PSCYH

• Mood Disorders


  • Also referred to as an Affective Disorder
  • Mood disorder is a broad term used to include all the different types of depressive and bipolar disorders, both of which affect the individual's mood and major functioning
  • Mood may range from extremely low (depressed) to extremely high (mania)

  
• Types of Mood Disorders in the DSM 5 Classification

  • Unipolar Disorder
  • Bipolar Disorder

  
• Unipolar Disorder


  • Major depressive disorder (MDD)
  • Persistent depressive disorder (PDD) / Dysthymia
  • Disruptive mood dysregulation disorder (DMDD)
  • Seasonal Affective Disorder (SAD)
  • Premenstrual Dysphoric Disorder (PMDD)

  
• Bipolar Disorder


  • Bipolar 1 Disorder
  • Bipolar 2 Disorder
  • Cyclothymic

  
• Depression


  The persistent feeling of sadness and emptiness "The Low"
• Major Depressive Disorder


  • Also referred to as the Major Depression or Clinical Depression
  • It involves periods of extreme sadness, accompanied by a variety of physical, cognitive, and emotional symptoms
  • Symptoms present at least 2 weeks almost everyday
  • Cause significant distress or severely impaired major functioning
• DSM 5 Diagnostic Criteria for Major Depressive Disorder


  • Depressed mood most of the day, nearly every day
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
  • Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
  • Insomnia or hypersomnia nearly every day
  • Fatigue or loss of energy nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day
  • Recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt
• Symptoms of Depressive Disorder

  • Anergia (no energy)
  • Avolition (no motivation)
  • Anhedonia (no pleasure)
  • Asocial (no social interest)
  • Insomnia / Hypersomnia
  • Feeling Hopeless, empty, sad, worthlessness
  • Poverty of Ideas / uncommunicative, Psychomotor Retardation, Poor concentration & indecisiveness
  • Weight loss (decreased appetite), Weight gain (Increased appetite)
  • Recurrent thought of death (suicidal ideation)
• Persistent Depressive Disorder (Dysthymia)

  • Symptoms are less severe than major depressive disorders but are still debilitating
  • Symptoms of depression may lasts for 2 years or longer and maybe present most of the time for most days of the week

  
• Symptoms of Persistent Depressive Disorder

  • Change in appetite or weight
  • Insomnia/Hypersomnia
  • Lack of energy or fatigue
  • Low self-esteem
  • Difficulty with concentrating or making decisions
  • Feeling of hopelessness
• Treatment for Depressive Disorders

  • Psychotherapy
  • Medication - antidepressants
  • Combination of the two
• Disruptive Mood Dysregulation Disorder (DMDD)


  It is used to categorize children up to 18 years of age who exhibit frequent episodes of extreme temper outbursts, extreme irritability, and hyperactivity, but without the manic episodes typical of bipolar disorder

  
• Diagnostic Criteria for DMDD

  • Severe temper outbursts (verbal or behavioral), on average, three or more times per week
  • Chronically irritable or angry mood most of the day, nearly every day
  • Trouble functioning due to irritability in more than one place (at home, at school, and with peers)
• Peripartum-Postpartum Depression (PPD)


  • Peripartum Depression - refers to a major depressive episode that occurs during pregnancy or after childbirth
  • Postpartum Depression - refers to an episode of major depression that begins within the first 4 weeks after delivery
• Major depressive disorder with peripartum (Onset)


  A woman may feel irritable, indecisive, anxious, and sudden mood swings during pregnancy or after childbirth
• Premenstrual Dysphoric Disorder (PMDD)

  • Women with PMDD have depression and other symptoms presence in the week before the onset of menstruation, followed by the resolution of these symptoms at the start of their menstrual period
  • Cause of PMDD is unknown but most likely caused by hormonal imbalances during menstrual cycle that affects mood regulation
• Seasonal Affective Disorder (SAD)


  • Also known as Seasonal Depression or Winter Depression
  • SAD is considered to be a sub-type of major depressive disorder (MDD) - Major Depressive Disorder with Seasonal Pattern
  • Happens during fall or winter for the past 2 years and typically goes away in the spring and summer
  • Begins at any age, but it typically starts between ages 18 and 30

  
• Symptoms of Seasonal Affective Disorder

  • Symptoms are similar to major depression but can vary from mild to severe
• Treatment for Seasonal Affective Disorder

  • Medication - Antidepressants
  • Light therapy - (15-30 min/day) special light therapy box which mimics natural sunlight
• Psychotic Depression


  • Psychotic depression is considered to be a sub-type of major depressive disorder (MDD) - Major Depressive Disorder with Psychotic Symptoms
  • People with psychotic depression have the symptoms of major depression along with "psychotic" symptoms, such as hallucination (Paranoia), delusions, and disorganized or disordered thinking

  
• Treatment for Psychotic Depression

  • Medication - a combination of antidepressant and antipsychotic drugs
  • ECT may also be an option
• Factors That Increase A Woman's Risk Of PPD

