Mood Disorders 21 05 2012 06 54 00 Major Depression Lifetime 16 1 Women 2 3x more Dysthymia Lifetime 3 5 women 2 3x more Bipolar Disorder Lifetime 1 3 Women 0 9 Men 0 7 Bipolar II Disorder Lifetime 1 men women 1 1 Cyclothymia Lifetime less than 1 the least common men women 1 1 Possible Neurological Influences Damage or less electrical activity to left prefrontal cortex Increased activity in amygdala increased focus on negative stimuli and decrease in hippocampus activity Seasonal Affective Disorder experience depression due to lack of sunlight which occurs in extreme northern southern climates o 1 Exposure to light decreases melatonin less sleep o 2 Melatonin increases the winter as darkness increases but only those with the disorder normals have regular levels o 3 Light therapy helps Stressful Life Events Severe stressful life events play a causal role in 25 50 of depression causes Women who were at genetic risk for depression were 3x more likely to develop depression after stressful events than low genetic risk women Bipolar and Unipolar Rates of suicide for Bipolar Disorder are 12 15x higher than the general population and 4x higher for Major Depression In a survey of 253 Bipolar 1 and 2 patients 57 were unable to be Bipolar patients with high stress trauma histories were more likely gainfully employed to relapse Bipolar Disorder patients that come from families with high negativity and critical hostility had high rates of relapse Rates of recurrence even when treated with psychotropic medication are 37 in 1 year 60 in 2 years and 73 in 5 years For Major Depression Those that experience 1 episode have a 37 chance of a second episode those with 2 episodes have a 48 chance of developing a 3rd episode each additional episode is increased by 15 The earlier that depression starts the more likely for recurrent relapses Causes of Unipolar disorder Biological Genetics 31 42 Neurotransmitters more often cited serotonin norepinephrine but this is not conclusive Early adversity and chronic negative circumstances Learned Helplessness and Attribution Theory Internal vs External o Bad Internal o Good External Stable vs Unstable o Bad Stable o Good Unstable Global vs Specific o Bad Global o Good Specific Becks cognitive theory A T Beck Thoughts I cant do anything right My future sucks I know it Emotions Depression Hopelessness Helplessness Behaviors Give up Isolation substance abuse Depressive Personality Born to be negative Poverty low education and unemployment linked to depression Causes of Bipolar Disorder Genetic 72 identical twins 14 fraternal twins Neurotransmitters most have been implicated Stress can trigger bipolar disorder especially mania Social Rhythm Stability Hypothesis o Problem in regularity in daily activity in sleep wake cycles o Sleep problems can trigger manic episodes as well as eating rest and stress seasons and bright lights Ions not functioning well within neurons sodium and potassium depletion Behavior Activation System being excessively on Mood Disorders Treatment Depression TX depressions o Cognitive Behavioral Therapy is best for mild moderate o ECT works for some that will respond to nothing else But there is STM loss and for some LTM loss and confusion Does not cause and initial seizure and convulsions High rates or relapse without any other treatment after ECT o Transcranial Magnetic Stimulation place a magnetic coil over the head to create an electromagnetic pulse Less side effects but does not work well as well as ECT o SSRI s 50 receive some benefit 1 2 are close to normal functioning An increased risk for suicide in children and adolescents Bipolar Disorder Treatment Lithium salt helps replenish electrolytes potassium sodium or helps in signaling neurotransmitters o Good fro treating and preventing mania May take 1 2 weeks Anticonvulsants Depakote is very popular Not a good as Lithium in to work preventing suicide SSRI s Signs of Mania Episode Sleep problems Decrease in anxiety not concerned exams don t matter Everything will work out attitude don t think things through Change in dress more sexual more shopping partying more Concentration changes cannot read changes activities quickly Extremely talkative misses social cues other doesn t want to talk Help for Bipolar Clients o Know when they are changing know warning signs not on o Monitor stress shifts jet lag sleep trouble break ups finals o Dysfunctional Cognitions overestimate self abilities underestimate risk minimize obligations rely on luck Try to ground with facts o Get feedback from at least 2 people before you do anything Sleep Stages 5 We dream about 90 minutes a night no matter if we remember or Stage 1 light sleep Stage 2 Stage 3 Stage 4 deep sleep REM Sleep dream We cycle through the sleep cycle several times a night 7 8 They change as the night goes on REM increases as the night goes Quality sleep is better than quantity sleep Block REM sleep Alcohol drugs sleeping meds Must have REM for good mental health Sleep Disorders Dyssomnias problems in getting to sleep staying asleep or quality Primary Insomnia difficulty going to sleep poor sleep or non o 1 Cannot be related to another medical or psychiatric of sleep refreshing sleep disorder Causes over Treatment o 2 1 3 of Americans suffer from insomnia 58 of lifetime o 3 Children 25 40 Middle Age 21 Old Age 26 o Women experience 2x more o Biology sleep apnea physical pain hormones women suffer more insomnia during pregnancy and menopause o Environmental change in routine or place vacation people o Psychological stress worry depression drug use o Relaxing period before bed o Get up if not asleep in 15 20 minutes o No caffeine No large meals o Stop studying or exercising at least 1 hour before bed o No naps stay on schedule o STOP WORRYING Examine worries that keep you up o Teach relaxation skills knows difference between relaxation and tension o Watch drug and alcohol intake need REM o Make the bedroom a positive place o Look at negative cognitions I will never get to sleep Tonight will be a bad night may not work well o Melatonin o Valerian herbal has been found to work well in research Narcolepsy irresistible attacks of refreshing sleep that the person repots having no control over 1 Cataplexy sudden loss of muscle tone most frequent 2 Sleep Paralysis cant move or speak upon awakening 3 Hypnagogic Hallucinations vivid scenes while falling asleep 4 Excessive Sleepiness the first symptom to appear most frequent 5 Onset in teens but most
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