Unit 3 Learning Objectives Mood Disorders Suicide and Substance Use Disorders Exam 3 Thursday April 4 2013 Mood Disorders and Suicide 1 What are the differences between major depression and dysthymia For major depression there are 9 possible symptoms and you must have at least 5 For Dysthymia you only need to meet 2 out of the 6 Dysthymia is considered less severe but must have symptoms for at least 2 years and symptoms must be consistent throughout Dysthymia symptoms Appetite problems Sleep problems Low energy Low self esteem Poor concentration Feelings of hopelessness Depression symptoms Depressed Mood Anhedonia decreased pleasure Appetite or weight changes Sleep problems Psychomotor changes Loss of energy Feelings of worthlessness or Inappropriate guilt Concentration problems Suicidality 2 How do rates of depression vary by age group and gender Highest rates are between 15 29 years old then slight decrease Lowest rates with people are around age 60 Less external pressure retirement less worries Peak again around 85 years old May be due to loss of a spouse and or social support 3 What are the differences between Bipolar I and Bipolar II Differ in the presence or absence of specific mood episodes For Bipolar 1 a major depressive episode is okay but not necessary for Bipolar 2 it is necessary Full manic episodes are necessary in Bipolar 1 and cannot be present in Bipolar 2 Hypomanic episodes are necessary in Bipolar 2 and okay but not necessary in Bipolar 1 4 What is cyclothymic disorder A less severe chronic form of Bipolar Parallel to dysthymia must last at least 2 years A person with cyclothymic disorder alternates between episodes of hypomania and moderate depression chronically over at least a 2 year period 5 How do the prevalence and course of bipolar disorder differ from those of unipolar disorder Bipolar disorder only will only be experienced by 1 or 2 people out of 100 For bipolar disorder men and women are equally likely to develop the disorder and there are no consistent differences In unipolar disorders women are twice as likely to develop than men Unipolar is more prevalent Bipolar is chronic if not treated Depression is recurrent regardless to treatment due to things like social triggers 1 6 What biological factors genetics neurotransmitters brain abnormalities are implicated in depression Genetic factors Serotonin regulates emotions Transporter Gene short allele vs long allele Neurotransmitters Deregulation of neurotransmitters Serotonin Norepinephrine adrenaline and Dopamine motivated behaviors and reward system Problems in production and regulation of serotonin and norepinephrine depression Decreased synthesis Abnormalities in transport Increased degradation by synaptic enzymes Impaired release or reuptake Abnormalities with receptor Brian abnormalities Prefrontal cortex Planning short term memory functioning decreased activity Anterior Cingulate Deregulation of stress response Hippocampus Decreased activity in memory Amygdala Increased activation influences toward negative stimuli Neuroendocrine factors Hypothalamic pituitary adrenal axis HPA stress response and cortical levels 7 Describe behavioral cognitive interpersonal and sociocultural theories of depression Behavioral theories Stress may lead to depression because it provides less positive reinforces Ex At work trying to do better therefore you miss out on having a social life Life stress reduces positive reinforcements therefore individual withdraws Learned helplessness Uncontrollable life stressors create belief that individual has no control Natural disasters Car accident Relationship ends Poor coping skills Cognitive theories o Negative cognitive triad Self world future Depressed individuals exhibit errors in thinking that negatively affect mood always thinking I m stupid Study for an exam get an A but instead of thinking you are smart you think well the teacher made that exam really easy I m sure everyone got A s o Reformulated learned helplessness theory Casual attribution errors Believe causes of negative events are stable internal and global 2 Contribute to depression Stable nothing s ever going to change Internal putting blame on yourself its all your fault Global nothing will ever work out for me Interpersonal Theories o Rejection sensitivity Easily perceive rejection from others o Excessive reassurance seeking Constantly look for reassurance from others that are accepted and loved Interacts with negative events to predict depression 8 Describe treatments used for major depressive disorder Biological treatments for Depression Monoamine Oxidase Inhibitors MAOIs not really used anymore due to side effects Problems Fatal interactions with other medications Can cause liver damage weight gain Fatal in overdose of only 3 4 times the prescribed amount Tricyclic antidepressants Problems Numerous side effects Fatal in overdose of only 3 4 times prescribed amount Selective Serotonin Reuptake Inhibitors SSRIs well known most effective and most widely used Relief within a couple of weeks Less severe side effects better tolerated No fatal overdose Selective Serotonin and Norepinephrine Reuptake Inhibitors SSNRIs Similar advantages to SSRIs but have more stimulant effects Medications work for 70 80 for the other 20 30 Electroconvulsive Therapy ECT Given to patients who do not respond to medication 6 12 sessions Relieves depression in 50 60 but 85 relapse Brian seizures while patient is asleep no pain can have slight headaches and memory loss Vagus Nerve Stimulation VNS 30 40 substantial relief 30 minimal relief Vagus nerve is stimulated by a small electronic device much like a pacemaker that is surgically implanted under the patient s skin in the left chest wall Repetive Transcranial Magnetic Simulation rTMS Few side effects Still painless but patients are awake similar to an MRI 3 Treatment 35 minutes a day 6 days a week for 6 weeks Psychological Treatments Cognitive Behavioral Therapy Changes patterns of how one interacts with others and their ways of thinking Specific techniques Functional when does this person seem depressed the most What are they doing Is there a time of day they felt better if so what were they doing Behavioral being active finding a new hobby to do Social Rhythms regulating a schedule and develop a routine Interpersonal Therapy IPT Goal Identify and address 1 of 4 interpersonal sources of depression 1 Grief and loss Help the client accept feelings and evaluate a relationship with a
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