  • Prenatal anxiety
  • History of previous depression
  • Maternity blues
  • Recent stressful life events
  • Inadequate social supports
  • Poor marital relationship
  • Low self-esteem
  • Child care stress
  • Difficult infant temperament
  • Single mother
  • Unwanted pregnancy
  • Low socioeconomic status
• Situational Depression


  • Also known as "Stress Response Syndrome or Reactive Depression"
  • Situational depression is a natural response to a traumatic or stressful event. Recovery is possible once the person recovers from the difficult life situation
  • It is characterized by depressed mood when someone is having trouble managing a stressful event in life
  • Previous life experiences, gone through considerable stress during childhood, existing mental health problems, and several difficult life circumstances occurring at the same time can contribute to situational depression
• Atypical Depression


  • Atypical depression can be a "specifier" for either major depression or persistent depressive disorder
  • In atypical depression, a positive event can temporarily improve the depressed mood
  • It is usually characterized by increased appetite or weight gain, sleeping more than usual, marked fatigue or weakness, and oversensitive to criticism and rejection
• Melancholic Depression


  • It is a form of major depressive disorder (MDD) which presents with melancholic features
  • Melancholic depression is a sub-type of major depressive disorder (MDD) - "Major depressive disorder with melancholic features"
  • People with melancholic depression may also experience symptoms of major depressive disorder
• Treatment for Depressive Disorders

  • PSYCHOPHARMACOLOGY
  • Antidepressant drugs
  • Antimanic drugs
  • Mood stabilizer drugs
  • Antianxiety drugs
  • ELECTRO CONVULSIVE THERAPY
• Antidepressant Drugs


  • Tricyclic Antidepressant Drugs (TCA)
  • Selective serotonin reuptake inhibitor (SSRI)
  • Monoamine oxidase inhibitor (MAOI)
  • Serotonin - norepinephrine reuptake inhibitor (SNRI)
  • Norepinephrine – dopamine reuptake inhibitor (NDRI)
• Psychotherapy


  • Interpersonal Therapy
  • Behavioral Therapy
  • Cognitive Therapy
• Interpersonal Therapy


  • Help client establish a successful relationship
  • Help client learn to trust others
• Behavioral Therapy


  • Reinforcing behavioral change through positive feedback and decreasing negative interactions
  • Focus on improving social & coping skills
• Cognitive Therapy


  Changing negative thinking into positive thinking
• Behaviors that can Mask Depression

  • Children - cranky behavior, hyperactivity, school phobia, learning disorders, failing grades, antisocial behavior
  • Adolescence - substance abuses, joining gangs, engage in risky behavior, overeating, sleepiness, underachiever, drop outs, cranky behavior
  • Adults - substance abuse, eating disorders, compulsive behavior, hypochondriasis
  • Older Adults - argumentative, cranky behavior, somatic ailments, other behavioral changes
• S.A.D. P.E.R.S.O.N.S.' Scale


  Tool For Suicide Assessment
• S.A.D. P.E.R.S.O.N.S.' Scale


  • Sex
  • Age - <19 and >45
  • Depression (good indicator)
  • Previous attempt
  • Ethanol or other substance use
  • Rational thinking is loss
  • Social support is lacking
  • Organized plan
  • No spouse
  • Sickness
• W.H.I.C.H.


  Behavioral Clues of Impending Suicide
• W.H.I.C.H.


  • Withdraws social activities and plans
  • Has death plan/ Leaves a note
  • Finalizes business or personal affairs
  • Gives away valuable possessions
  • Improved mood 10 – 14 days after taking antidepressant drug
  • Change in patient's behavior
  • He/she makes direct or indirect statements
• Contributory factors for Suicide in Adolescence (U.S.E.D. P.I.L.L.)

  • Used of drugs
  • Social problems with peers
  • Emotional isolation
  • Dysfunctional family interaction
  • Depression
  • Poor judgment/ poor impulse control
  • Immature coping skills
  • Low self-esteem
  • Lack of self-integration & identity
• Contributory Factors for Suicide in Adults (C.O.L.D.S.)

  • Crisis in the past or upcoming two weeks
  • Criminal legal problems
  • Occupational and financial problems
  • Loss of significant relationships
  • Loss of housing
  • Drug addiction and alcoholism
  • Sickness or physical health problems
• Contributory Factors for Suicide in the Elderly (P.E.R.C.I.V.D)

  • Passive suicide (refusing to eat, drink, cooperate with care)
  • Exhaustion
  • Retirement
  • Chronic medical condition
  • Incidence of suicide increases with age
  • View self as useless
  • Dependent
• Psychiatric Conditions with High Incidence of Suicide (M.A.D. P.E.R.S.O.N.)

  • Major depression
  • Alcoholism
  • Drug addiction
  • Panic disorder & other personality disorders
  • Eating disorders (Anorexia nervosa)
  • Schizophrenia
  • Obsessive-compulsive disorder
  • Any type of depression