Depression2

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  • How one views themselves How one views their experiences How one views their future
  • Depression2

    1. 1. WHAT IS A MOOD DISORDER? <ul><li>A disturbance of mood </li></ul>
    2. 2. BACKGROUND <ul><li>All respond to treatment </li></ul><ul><li>Treatments vary on type of depression </li></ul><ul><li>Multiple occurrences </li></ul><ul><li>Physical Examination </li></ul><ul><li>Myths </li></ul>
    3. 3. COGNITIVE TRIAD <ul><li>How one views themselves </li></ul><ul><li>How one views their experiences </li></ul><ul><li>How one views their future </li></ul>
    4. 4. DEPRESSION <ul><li>DSM-IV CRITERIA </li></ul><ul><li>Major Depressive Disorder – Single Episode </li></ul><ul><li>Major Depressive Disorder – Recurrent </li></ul><ul><li>Major Depressive Episode </li></ul><ul><li>Depressed mood most of the day nearly every day </li></ul><ul><li>Diminished interest in activities </li></ul><ul><li>Weight loss/gain </li></ul><ul><li>Insomnia/hypersomnia nearly every day </li></ul><ul><li>Psychomotor agitation/retardation </li></ul><ul><li>Fatigue/loss of energy </li></ul><ul><li>Feelings of worthlessness/inappropriate guilt </li></ul><ul><li>Difficulty concentrating </li></ul><ul><li>Recurrent thoughts of death </li></ul>
    5. 5. Most Common Physiological Symptoms <ul><li>Sleep disturbance </li></ul><ul><li>Appetite </li></ul><ul><li>Sexual </li></ul>
    6. 6. Self-Help Strategies <ul><li>Set Realistic Goals </li></ul><ul><li>Break Large Tasks into Smaller Ones </li></ul><ul><li>Don’t Isolate </li></ul><ul><li>Participate in Activities </li></ul><ul><li>Gradual Improvement </li></ul><ul><li>Postpone Major Decisions </li></ul>
    7. 7. DYSTHYMIA <ul><li>“Mild Depression” </li></ul><ul><li>Long-term and chronic but does not disable </li></ul><ul><li>Many experience Major Depression at some point </li></ul>
    8. 8. DYSTHYMIA <ul><li>DSM-IV Criteria </li></ul><ul><li>1) Depressed mood most days, more </li></ul><ul><li>days than not, at least 2 years </li></ul><ul><li>2) Presence of: </li></ul><ul><li>A) Increased/Decreased appetite </li></ul><ul><li>B) Insomnia/Hypersomnia </li></ul><ul><li>C) Low Energy/Fatigue </li></ul><ul><li>D) Low Self-Esteem </li></ul><ul><li>E) Poor Concentration, Difficulty making </li></ul><ul><li>decisions </li></ul><ul><li>F) Hopelessness </li></ul><ul><li>3) During two Years, never symptom free for more than two </li></ul><ul><li>months </li></ul><ul><li>4) No Major Depressive Episode </li></ul><ul><li>5) No Manic/Mixed/Hypomanic episodes </li></ul><ul><li>6) No Psychosis </li></ul><ul><li>7) No Substance Abuse </li></ul><ul><li>8) Clinically significant distress </li></ul>
    9. 9. DYSTHYMIA <ul><li>Symptoms </li></ul><ul><li>1) Critical/Irritable/Complaining </li></ul><ul><li>2) Prone to worry </li></ul><ul><li>3) Feelings of worthlessness, inferiority, </li></ul><ul><li>Lack of self-confidence </li></ul><ul><li>4) Excessive guilt/Self-critical </li></ul><ul><li>5) Low stress tolerance, easily </li></ul><ul><li>overwhelmed </li></ul><ul><li>6) Overly cautious </li></ul><ul><li>7) Difficulty being assertive </li></ul>
    10. 10. BIPOLAR DISORDER <ul><li>Bipolar I – “Classic Bipolar” </li></ul><ul><li>Long bouts of Depression + Long bouts </li></ul><ul><li>of Mania or Mixed episodes </li></ul><ul><li>DSM-IV Criteria – Six separate </li></ul><ul><li>1) Single Manic Episode </li></ul><ul><li>2) Most recent episode Hypomanic </li></ul><ul><li>3) Most recent episode Manic </li></ul><ul><li>4) Most recent episode Mixed </li></ul><ul><li>5) Most recent episode Depressed </li></ul><ul><li>6) Most recent episode unspecified </li></ul>
    11. 11. BIPOLAR DISORDER <ul><li>Bipolar Disorder II – hypomanic episodes </li></ul><ul><li>+ depressive episodes </li></ul><ul><li>One or more MD episodes </li></ul><ul><li>At least one Hypomanic episode </li></ul><ul><li>Never had a Manic Episode </li></ul>
    12. 12. BIPOLAR DISORDER <ul><li>Don’t recognize how it affects their life or </li></ul><ul><li>others </li></ul><ul><li>Typically begins in adolescence/early adult </li></ul><ul><li>Sometimes dramatic – most often gradual </li></ul>
