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Anxiety and Mood Disorders

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Chin Shengt'an's Thirty Three Happy Moments (17th century), 'moments when the ... (Supposedly written while Chin was stuck in a temple for 10 days due to rain. ... – PowerPoint PPT presentation

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Title: Anxiety and Mood Disorders


1
Mood Disorders
2
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 Yutangs 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 Kathes talk

3
The continuums of Mood Disorders
  • Unipolar - Bipolar
  • Chronic - Acute
  • Agitated Slow
  • Neurotic Psychotic

4
Depression symptoms
  • Diagnostic Exercise
  • What are the symptoms and diagnosis?
  • Case studies on the video clips
  • VHS -- Program 8 (Mood Disorders)
  • Faces DVD

5
Depression symptoms
6
Severity and diagnosis
Number of symptoms
Duration
7
Depressive Disorders Double Depression
  • Clinical Description

Dysthymia
Dysthymia
Major Depression
8
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)

9
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

10
Seasonal Pattern
  • SAD
  • Episodes during certain seasons (usually winter)
  • Typically characterized by anergy, hypersomnia,
    overeating, weight gain, and a craving for carbos

11
Bipolar Disorders
  • Major Features
  • Experience Both
  • Manic Episodes
  • Major Depressive Episodes
  • Roller Coaster of Mood

12
Bipolar Disorders
  • Mania and Hypomania
  • Elevated Mood
  • Decreased need for sleep
  • Grandiosity
  • Increased Activity
  • More talkative

13
Causes of Mood Disorders
Biological Psychological Socio-cultural
14
Biological Factors in Mood Disorders
  • Genetic contribution (heritable vulnerability in
    mood disorders). Example Bipolar

15
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)

16
Biological Factors in Mood Disorders
  • Endocrine Factors
  • Stress and its neurochemical impacts
  • Chronic glucocorticoid exposure ? monoamine
    depletion hippocampal cell atrophy (memory
    dysfunction)

17
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
DepressionHelen S. Mayberg, Andres M. Lozano,
Valerie Voon, Heather E. McNeely, David
Seminowicz, Clement Hamani, Jason M. Schwalb, and
Sidney H. KennedyNeuron, Vol 45, 651-660, 03
March 2005
18
Biological Factors (in concert with behavioral
factors) in Mood Disorders
  • Brain factors
  • Effort-driven Rewards Center
  • Nucleus accumbens-striatum-PFC
    (emotion-movement-thinking)
  • Lifestyle-depression link (hypothesis regarding
    increasing depression with decreasing effort /
    use of our hands)

www.kellylambert.com
19
Mood Disorders Psychological Causes
  • Stressful Life Events
  • Learned Helplessness
  • Rumination
  • Attributional Style / Negative cognitions
  • Internal (I blew it)
  • Stable (Ill blow it again)
  • Global (I blow it in tons of situations)

20
Mood Disorders Socio-cultural Causes
  • CD Article (neighborhood characteristics)

21
Social-cultural support
22
Treatments for Mood Disorders
  • Men get depression DVD clips (treatment section)

23
Biological Treatments for Mood Disorders
  • Medication (prescribed and herbal)
  • Electroconvulsive therapy (ECT)
  • Repetitive transcranial magnetic stimulation
  • Vagus nerve stimulation
  • DBS
  • Light therapy
  • Exercise

24
See Manufacturing Depression
25
Treatment of Mood Disorders
  • Medications
  • Tricyclic Antidepressants
  • MAOIs
  • SSRIs
  • Herbal (e.g., St. Johns Wort)
  • Lithium
  • Anti-convulsants

26
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

27
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
    cognitivebehavioral 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 relapserecurrence ,
    but prevalent relapserecurrence 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
    relapserecurrence. 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.
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