Ch7moodandsuic

Features and Epidemiology

Causes and Prevention

Assessment and Treatment




Emotions

Cognitions

Behaviors

Normal

Good mood.

Thoughts about what one has to do that day. Thoughts about how to plan and organize the day.

Rising from bed, getting ready for the day, and going to school or work.

Cycle of Major Depressive Disorder

Feeling upset and sad, perhaps becoming a bit teary-eyed.

Dwelling on the negative aspects of the day, such as a couple of mistakes on a test or a cold shoulderfrom a coworker.

Coming home to slump into bed without eating dinner.Tossing and turning in bed, unable to sleep.Some difficulty concentrating.




Emotions

Cognitions

Behaviors

NormalMild


Mild discomfort about the day, feeling a bit irritable or down.

Thoughts about the difficult of the day.Concern that something will go wrong.

Taking a little longer than usual to rise from bed.Slightly less concentration at school or work.




Emotions

Cognitions

Behaviors

NormalMildModerate


Intense sadness and frequent crying. Daily feelings of “heaviness” and emptiness.

Thoughts about one’s personal deficiencies, strongpessimism about the future, and thoughts aboutharming oneself (with little intent to do so).

Inability to rise from bed many days, skippingclasses at school, and withdrawing fromcontact with others.




Emotions

Cognitions

Behaviors

NormalMildModerateDepression – Less Severe


Extreme sadness, very frequent crying, andfeelings of emptiness and loss. Strong sense of hopelessness.

Thoughts about suicide, funerals, andinstructions to others in case of one’s death.Strong intent to harm oneself.

Complete inability to interact with others or evenleave the house. Great changes in appetite andweight. Suicide attempt or completion.




Emotions

Cognitions

Behaviors

NormalMildModerateDepression – Less SevereDepression – More Severe





• Click below to see a one-minute video

• depressive episode




Manic

Normal

Depressive





Symptoms of a Manic Episode

Inflated self-esteem or grandiosity

Decreased need for sleep, such as feeling rested after only 3 hours of sleep

More talkative than usual or pressure to keep talking

Subjective experience that one’s thoughts are racing,or flight of ideas

Distractibility

Mania in video

• Click below for two one-minute videos:– mania-grandiosity– mania-inappropriate affect

• If you’re interested, a one-minute video of the same individual in the midst of a depressive episode:– bipolar-depressive episode




Manic

Normal

Depressive




Will to live

Feeling thoughts of death

Suicidalideation

Planningsuicidal

acts Suicideattempt

Suicidecompletion




Note: These numbers reflect the fact that some people have more than one mood disorder.

Dis

ord

er

0 5 10 15 20 25

Percentage

Any mood disorder

Major depressive

disorder

Dysthymia

Bipolar I and II disorders

20.89.5

16.66.7

2.51.5

3.92.6

Lifetime prevalence rate (%) 12-month prevalence rate (%)




0 5 10 15 20 25

Prevalence

5-14

15-24

25-44

45-64

Male Female

Ag

e a

t d

ea

th i

n y

ea

rs

30 35

1.20.3

17.13.0

31.14.0

21.36.2

65+

21.35.4




Amygdala

Anterior cingulate cortex

Prefrontal cortex

Caudate nucleus, putamen

Basal gangalia

Hippocampus

Pons






Biological vulnerabilities/early predispositions: Genetic contributions, neurochemical and hormonal changes, brain changes

Early family problems: Poor attachment, disengaged parents, expressed emotion, modeling of parental depression

Stressful life events: Family conflict, alienation fromothers, academic and other challenges

Cognitive-stress and behavioral vulnerabilities: Sense of learned helplessness and hopelessness, intense negative emotions and arousal, escape-oriented behavior, lack of social support

Possible mood disorder






RAP-A teaches adolescents to:

Declare existing strengths

Manage stress

Modify negative and irrational thoughts

Solve problems efficiently

Develop and use social support networks

Enhance social skill and recognize other perspectives






Hamilton Rating Scale for Depression






• Elderly• Unmarried• White• Male• Living alone

Assesssociodemographicrisk factors

How are things going in your marriage, in your family, at home, at work?” (Cover health, financial, marital, family, legal, and occupational factors)

“Have you experienced sad, blue, or empty feelings and at least two of the following in the past two weeks?”

• Trouble falling or staying asleep• Feeling tired or having little energy• Poor appetite or overeating• Little interest or pleasure in doing things• Feeling bad about yourself• Trouble concentrating• Feeling fidgety, restless, or unable to sit still

“Have you felt nervous, anxious, or on edge?”“Have you had anxiety or panic attacks recently?”

Ask about stressors

Screen for depression and associated anxietyor agitation

“Have you ever felt you should cut down on your drinking?”

“Have people annoyed you by criticizing your drinking?”“Have you ever felt bad or guilty about your drinking?”“Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?”

Yes to two or more means probable alcohol abuse.

Screen foralcohol abuse

“Have you had thoughts about death, or about killing yourself?” If yes, ask:

“Do you have a plan for how you would do this?”“Are there means available (e.g., a gun and bullets or poison)?”

“Have you actually rehearsed or practiced how you would kill yourself?”

“Do you tend to be impulsive?”“How strong is your intent to do this?”“Can you resist the impulse to do this?”“Have you heard voices telling you to hurt or kill yourself?”

Ask about previous attempts, especially the degree of intent.Ask about suicide of family members.

Assessrisk of suicide






• Medication:– Selective serotonin reuptake inhibitors

(SSRIs)– Tricyclics– Mood stabilizers

• Electroconvulsive therapy

• Transcranial magnetic stimulation

Ch7moodandsuic

Education

Transcript of Ch7moodandsuic