Transcript Anxiety and Mood Disorders

33 Happy Moments
•Write 33 Happy Moments!
•Background of “33 Happy Moments”
 Chin Shengt'an's Thirty Three Happy Moments (17th
century), "moments when the spirit is inextricably tied up with the
senses." (Supposedly written while Chin was stuck in a temple for 10
days due to rain.)
 Referred to in Lin Yutang’s The importance of living (1937) in
which Lin describes happiness as “sensuous” – meaning coming
from the senses. And that we recognize that we must
enjoy/honor the senses throughout our lives (30,000 mornings).
Relate this to Kathe’s talk
The continuums of
Mood Disorders
Unipolar - Bipolar
Chronic - Acute
Agitated – Slow
Neurotic – Psychotic
Depression symptoms
Diagnostic Exercise
What are the symptoms and diagnosis?
a. Case studies on the video clips
1.
VHS -- Program 8 (Mood Disorders)
2.
Faces DVD
Depression symptoms
• Cognitive
• Poor concentration, indecisiveness,
poor self-esteem, hopelessness,
suicidal thoughts, delusions,
memory problems
• Physiological and
Behavioral
• Sleep or appetite disturbances,
psychomotor problems, fatigue,
• Emotional
• Sadness,anhedonia (loss of interest
or pleasure in usual activities),
irritability
Duration
Number of
symptoms
Severity and diagnosis
Major Depression
Dysthymic Disorder
5 or more symptoms
including sadness or
loss of interest or
pleasure
3 or more symptoms
including depressed
mood
At least 2 weeks in
duration
At least 2 years in
duration
 Clinical Description
Dysthymia
Dysthymia
Major
Depression
Feature Specifiers in Mood
Disorders
Melancholic
– Occurs within Major Depressive
Episode
– Near-complete absence of the
capacity for pleasure
– Strong biological component (e.g.,
psychomotor retardation; early
morning awakening; significant
anorexia)
Postpartum Onset
– Onset within four weeks following birth
– Spontaneous crying long after the usual duration
of “baby blues” (3-7 days postpartum)
– Lability of mood -- can be of a psychotic nature
– Suicidal ideation
Seasonal Pattern
– SAD
– Episodes during certain seasons
(usually winter)
– Typically characterized by anergy,
hypersomnia, overeating, weight
gain, and a craving for carbos
 Major Features
Experience Both
– Manic Episodes
– Major Depressive Episodes
Roller Coaster of Mood
 Mania and Hypomania
 Elevated Mood
 Decreased need for sleep
 Grandiosity
 Increased Activity
 More talkative
Causes of Mood Disorders
Biological
Psychological
Socio-cultural
Biological Factors in
Mood Disorders
• Genetic contribution (heritable vulnerability in mood disorders).
Example: Bipolar
70
60
50
40
30
20
10
0
MZ twins
DZ twins
Sibs, parents,
children
Biological Second-degree
parents of BP
relatives
adoptees
General
population
Biological Factors in
Mood Disorders
• Neurotransmitters
•Monoamines – Dopamine, Norepinephrine, Serotonin
• Evidence
•Reserpine (hypotensive agent)  breakdown of monoamine storage in
vesicles  depression
•Antidepressants work on increasing MAs
•MAO Inhibitors
•SSRIs
•Decreased CSF levels of 5-HIAA in patients with severe depression
(and in completed suicides, post-mortem analysis)
Biological Factors in
Mood Disorders
• Endocrine Factors
•Stress and its neurochemical impacts
•Chronic glucocorticoid exposure  monoamine depletion &
hippocampal cell atrophy (memory dysfunction)
Biological Factors in
Mood Disorders
• Brain factors
•Activity in the multi-nodal depression “circuit” (i.e.,
connections between and among the PFC, nucleus
accumbens, overactive anterior cingulate cortex [Cg25])
Deep Brain Stimulation for Treatment-Resistant Depression
Helen S. Mayberg, Andres M. Lozano, Valerie Voon, Heather E.
McNeely, David Seminowicz, Clement Hamani, Jason M. Schwalb,
and Sidney H. Kennedy
Neuron, Vol 45, 651-660, 03 March 2005
Biological Factors (in concert with behavioral factors)
in Mood Disorders
• Brain factors
• Effort-driven Rewards Center
• Nucleus accumbens-striatum-PFC (emotion-movementthinking)
• Lifestyle-depression link (hypothesis regarding increasing
depression with decreasing effort / use of our hands)
www.kellylambert.com
 Stressful Life Events
 Learned Helplessness
 Rumination
 Attributional Style / Negative
cognitions
 Internal (“I blew it”)
 Stable (“I’ll blow it again”)
 Global (“”I blow it in tons of situations”)
CD Article (neighborhood
characteristics)
Social-cultural support
Treatments for Mood Disorders
• Men get depression DVD clips (treatment
section)
Biological Treatments for Mood
Disorders
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Medication (prescribed and herbal)
Electroconvulsive therapy (ECT)
Repetitive transcranial magnetic stimulation
Vagus nerve stimulation
DBS
Light therapy
Exercise
See “Manufacturing Depression”
 Medications
 Tricyclic Antidepressants
MAOI’s
SSRI’s
Herbal (e.g., St. John’s Wort)
Lithium
Anti-convulsants
Psychological Treatments for
Depression
• Behavioral Therapy
– Increase positive reinforcers and decrease aversive events by teaching the
person new skills for managing interpersonal situations and the environment
• Cognitive-Behavioral Therapy
– Challenge distorted thinking and help the person learn more adaptive ways
of thinking and new behavioral skills
• Interpersonal
• Existential
• Psychodynamic Therapy
– Help the person gain insight to unconscious factors to facilitate change in
self-concept and behaviors
Cycle of Psychological Treatments
The risk of suicide and life interference can be reduced by shortening
the duration of MDEs with effective acute-phase treatments,
including pharmacotherapy, interpersonal psychotherapy, and
cognitive–behavioral therapy . We define acute-phase treatments
as those applied during an MDE with the goal of reducing
depressive symptoms and producing initial remission. Responders
to some acute-phase treatments (e.g., CT) may receive some
protection from relapse–recurrence , but prevalent relapse–
recurrence after successful antidepressant treatments has long been
recognized as a serious limitation of these interventions
Consequently, continuation-phase treatments (e.g.,
pharmacotherapy, interpersonal psychotherapy, CT) may be
applied to sustain remission of an MDE and reduce the probability
of relapse–recurrence. Continuation-phase treatments can match
the “modality” used in the acute phase or differ in modality
compared with the acute-phase treatment (e.g., acute-phase
pharmacotherapy followed by C-CT
Vittengl et al., JCCP, Vol 75(3), Jun 2007. pp. 475-488.