Mood Disorders

Video – Out of the Shadows

• Handout with questions – – Descriptions

– Contributing factors

– Treatments

– Your curiosity

Recognizing signs of depression and mania

• Consider various domains-handout

• Varying degrees of severity

Mood Episodes

• Major Depressive Episode• Manic Episode• Mixed Episode• Hypomanic Episode

Episodes describe sets of sx The pattern of the episodes defines the

disorder

Depressive Disorders

1. Major Depressive Disorder• Major depressive episode• Not better accounted for…• No history of manic, mixed or hypomanic

episode• Specifiers

2. Dysthymic Disorder• Two year duration (one year in kids)• Depressed most of the time• At least 2 specific sx• <2 months free of sx during 2 or 1 year period• No major depressive episode during first 2 or 1 year period• No evidence of manic, mixed, hypomanic episodes or

cyclothymic d/o• Doesn’t occur exclusively during a psychotic d/o• Not better accounted for by substance or medical condition• Clinically significant distress and/or impairment in functioning• Specifier-atypical

3. Depressive Disorder NOS

Bipolar Disorders

1. Bipolar I• Presence of a manic episode• Not better explained by schizoaffective d/o or a part

of another psychotic disorder.• A variety of specifiers

2. Bipolar II• Major depressive episode• Hypomanic episode• No manic or mixed episode• Not better accounted for by…

3. Cyclothymic• 2 years of numerous periods with

hypomanic sx. and depressive sx, but no major depressive episode.

• Sx-free no more than two months.• No major dep., manic or mixed episode

during first two years.• Not better accounted for…• Not due to substance or medical condition.

Others

4. Bipolar Disorder NOS

5. Mood Disorder due to general medical condition.

6. Substance-induced Mood Disorder

7. Mood Disorder NOS

Etiology

1. Exogenous

2. Endogenous

3. Vulnerability-Stress model• Biological vulnerability• Cognitive vulnerability

• Hopelessness theory• Beck’s cognitive distortions• Learned helplessness

Treatment for depression and s-r d/o-Cognitive-Behavioral Therapy

1. Typically used in tx for depressive disorders and substance use disorders alone.

2. Match the tx to the stage of change or treatment stage:

• CBT is most useful during active treatment and relapse prevention.

3. Analyze and work with the ABCs of problem behavior.

• Antecedent-(thoughts, events, people, places, etc.)

• Behavior• Consequence

4. Event to behavior sequence model-• Identify the sequence• Evaluate thoughts• Challenge rationality of thoughts• Identify positive alternative thoughts

Role playing with “Jim,” pg. 379

• Identify cognitive distortions and their consequent feelings.

• Explain event to behavior sequence model to client.

• Challenge the thoughts.

• Help cx develop constructive thoughts.

Issues Specific to Mood Disorders

• Distinguishing mood d/o from substance, medication or medical induced sx is tricky.

• Assessment includes self-report, along with observation and collateral information.

• Recognize how common sx of depression are as a consequence of substance use.

• Suicide risk should be assessed.

Bipolar and suicidality

• Most likely during transition for cx with bipolar

• S/I=80%

• S/A=25%

• S/C=7-19%

• Intoxication increases impulsivity and impairs judgment, putting person at greater risk.

A mnemonic: IS PATH WARM

ideationsubstance abuse  purposelessnessanxietytrappedhopelessness  withdrawalangerrecklessnessmood changes

Your role

1. Recognize risk factors and respond appropriately

2. Assess seriousness of risk-Fig. D-1, pg 330• What is wrong?• Why now?• How?• Where and when?• When and with what in the past?• Who is involved?• Why not now?

3. Consider appropriate responses-low level of risk

• Talking about it• Address particular triggers• Contracting• Obtaining support from friends/family• Identify and plan use of crisis services• Explore reasons for not killing self• Refer to medication provider-ARNP or psychiatrist

4. Responses with higher level of risk• Schedule additional sessions• Eliminate potential methods, e.g. weapons,

meds, etc.• Explore option of voluntary hospitalization• Contact CDMHPs for involuntary outpatient

or commitment evaluation-206-461-3222• 72 hours, 14 days, 90 days inpatient• 90 (adult) or 180 (youth) days of outpatient

A scenario

1. Read the scenario.

2. Identify problem behavior.

3. What are probable antecedents to the bx?

4. What are the consequences to the bx?

5. How might you and Melody work with the antecedents or consequences to help her resolve the problem behavior?

1. Identify problem behavior.2. Explore the likely feelings that occur prior

to the behavior.3. Explore the likely thoughts that occur

prior to the feelings.4. Challenge these thoughts: are they

rational? Accurate? Constructive? Destructive?

5. Identify positive alternative thoughts.

Test Review

• Stages of change• Substance-related disorders:

– know the difference between use and induced disorders – be able to describe abuse and dependence

• Medications:– Important terms– Stepwise treatment– Your role re: meds– Reasons why clients discontinue meds

• Mood Disorders– Mood episodes– Depressive disorders and Bipolar disorders– Cognitive-behavioral theory – event to behavior sequence model

and cognitive distortions