Chapter 7 - Mood Disorders

Transcription

1 Chapter 7 - Mood Disorders I. DEPRESSION A. Description Symptoms: 5+ constant over 2 weeks - sadness/depressed mood - guilt/remorse/worthlessness - suicidal thoughts - anhedonia (lack of pleasure) - fatigue/lethargy (low energy) - sleep/appetite change - psychomotor retardation/agitation - impaired cognition (< concentration memory, decisions) Many mimicking illnesses - fatigue/slowness (schizophrenia) - use own reaction Dysthymia - low-grade depression - lasting 2+ years (usually ~ 5 years) - can still function - feel bad (sleep/appetite, hopelessness, fatigue, concentration, self-esteem) B. Possible Causes Psychodynamic Theory = Anger in = Anger at others turned inward - lose significant person - angry toward him/her - turn inward to self New model = focus on negative aspects of oneself Humanistic = lack of identity/purpose - when not living authentically, life loses meaning - people get depressed without goals Learning/Behavioral = Lack of reinforcers - lose reinforcers -> depression - depression -> reduce other reinforcers negative cycle - friends withdraw, reducing reinforcement

2 Cognitive - cognitive errors & helplessness triad: self, world, future - vs.: Depressive realism Biological 1. genetic basis (diathesis-stress) 2. deficiency of 1+ neurotransmitter(s) so decreased firing catecholamine & indolamine hypotheses (NE/norepinephrine) (SE/serotonin) -> treatment = increase Explanation is inadequate a. neurotransmitters interact b. not all antidepressants increase NE/SE 3. Current = permissive hypothesis" - serotonin regulates other neurotransmitters - low serotonin = other neurotransmitters fluctuate more widely Integrative Theory Biological Vulnerability Psychological Vulnerability/Poor Coping Stressful Life Event Biological Cognitive Social Activate hormones Negative attributions Interpersonal w/effects on Cognitive errors problems; poor neurotransmitters Hopelessness social support Mood Disorder COMPLEX INTERACTION OF MANY SYSTEMS

3 Treatment General - High recovery rate, even w/o treatment - Most in 6-18 months Exercise - effective - increase endorphins? - increase personal mastery? Psychotherapy - Provides support - Also helps make changes - Uncover anger towards others - Change own behavior & cognitions - Find meaning & pleasure - Therapy -> most lasting effects Antidepressant Medication - extremely effective weeks to work - but relapse if just medication 3 major groups - MAOIs toxicity => dietary restrictions - Tricyclics = danger of overdose * - SSRIs = selective serotonin-reuptake inhibitors Electroconvulsive Therapy (ECT) - last resort - very effective - induces seizure - memory loss

4 II. BIPOLAR DISORDER A. Description - depression & mania Mania - Euphoric mood And 3+ over 1 week - Inflated self-esteem - even psychotic - Decreased sleep (high energy) - Talkative: speech = rapid, pressured, loud - Thoughts: flight of ideas thoughts racing; clang associations - Distractible - Agitation - Judgment: poor, low inhibitions Cyclothymic Disorder = cycles of dysthymia & hypomania Hypomania - high energy, low sleep - good leaders/high achievers - Cyclothymia is usually lifelong - considered moody, high-strung Bipolar I = mania +/- depression Bipolar II = hypomania + depression impulsivity & poor judgment Misdiagnosis - Mania is hard to sustain -> irritability - Psychotic aspect => schizophrenia? 1) Bipolar = periods of normal functioning & depression Schizophrenia = chronic, gradually deteriorating behavior 2) Bipolar = gregarious Schizophrenia = solitary

5 B. Possible Causes Psychodynamic = Mania as defense against guilt - Depression = superego overworking - Mania counterbalances low self-esteem of depression - Superego (depression) & ego (mania) shift dominance of personality Biological - strong genetic basis - Risk is for any mood disorder - Requires environmental precipitant - Excess norepinephrine? - Insomnia may trigger manic episodes -> bodily (circadian) rhythms involved C. Treatment Medication - Lithium - Therapeutic level is close to toxic level - SSRIs can induce mania Problems: 1. Mania can feel good -> quit medication -> deny illness & not seek treatment 2. Some respond to antipsychotics -> increases misdiagnosis Psychotherapy - Treat interpersonal problems - Insure adherence to lithium Research - Psychotherapy alone is ineffective - psychotherapy + lithium is effective Family tx + lithium = 56% recovered Lithium alone = 20% recovered - Goals = reduce family conflict, increase support & appropriate behavior

6 III. SUICIDE A. Myths or reality? 1. People who threaten won t really do it 2. People suicide at depth of depression 3. By talking about suicide, I will give them the idea 4. People who attempt suicide are crazy 5. Suicides really want to die 6. People just want attention B. Possible Causes/Risk Factors 1. Sex 2. Age 3. Ethnicity 4. Family history 5. Neurobiology 6. Psychological disorders & alcohol

7 C. Signs of Suicide Risk Aspects of Depression 1. Poor concentration 2. Anhedonia 3. Personality change 4. Change in sleep & appetite Reckless with own life 5. Sexual promiscuity 6. Alcohol or drug abuse Other 7. Recent loss 8. Giving away possessions & making will 9. Writing or talking about death 10. Mention of suicide or previous attempt D. Intervention & Treatment *** 1. Talk openly -- MOST IMPORTANT 2. Assess the risk - plan (lethal?) - means - time - plan, lethal means, time set -> high risk 3. Make contract (or hospitalize) Positive: crisis often passes glad they ve survived Negative: not their own decision can t stop a suicide, can only delay

8 4. Treatment - after the crisis - Deal with precipitating stressor - Develop better coping (e.g., problem-solving) - Build social support - Treatment for underlying disorder

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