    13. 13. SYMPTOMS <ul><li>SUBJECTIVE REPORTS OF BD </li></ul><ul><li>Lack of motivation vs increased productivity </li></ul><ul><li>Dulling of thinking process vs clarity of thought </li></ul><ul><li>Low self-esteem vs inflated ego/over confidence </li></ul><ul><li>Pessimistic brooding/worry vs carefree </li></ul>
    14. 14. SYMPTOMS <ul><li>UNSTABLE MOOD CHARACTERISTICS </li></ul><ul><li>Easily bored </li></ul><ul><li>Difficulty holding enthusiasm </li></ul><ul><li>Easily irritated if don’t get their way </li></ul><ul><li>Impulse control problems </li></ul><ul><li>Reckless behavior </li></ul><ul><li>Stormy relationships </li></ul><ul><li>Multiple relationships/marriages </li></ul><ul><li>Frequent moves </li></ul><ul><li>Multiple job/career changes </li></ul>
    15. 15. SYMPTOMS <ul><li>MANIC PHASE </li></ul><ul><li>Euphoria, optimism, inflated self-esteem </li></ul><ul><li>Rapid speech, racing thoughts,increased physical activity </li></ul><ul><li>Poor judgement and recklessness </li></ul><ul><li>Easily distracted </li></ul><ul><li>Inability to concentrate/Flight of ideas </li></ul><ul><li>Extreme instability </li></ul><ul><li>Restlessness </li></ul><ul><li>Goal-directed activity </li></ul><ul><li>Decreased need for sleep </li></ul><ul><li>Increased sexual desire </li></ul><ul><li>Inappropriate social behavior </li></ul>
    16. 16. SYMPTOMS <ul><li>DEPRESSIVE PHASE </li></ul><ul><li>Persistent sadness, anxiety, guilt, hopelessness </li></ul><ul><li>Sleep/appetite disturbance </li></ul><ul><li>Anhedonia </li></ul><ul><li>Difficulty concentrating </li></ul><ul><li>Recurring thoughts od suicide </li></ul><ul><li>Chronic pain not caused by physical problems </li></ul><ul><li>Restlessness, irritability, agitation </li></ul><ul><li>Decreased energy </li></ul>
    17. 17. TREATMENT <ul><li>SELF-CARE </li></ul><ul><li>Bipolar Disorder is NOT an illness one can treat on their own </li></ul><ul><li>Med compliance </li></ul><ul><li>Warning signs </li></ul><ul><li>Avoid drugs and alcohol </li></ul><ul><li>Check for interaction before taking other meds </li></ul><ul><li>Find enjoyable activities </li></ul><ul><li>Enhance friendships and relationships </li></ul>
    18. 18. CYCLOTHYMIA <ul><li>Everything is pretty much o.k. </li></ul><ul><li>Irregular, short cycles of depression and hypomania </li></ul><ul><li>DSM IV Criteria </li></ul><ul><li>For two or more years hypomanic </li></ul><ul><li>symptoms and depressive symptoms </li></ul><ul><li>that don’t meet criteria for MD </li></ul><ul><li>During 2 year period, not without symptoms </li></ul><ul><li>for more than 2 months </li></ul><ul><li>No Major Depressive Episode, Manic Episode, nor </li></ul><ul><li>Mixed Episode </li></ul><ul><li>No Psychotic Disorder </li></ul><ul><li>No physiological problem </li></ul><ul><li>Causes significant distress or impairment </li></ul>
    19. 19. SUICIDE <ul><li>Suicide assessment is critical </li></ul><ul><li>MYTH – talking about suicide will put the idea in their head </li></ul><ul><li>Consider: </li></ul><ul><li>Method contemplated </li></ul><ul><li>Access to method </li></ul><ul><li>Environmental resources </li></ul><ul><li>Assistance if attempt is made </li></ul>
    20. 20. SUICIDE <ul><li>Assessment </li></ul><ul><li>Newspaper reporter </li></ul><ul><li>Ideation, Plans, Attempts/Intent </li></ul><ul><li>Clues </li></ul><ul><li>Secretive </li></ul><ul><li>Making a will suddenly </li></ul><ul><li>Verbal Statements </li></ul>
    21. 21. SUICIDE <ul><li>Motives </li></ul><ul><li>To die </li></ul><ul><li>Based on reality </li></ul><ul><li>Influence others </li></ul><ul><li>Tipping the scale against suicide </li></ul><ul><li>Play for time </li></ul><ul><li>No-Harm Contract </li></ul><ul><li>Elicit reasons to live and die </li></ul>
    22. 22. SUICIDE <ul><li>Dealing with Hopelessness </li></ul><ul><li>Problem solving </li></ul><ul><li>Stress inoculation </li></ul><ul><li>Training people to think differently </li></ul><ul><li>Increases in suicidality </li></ul>

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