
• There are no significant symptoms, but it has
  been less than two months
• If the Major Depressive Episode was superimposed
  on Dysthymic Disorder, it is recorded as Major
  Depressive Disorder, Prior History
• Chronic in the most recent Major Depressive
  Episode full criteria have been met for at least
  2 years

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Mood Disorder Specifiers

• Catatonic Features
• Melancholic Features
• Atypical Features

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Mood Disorder Specifiers Catatonic Features

• The Clinical picture is dominated by at least two
  of the following
• Motoric immobility as evidenced by catalepsy or
  stupor
• Excessive motor activity
• Extreme negativism
• Peculiarities of voluntary movement as evidenced
  by posturing, stereotyped movements, prominent
  mannerisms, or prominent grimacing
• Echolalia or echopraxia

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Mood Disorder Specifiers Melancholic Features

• Either of the following, occurring during the
  most severe period of the current episode
• Loss of pleasure in all, or almost all,
  activities
• Lack of reactivity to usually pleasurable stimuli
  (does not feel much better, even temporarily,
  when something good happens)

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Mood Disorder Specifiers Melancholic Features

• Three (or more) of the following
• Distinct quality of depressed mood (i.e., the
  depressed mood is experienced as distinctly
  different from the kind of feeling experienced
  after the death of a loved one)
• Depression regularly worse in the morning
• Early morning awakening (at least 2 hours before
  usual time of awakening)
• Marked psychomotor retardation or agitation
• Significant anorexia loss of appetite or weight
  loss
• Excessive or inappropriate guilt

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Mood Disorder Specifiers Atypical Features

• Mood reactivity (i.e., mood brightens in response
  to actual or potential positive events)
• Two (or more) of the following features
• Significant weight gain or increase in appetite
• Hypersomnia
• Leaden paralysis (i.e., heavy, leaden feelings in
  arms or legs)
• Long standing pattern of interpersonal rejection
  sensitivity (not limited to episodes of mood
  disturbance) that results in significant social
  or occupational impairment
• Criteria are not met for With Melancholic
  Features or With Catatonic Features during the
  same episode

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Suicide

• A large percentage of people with mental illness
  attempt or commit suicide
• Particularly common in
• Mood Disorders
• Schizophrenia
• Eating Disorders, especially anorexia
• Borderline Personality Disorder

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Age group, Method, Fatality
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High School Students, Attempts by Gender
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Additional Information About Suicide

• 3rd leading cause of death among
  adolescents/young adults (15-24)
• Fastest growing rates among youth
• 3 times as many women attempt, 3 times as many
  men succeed
• Men are more likely to use violent methods
• Elderly people have the highest suicide rates
• Also higher rates in people with general medical
  conditions

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Additional Information About Suicide

• Depression is the most common diagnosis
• Higher risk among people with bipolar disorder
• Suicide or risky behavior with a high likelihood
  of fatality may occur when the person is in a
  manic phase
• Higher risk among people with substance abuse and
  other dual diagnoses

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Additional Information About Suicide

• Particularly dangerous during the time a person
  is, or seems to be, coming out of a depression
• Before they may have been too depressed to put in
  the energy to act on suicidal impulses
• A person who has decided on committing suicide
  may seem happier because he or she is
  anticipating an end to their pain

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Additional Information About Suicide

• Suicidal ideation is not uncommon in the general
  population
• Affects all groups
• highest rates among white people
• Socio-economic status/income has an ambiguous
  role mixed findings
• Unemployed people have higher rates, but this is
  correlation not causation
• A person may be depressed because they lost their
  job, or the person may not have been able to
  perform at their job due to depression

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Summary and Notes

• Risk factors/protective factors
• Nothing to suggest that theres a seasonal
  increase

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Summary and Notes

• Risk Factors
• Family history of suicide
• Family history of child maltreatment
• Previous suicide attempt(s)
• History of mental disorders, particularly
  depression
• History of alcohol and substance abuse
• Feelings of hopelessness
• Impulsive or aggressive tendencies
• Cultural and religious beliefs (e.g., belief that
  suicide is noble resolution of a personal
  dilemma)
• Local epidemics of suicide
• Isolation, a feeling of being cut off from other
  people
• Barriers to accessing mental health treatment
• Loss (relational, social, work, or financial)
• Physical illness
• Easy access to lethal methods
• Unwillingness to seek help because of the stigma
  attached to mental health and substance abuse
  disorders or to suicidal thoughts

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Summary and Notes

• Protective Factors
• Effective clinical care for mental, physical, and
  substance abuse disorders
• Easy access to a variety of clinical
  interventions and support for help seeking
• Family and community support (connectedness)
• Support from ongoing medical and mental health
  care relationships
• Skills in problem solving, conflict resolution,
  and nonviolent ways of handling disputes
• Cultural and religious beliefs that discourage
  suicide and support instincts for
  self-preservation
• (U.S. Public Health Service 1999)