Mood Disorder Discussion Post:
The Case of Andrea Yates. This was one of the first cases that brought attention to the importance of Postpartum Depression.
Please discuss this disorder and its impact on the mother-infant relationship.
Do research to find out the best therapeutic approaches to treatment of this disorder.
Mood Disorder Discussion Post:
The Case of Andrea Yates. This was one of the first cases that brought attention to the importance of Postpartum Depression.
Please discuss this disorder and its impact on the mother-infant relationship.
Do research to find out the best therapeutic approaches to treatment of this disorder.
Mood Disorders
History:
Depression which is one of the mood disorders has been recorded since antiquity and descriptions of what we now call mood disorders can be found in many ancient documents. The Old Testament story of King Saul describes a depressive syndrome. The story of Ajax’s suicide in Homer’s Illiad. About 400 B.C. Hippocrates used the terms “mania” and “melancholia” for mental disturbances. About A.D. 30 Aulus Cornelius Celsus described melancholia in his work De re medicina as a depression caused by black bile. The term continued to be used by other medical authors, including Arateus (120-180), Galen (129-199), and Alexander of Tralles in the sixth century. The 12th-century Jewish physician Moses Maimonides considered melancholia a discrete disease entity. In 1686 Bonet described a mental illness that he called maniaco-melancholicus.
In 1854 Emil Kraepelin described the manic depressive psychosis that contained the criteria that the DSM now uses to establish the diagnosis for bipolar I disorder. Kraepelin also described a type of depression that began after menopause in women and during late adulthood in men that came to be known as involutional melancholia and has since come to be viewed as a form of mood disorder with a late onset.
DSM-IV Criteria for Major Depressive Episode
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
A depressed mood and a loss of interest or pleasure are the main symptoms of depression. Persons suffering from this disorder speak of feeling blue, hopeless, in the dumps, or worthless.
About 2/3rds of all depressed persons contemplate suicide and approximately 10-15% do so. Reduction in energy is a sign of depression. Persons experience difficulty in finishing tasks, school and work impairment, and decreased motivation to take on any new projects. Trouble sleeping is also common. Some persons sleep too much; others suffer from insomnia because they ruminate about their problems. Decreased appetite and weight loss is also common. However, some overeat and have weight gains.
The elderly have high rates of depression due to their changing health, socioeconomic status, loss of loved ones, social isolation, and loss of control over their own lives.
Depression can also include psychotic symptoms as we saw in the case of Andrea Yates who suffered from Postpartum Depression.
Bipolar disorder includes mood swings. Persons may swing from manic episodes to depressive episodes. When there is no depressive episode, the symptoms are only those described for a manic episode. This is Bipolar II.
DSM-IV Criteria for Manic Episode
Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of bipolar I disorder.
Manic episodes include an expansive, or irritable mood. The mood is euphoric and often infectious. Persons in the midst of a manic episode often talk excessively, do not sleep, have grandiose ideas, go on spending sprees, become sexually promiscuous, among other behaviors.
Dysthymic Disorder is a milder form of depression but it is more chronic. This form of depression often goes unnoticed because of the milder symptoms. However, it is very disruptive to the life of the person it is affecting.
Cyclothymic disorder is a milder form of Bipolar Disorder.
Seasonal Affective Disorder is a form of depression that is caused by changes in light for persons who live in seasonal climates. This disorder is treated easily by exposing the sufferer to light therapy for several hours each day.
Postpartum Depression results from hormonal changes that result from childbirth. Loss is also a issue with this disorder. Women who have shared their bodily space with their infant for nine months find that the infant is quickly separated from their body as a result of birth. This can lead to feelings of separation and loss and can be traumatic when there is a history of separation of loss.
Etiology:
Psychodynamic – the psychodynamic explanation for depression focuses on separation (see the work of Harlow on attachment) and anger. Freud would see loss as also being “symbolic loss,” meaning that the person perceives any form of rejection as symbolic of an earlier loss. Freud would have also argued that depressed people are excessively dependent because of their fixation at the oral stage of development. This stage represents passivity and having others fill our needs. Therefore, when these persons become adults, their self-esteem depends on other important people in the environment. Loss of these important people brings low self-esteem.
Freud also believed that depressed people are those persons who failed to follow the normal process of mourning, “grief work.” The mourner can also be flooded with anger and guilt. Anger comes from feelings of being deserted and guilt from the imagined wrongs committed against the lost person. Anger can also be turned against the self, resulting in depression.
Behavioral – this approach to depression focuses on reinforcing events and their availability. Low rates of positive reinforcement are perceived to be linked to depression.
Cognitive – cognitive explanations focus on self-esteem and distorted self-concept that leads to messages that the person is inept, unworthy, and incompetent. Learned helplessness (see learning theory lecture) was suggested by Martin Seligman (1975) to be the cause of depression. When persons believe that they have no control over themselves, others or their environment they are likely to become psychologically helpless. Stress is also related to depression.
Biology – The Catecholamine Hypothesis is the biological explanation for the Mood Disorders. Depression results from the failure of reuptake or MAO effects (see textbook).
Treatment:
The treatment of these disorders depends on the severity. In the case of Bipolar Disorder, lithium is the treatment of choice. It appears to have much success in moderating the mood levels of persons who suffer from this disorder.
The depressions depend on the severity. In the case of a person suffering from severe clinical symptoms of depression, medication might be necessary to stabilize the person. However, psychotherapy could focus on issues of separation, loss, and anger. Some believe that manic episodes are defenses against depression. In the case of cognitive-behavioral therapy it would be important to focus on the negative messages that persons often give to themselves and issues of control.
The book lists ten common characteristics of suicide on page 387. In general men are more likely to complete suicide attempts even though women make more attempts. This is because men often choose more violent means of ending their lives than do women, therefore, they are more likely to be successful. For example, a 17-year-old man jumped in front of a train at the train station near where I live last Thursday. He did this after a breakup with his girlfriend and his attempt to kill her. Thinking he did kill her, he took his own life. A woman would be more likely to take an overdose of pills.
People who commit suicide often feel hopeless. They are unable to see that tomorrow can be brighter than today. From a psychodynamic perspective self-destruction is a result of hostility directed inward against the internalized object (loved one).
Adolescents tend to only see today and are unable to look toward the future. Adolescence is a confusing time during which they are very sensitive and struggling to find their identity.
The elderly are the most at-risk group for suicide. They often must face losing loved ones, losing their physical and/or mental capabilities, relocation, lowered finances, and feeling isolated and worthless.
When a person is deemed to be at-risk for suicide the mental health professional must make a decision as to whether the person needs to be hospitalized or can be managed on an outpatient basis. This is always a difficult decision to make. Often, persons will sign an agreement that they will not harm themselves and will set up a meeting time for further discussion. However, persons are often most at-risk when they are coming out of a depressive state because they do not have the energy when they are in the midst of depression.
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