Anxiety and Mood Disorders

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Mood Disorders
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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

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The continuums of Mood Disorders

• Unipolar - Bipolar
• Chronic - Acute
• Agitated Slow
• Neurotic Psychotic

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Depression symptoms

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

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Depression symptoms
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Severity and diagnosis
Number of symptoms
Duration
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Depressive Disorders Double Depression

• Clinical Description

Dysthymia
Dysthymia
Major Depression
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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)

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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

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Seasonal Pattern

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

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Bipolar Disorders

• Major Features

• Experience Both
• Manic Episodes
• Major Depressive Episodes
• Roller Coaster of Mood

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Bipolar Disorders

• Mania and Hypomania

• Elevated Mood
• Decreased need for sleep

• Grandiosity

• Increased Activity

• More talkative

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Causes of Mood Disorders
Biological Psychological Socio-cultural
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Biological Factors in Mood Disorders

• Genetic contribution (heritable vulnerability in
  mood disorders). Example Bipolar

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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)

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Biological Factors in Mood Disorders

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

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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
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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
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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)

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Mood Disorders Socio-cultural Causes

• CD Article (neighborhood characteristics)

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Social-cultural support
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Treatments for Mood Disorders

• Men get depression DVD clips (treatment section)

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Biological Treatments for Mood Disorders

• Medication (prescribed and herbal)
• Electroconvulsive therapy (ECT)
• Repetitive transcranial magnetic stimulation
• Vagus nerve stimulation
• DBS
• Light therapy
• Exercise

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See Manufacturing Depression
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Treatment of Mood Disorders

• Medications

• Tricyclic Antidepressants
• MAOIs
• SSRIs
• Herbal (e.g., St. Johns Wort)
• Lithium
• Anti-convulsants

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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

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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.