Case Study
Scorpyo_77
Psychopathology_and_Counseling_Mood_Disorders.ppt
Psychopathology and Counseling: Mood Disorders
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Mood Disorders: General
Mood vs. Feeling
Mood Climate
Affect/Feeling Weather
Fundamental distinction:
Unipolar (depression only)
Bipolar (depression and mania)
Most prevalent disorders after the anxiety disorders
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Four Kinds of Symptoms
Emotional: sadness, anger, crying, withdrawal, anhedonia
Cognitive: low self-esteem, pessimism
Motivational: apathy
Somatic (Vegetative): insomnia, anorexia
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Emergence of Symptoms
How might these emerge sequentially or cause one another?
How might these symptoms arise from a common cause?
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Depressive Cognition
Three Courts:
Self
Others
God
Depressive Triad: Negative view of…
Self: Hapless
Situation: Helpless
Future: Hopeless
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Etiology of Depression
Biological
Diseases and Disorders
Medication Responses
Loss
Any loss
Maternal loss and depression
Reaction is biphasic with initial “protest” phase (e.g., anxious vocalizations) and later “despair” phase (e.g., clinging)
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Etiology of Depression (2)
Hurt
Disillusionment
Abandonment
Betrayal
Trauma
Stress
Sin/Spiritual
Shame
Guilt
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Patterns of MDD
Infants: depression looks like failure to thrive, developmental delays
Elementary/Middle School: acting out, anxiety based school problems (phobias)
Adolescents: social deficits, self-esteem difficulties
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Dysthymia
Less severe than MDD
Chronic
Depressed mood most of day, majority of days for 2 years
Must have 2 or more of:
Poor appetite/overeating
Sleep disturbance
Low energy level
Poor self-esteem
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Dysthymia (2)
Concentration/decision making problems
Hopelessness
Exclusions
No major depressive episode the first two years
No manic, mixed, or hypomanic episode
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Double Depression
MDD arises out of chronic dysthymia
Characteristics:
More severe
More often melancholic
More likely suicidal
Often have PD
Subject to more social stressors
Poorer prognosis
More genetic
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Disruptive Mood Dysregulation
The unique features of DMDD necessitated a new diagnosis to ensure that children affected by this disorder get the clinical help they need.
This was developed in response to many children being diagnosed with Bipolar Disorder who did not adequately meet the criteria.
Disruptive Mood Dysregulation
Characterized by severe and recurrent temper outbursts
Outbursts are grossly out of proportion in intensity or duration to the situation. These occur, on average, three or more times each week for one year or more.
Between outbursts, children with DMDD display a persistently irritable or angry mood, most of the day and nearly every day, that is observable by parents, teachers, or peers.
Diagnosis requires the above symptoms to be present in at least two settings (at home, at school, or with peers) for 12 or more months, and symptoms must be severe in at least one of these settings.
Child must not have gone three or more consecutive months without symptoms.
Onset of symptoms must be before age 10, and a DMDD diagnosis should not be made for the first time before age 6 or after age 18.
Differential Diagnoses
Oppositional Defiant Disorder
Conduct Disorder
Bipolar Disorders
Bipolar Disorder
Bipolar I - manic or mixed episodes
Bipolar II - no full-blown manic episode, has been hypomanic
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Bipolar Disorder (2)
Manic episode: abnormally and persistently elevated, expansive, or irritable mood lasting at least a week
One study revealed the dominant gene on the tip of human chromosome II is associated with inherited bipolar disorder.
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Manic Episode Criteria
3 (4 if mood only irritable) or more of:
Grandiosity
Decreased need for sleep
More talkative than usual
Flight of ideas/racing thoughts
Distractibility
Increase in activity or agitation
Excessive pleasurable activities
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In Children and Adolescents
Symptoms in children may include:
Sexual promiscuity
Failure in school
Early cigarette smoking
Substance abuse
Extreme aggressive behavior (e.g., assaults)
Severe depression
Suicide attempts
Scale developed: The Child Mania Rating Scale—Parent Version
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In Children and Adolescents (2)
Developmental course:
Ages 4–6: diagnosed with ADHD
Ages 7–8: mood disturbances evident
By puberty: strong mood symptoms emerge that resemble bipolar
10–15% of all children with current depression will develop bipolar
16% of all children in psychiatric clinics might actually have bipolar
Average age of onset is 6.5 years of age
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Differential Diagnosis
Bipolar I differentiated from psychosis by:
Rapid onset of symptoms
Absence of prodromal signs of schizophrenia
Quick return to previous level of functioning
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Differential Diagnosis (2)
Half of the cases begin before adulthood
Many are misdiagnosed as attention or behavioral disorders or simple depression.
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Cyclothymia
Periods of hypomanic and depressive symptoms
Not either a manic or major depressive episode
Sx last at least 2 years
No Sx free interval > two months.
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Cyclothymia (2)
Borderline Personality Disorder associated with shifts in mood that may suggest cyclothymia
If criteria met for both, both diagnoses are given
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Biological Treatments
Norepinephrine and serotonin
Tricyclics block reuptake of norepinepherine
MAO inhibitors prevent breakdown of NE
SSRI’s prevent reuptake of serotonin
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Biological Treatment (2)
ECT
Successful with extremely severe depression
Relatively safe
Anesthetics and muscle relaxants
When applied to only one side of the head
Works fairly quickly
Still not understood why it produces positive effects
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Suicide
Manipulation vs real?
Go to heaven or hell?
Should the state interfere with a decision to end one's own life?
Three Groups:
“To Be” 30–35%; want to live
“To Be or Not To Be” ambivalent; leave result up to fate or God
“Not To Be” want to die
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Suicide Predictors
Best predictor: previous attempt
Other predictors:
Male
Older
Unemployed
Unmarried
Living alone
Chronic illness
Culturally alienated group
Substance abuse (alcohol)
Hopeless
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Suicide Predictors (2)
We’re very poor at predicting
Why?
“psych-ache”
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Diagnosis of Suicide
Take it seriously
Parasuicidal behaviors
Intent
Plan
Lethality: “How would you do it?”
Agenda: “Who will find you?”
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