Mental Illness Final

Mood Disorder Basics

1. Types

2. Prevalence

3. Causes

4. Treatment

General Criteria for Major Depressive Episode

1. Emotional/Affective Responses (Depressed mood)

2. Physical Responses (Weight/appetite/sleeping changes)

3. Cognitive Responses (Low self-esteem, guilt, concentration problems)

Specific Criteria for Major Depressive Episode (Must Experience 5)

1. Depressed mood most of the day

2. Diminished interest or pleasure in all or most daily activities

3. Significant unintended weight loss or unusual increase/decrease in appetite

4. Insomnia

5. Psychomotor agitation observable by others

6. Fatigue or loss of energy

7. Feelings of worthlessness or excessive/inappropriate guilt

8. Difficult maintaining concentration or making decisions

9. Recurrent thoughts of death or suicidal thought

Qualifiers for Specific Depression Criteria

1. Symptoms are not attributable to a medical condition or substance use

2. The symptoms cause significant distress or impairment

Percentage of US Adults with a Major Depressive Episode that have a Second

60%

Removal of Bereavement Exclusion for MDD

From DSM 4: No diagnosis within first 2 months of loss, DSM 5: No such exclusion

Reasons for Removal of Bereavement Exclusion

1. No other adverse life events can negate diagnosis

2. Depressive syndromes share features with non-bereavement related depressions

3. Bereavement exclusion has unintended consequence of suggesting that the grief should end in two months, or that grief and major depression disorder cannot co-occur

Difference Between Grief and Depression

1. Different Feelings

   1. Grief: painful feelings come in waves, mixed w/ positive memories of deceased; Depression: mood and ideation are almost constantly negative

2. Different Cognitions

   1. Grief: self-esteem is usually preserved;

      Depression: corrosive feelings of worthlessness and self-loathing

Cultural Variations of MDD

Guilt and self-blame (individualistic) dramatically less common in eastern countries; shame (collectivist) more common

Other Additions

Fewer verbal expressions and more somatic (relating to the body) expressions

Dysthymic Disorder

Less intensity than major depressive disorders

1. Simple pessimism vs despair; inferiority v. self-hatred

2. Need symptoms for 2+ years

3. In 2.5% of adults

Mania

Periods of

1. Heightened thinking

2. Behavior

3. Emotionality

4. Decreased need for sleep

Hypomania

1. milder form of mania

2. Characterized by a heightened, elevated, or irritable mood

3. Increased energy or activity level

Bipolar Disorders

1. Mania or hypomania with or without depression

2. Prevalence: 3.9% of US pop.

3. Following a single episode, 90% chance of others

Bipolar 1

One or more MANIC episodes, possible alternation with depressive episodes

Bipolar 2

One or more depressive episodes and at least one HYPOMANIC episode

Cyclothymic Disorder, or Cyclothymia

1. Milder depressive episodes (dysthymia) and milder manic episodes (hypomania)

New Mood Disorder: Premenstrual Dysphoric Disorder

1. Depressed mood during the premenstrual phase of cycle

2. Most cycles in preceding year

3. Prevalence: 12-month prevalence is between 1.8 to 5.8%

Controversy with PDD

1. Does it pathologize women’s experiences

2. Does it provide welcome access to mental health care that would have otherwise been denied

Biological Perspectives

1. First-degree relatives: 2-4 times as likely to have major depressive disorder, accounting for environment

2. With identical twins studies: they have a higher concordance than fraternal twins, also accounting for environment

Overall Hypothesis for Genetic Influence

Range of 30-40%

Biological Intervention: Medication

Example: SSRIs, which block the uptake of serotonin leaving more availability at the receptor sites

1. Takes 2-6 weeks to help

2. Less useful for mild cases

3. Unknown effect when used with ECT and TMS

4. Lifestyle changes

ECT

Electric Current Therapy, induces a controlled seizure

TMS

Transcranial Magnetic Stimulation, magnetic waves to stimulate certain brain areas

Cognitive Behavioral Perspective

• Negative Cognitive Triad

• Cognitive Distortions

Negative Cognitive Triad

Part of CBP,addresses problems in content of thought, especially negative thoughts about:

1. Self

2. World

3. Future

Cognitive Distortions

Address problems with style of thought, EX: overgeneralizing, catastrophizing

Sociocultural Perspective

Culture shapes how individuals understand and experience depression, as well as how they seek and receive help

At-Risk Populations for Suicide

1. Men more than women

2. Divorced, single, widowed

   more than married

3. Whites more than Blacks or

   Latina/Latinos (but not Native

   Americans)

Suicidal Assessment

1. Assessing Risk Factors

   1. Suicidal Intent

   2. Suicidal Lethality

   3. Questions to Ask

Means of Suicide Prevention

1. Social Support

2. Contract

3. Alternative Coping Strategies

4. Demonstrating their impaired judgement

Understanding of Schizophrenia

Understanding constantly evolving, but we don’t know that much, tons of symptom variation: the inability to tell whether the things you are thinking are actually taking place in reality

Stats for Schizophrenia

1. Approximately 1% of Americans are affected by schizophrenia

2. Lifetime prevalence of early psychosis – 5%

3. Age of onset varies ◦ Men: early 20’s, Women: 25-mid thirties

4. 20% - full recovery for the most part

5. 25%-30% - chronic psychotic symptoms

Stages of Schizophrenia

Prodromal, Active, Residual

Prodromal

Early symptoms: withdrawal, distraction, unclear communication

Active

When symptoms are noticeable, lasts at least a month; symptoms include hallucinations, delusions, and disorganized thinking

Residual

Reduced severity in active symptoms, however social withdrawal may still play a factor

Positive Symptoms

Presence of exaggerated thoughts and behaviors, delusions

Different Delusions

Persecution, reference, grandeur, control

Disturbances in Perception

Hallucination, heightened sensitivity, sensory blunting

Negative Symptoms