Mood Disorders - SAD and PPD Flashcards
DSM criteria for Seasonal pattern specifier
With Seasonal Pattern (can be applied to the pattern of Major Depressive Episodes in Bipolar I or Bipolar II Disorder or Major Depressive Disorder, Recurrent)
There has been a regular temporal relationship between the onset of Major Depressive Episodes in Bipolar I or Bipolar II Disorder or Major Depressive Disorder, Recurrent, and a particular time of the year
Note: Do not include cases in which there is an obvious effect of seasonal-related psychosocial stressors
Full remissions (or a change from depression to mania or hypomania) also occur at a characteristic time of the year
In the last 2 years, two Major Depressive Episodes have occurred that demonstrate the temporal seasonal relationships defined in Criteria A and B, and no non-seasonal Major Depressive Episodes have occurred during that same period
Seasonal Major Depressive Episodes substantially outnumber the nonseasonal Major Depressive Episodes that may have occurred over the individual’s lifetime.
clinical characteristics of SAD
Onset (winter) and remission of depressive symptoms occur seasonally (spring) - 2 yrs
-fatigue, hypersomnia, overeating, weight gain, carbohydrate craving, decrease in libido
More rarely, summer depressions
Seasonal exposure to (less) sunlight leads to biological changes which lead to depression
Prevalence increase in higher latitudes
Treatment for SAD
Phototherapy is the best available acute treatment (Golden et al., 2005 – meta-analysis)
- Approz 53% of case will show remission with daily light therapy
- Up to about 2 hours a day. Recommended to use for preventing relapse (not usually acceptable to individuals)
CBT and phototherapy are equally effective for acute treatment of SAD (Rohan et al., 2007)
-Bx dysreg, disfucntion attitudees, rumination, and behavioral disegagement
CBT is superior in preventing recurrence of depressive episode at 1 year f/u (Rohan et al., 2009)
- 7.0% CBT
- 5.5% CBT + light therapy
- 36.7% Light therapy alone
Whats is PPD?
A clinically significant episode of major depression occurring after childbirth
Onset is usually gradual but it can also occur rapidly
Specify if:
With Postpartum Onset (can be applied to the current or most recent Major Depressive, Manic, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder, or Bipolar II Disorder; or to Brief Psychotic Disorder)
Onset of episode within 4 weeks postpartum
-researchers use wider time frames (sometimes as much as 6 mos. After delivery)
CLinical characteristics of PPD
Postpartum episodes may include psychotic features
May be suicidal ideation, obsessional thoughts regarding violence to the child, lack of concentration, and psychomotor agitation
Women with postpartum MDE’s often have severe anxiety, panic attacks, spontaneous crying long after the duration of “baby blues”, disinterest in the new infant and insomnia.
all the sx’s of depression, but with a focus on the infant or feeling about oneself as a mother/the role transition/sig others
the role of guilt in presentation of PPD
Many women with PPD feel guilty about their depressive feelings
As a result, they may be reluctant to discuss with others their depressive symptoms or negative feelings they may have towards their child
The added (compounded) guilt might exaccerbate mood disturbance
what percetnage of women are affected by PPD?
10-15%
On average how many women a year are affected by PPD?
400,000
What percent of cases of PPD go undetected by health professionals?
50%
cross-cultural prevalence of PPD
Prevalence rates vary across cultures 57% in Guyana to 0.5% in Singapore! Many studies use the EPDS Does not include anxiety, irritability Different cut-offs Higher rates when using self-reports Cultural differences in symptom presentation Numerous cultural factors that can impact reporting and/or prevalence
HOw is PPD different than the baby blues?
baby blues is not a clinical disorder; we see it as a normal process (60-80% women will experience it); not related to history, psychological factors, cultural factors
happens shorty after delivery
symptoms that look like depression/anxiety
doesn’t last very long
Describe the clinical course of PPD
PPD episodes may last from 4 weeks to more than 6 months
30-70% of women with PPD have episodes that last a year or longer
The longer the delay from onset to treatment, the longer the duration of PPD
predictors of PPD
Beck, 2001
MS. PTSD SCAB
Marriage (low satisfaction) Self-esteem (low) Planned (not) Temperament (difficult child) Social support (low) Depression (prenatal, hx of) SES (low) Childcare (stress) Anxiety (prenatal) Baby blues
what causes PPD??
Biological
- Hormonal changes (estrogen, progesterone, prolactin)
- Fatigue
- Recovery from surgery (if cesarean delivery)
- Breastfeeding difficulties
Social
- Baby born early
- Financial difficulties
- Family/marital problems
Psychological
Difficulties in adjusting to new roles
Feelings of doubt
Failure to meet high standards set for oneself
What changes occur after birth (closely correspond with the causes of PPD)
SHIT FUCK
Sleep Hormone changes Increased (work load/responsibility) To’ up (recover from pain of birth) Freedom (loss of) Unpredictable (schedule) Care (24/7)
Major themes in beck’s qual stud of PPD
Incongruity between expectations and reality of motherhood
spiraling downward
pervasive loss
making gains
Med tx’s for PPD
SSRI’s
TCA’s and other antidepressants
Antipsychotics
ECT – there might be a quicker response than a medication treat, some mother opt for this also because it allows them to continue to nurse the child
Whats the literature look like for med tx’s and breastfeeding?
Limited data on the issue of breastfeeding while on medications.
- fluoxetine is the most weel studied (mixed findings)
- other studies, there are low to trace amounts of the drug in the infants blood
psychsocial treatments for PPD
CBT – involves identifying, evaluating, and modifying dysfunctional patterns of thinking and behavior
IPT – relates depression to problematic relationships with others; common areas of treatment in PPD include conflict with partner or extended family (interpersonal disputes), loss of social/work relationships (role transition), and losses associated with the birth, such as previous perinatal loss or the death of significant others (grief)
O’hara’s study of IPT and PPD
studied IPT as tx for PPD in 99 women; IPT vs. waitlist control group, random assignment; self-report symptoms
IPT is an effective treatment for PPD
Women suffering from PPD should be treated as soon as possible
suicide is the ___ leading cuase of death (2004)
11th
Risk factors for suicide
Demographics
Age, Unemployment, Non-married martial status, gender
Psychiatric history
Previous psychiatric hospitalizations, previous suicide attempts, previous pharmacotherapy, family history of suicide
Psychological measures
Suicidal ideation, depression, hopelessness
BSS – score of 9 or above a sign predictor of death by suicide
Diagnoses
MDD (single episode not predictive), Recurrent; Bipolar D/O; Personality D/O (but if u control for mood disorder, personality not as significant)
Medical illnesses Social isolation Precipitating triggers Contributing risk factors E.g., access to firearm, recent discharger from psych hospital, exposure to another’s suicide
contagion effect – hearing about another person’s suicide (limit media coverage, minimize talking about how another person attempted suicide)
characteristics of suicidal patients
Medical illnesses Social isolation Precipitating triggers Contributing risk factors E.g., access to firearm, recent discharger from psych hospital, exposure to another’s suicide
menomic for suicide risk assessment
Is Path Warm
Ideation Substance use Purposelessness Anxiety Trapped Hopelessness Withdrawal Anger Recklessness Mood changes
