1
Q
Perceptual Styles
Field independent
A
- not influenced by people around them;
- do their own thing;
- will not do well in a group;
- not interested in learning from others b/c they don’t need it;
- shouldn’t be sent to AA, NA, Group therapy, etc.;
- require individual therapy and teaching of social skills
2
Q
Perceptual Styles
Field dependent
A
- dependent on people around them;
- This matters to therapy because there are two chunks of therapy- group and individual therapy;
- Field independent people will not do well in group therapy;
- likely to do well with teamwork and group activities
3
Q
Perceptual Styles
Self-efficacy
A
- belief that you can achieve w/e you must achieve in the moment;
- highest correlate in recovery of mental health;
- therapy should have a spark to it –
- optimism, hopefulness, inspirational
4
Q
Perceptual Styles
Learned Helplessness
A
- undercut and change this;
5
Q
Stress Sources
Internally generated
A
- stress generated by the self onto the self
6
Q
Externally generated
A
- stress generated by an outside source
- very prevalent
7
Q
Depressive and Bipolar Disorders (used to be Mood)
Genetics and temperament are big predictors of depression
A
- it runs in families.
- Even though it runs in families (genetics causes nothing by itself), it requires an environmental precipitator.
- Something will kindle depression-stressors, death, tragedies, major health problems, and crisis.
- Want to prevent those phenomenon from kindling depression that becomes self-sustained.
8
Q
Depressive and Bipolar Disorders (used to be Mood)
Trend
A
- Women twice as likely
- Disorders are on the increase
- Onset age getting younger
9
Q
Depressive and Bipolar Disorders (used to be Mood)
Prevalence
A
- Mood Disorders during lifetime – 30% of population
- Clinical depression treated – 25% (**75% suffering depression get no treatment)
- Hospitalized for depression 1:50
- Successful suicides: 1:100
- 80% of all suicides are linked to depression – 20% of suicides linked to a variety of things like other psychotic disorders.
- Depression blinds people from the obvious.
- # 1 cause of premature death is depression by 2020.
- Without treatment, 10% or so will end their lives.
- 60% have moderate depression, 40% will have severe depression.
- Depression spontaneously remits.
- Mild versions of depression last 4-6 months.
10
Q
Depressive and Bipolar Disorders (used to be Mood)
Highest Risk
A
- Married women who are full time homemakers with young children and who are at the low socioeconomic level
11
Q
Depressive and Bipolar Disorders (used to be Mood)
Duration
A
- Depression lasts about 1 year
- Relapse occurs in half of the people
- Mild symptoms can last 2 years
12
Q
Mood Episodes
A
- Not diagnosable by itself (in order to diagnose, must have mood episodes)
- The basis of a mood diagnosis
13
Q
Mood Episodes
Types of Mood Episodes
A
- Major Depressive Episode
- Manic Episode
- Mixed Episode
- Hypomanic Episode
14
Q
Mood Episodes
Major Depressive Episode
A
- Depressed mood – most of the day, nearly every day OR Loss of interest in pleasure (must have one of these for this diagnosis)
- Weight gain or loss (appetite: loss - without the intention; gain – eating excessively)
- Insomnia (broken fragmented sleep) or hypersomnia (can’t get up after sleeping)
- Psychomotor agitation (edgy, mindless fidgeting) or retardation (everything is slowed down)
- Fatigue (lack of energy when you do nothing)
- Feeling worthless and guilty nearly everyday
- Indecision and inability to concentrate
- Recurrent thoughts of death or suicide
- Bereavement
- Need to have 5 (INCLUDING one from the first) of 9 for at least two weeks, most of the day, nearly every day.
15
Q
Mood Episodes
In order to have a diagnosis of major depressive disorder you must…
A
- have had at least one Major Depressive Episode.
16
Q
Mood Episodes
Manic Episode
A
- Abnormally elevated or irritable mood disturbance lasting at least one week.
- During this Mood Disorder you must have 3 (if abnormally elevated) or 4 (if irritable mood) of the following:
- Inflated self-esteem, grandiosity
- Decreased need for sleep (2-3 hours/night)
- More talkative (than normal) – hyperverbal
- Racing thoughts [“flight of ideas”…like being in a whirlwind] – subjective prompts from within
- Distractibility (externally)
- Increase in goal directed activity (socially, sexually, work) this is taken to an extreme
- Excessive involvement in pleasurable activities that have painful consequences (business, excessive shopping for things that don’t get used, indiscriminate sex)
17
Q
Mood Episodes
MIxed Episode
A
- Criteria for Major Depression and Manic Episodes are met
- For at least one week of duration
- Client has always had daily swings
- Not as common as Rapid-Cycling (in which time between episodes shortens)
18
Q
Mood Episodes
Hypomanic Episode
A
19
Q
Mood Episodes
Difference btw Manic and Hypomanic Episodes
A
- Hypomanic episode will:
- The symptoms are uncharacteristic of the person when not symptomatic
- The change in mood is noticeable by others
- Not severe enough to cause marked impairment or need for hospitalization
20
Q
Common Disorders That Cause Depression
A
- AIDS
- Chronic Infections
- COPD (Chronic Obstructive Pulmonary Dysfunction)
- Diabetes
- Hyperthyroidism – metabolism is up; weight loss
- Hypothyroidism – metabolism is down; weight gain
- Cancer
- Colitis
- Multiple Sclerosis
- Hepatitis (medication for Hepatitis C costs $1 to make each pill, $1,000 to buy one pill, 90 day treatment.)
21
Q
The Depressed Patient
A
- Severe emotional pain that they feel will not end; hopelessness
- Suicide commonly considered. Always check suicidal ideation in detail, all the time, every time
- Depression and suicide runs in families (This can be helpful when giving meds since something may have worked for another depressed person in their family. In that case, it will most likely work for them too.)
- Depression and Borderline or Delusional Disorders are very high risk patients
- If diagnosis is Major Depressive Disorder – must check on suicidal ideation every visit; needs to be noted in progress notes every visit
- Preventing suicide is priority
- Patients with Mood Disorders are usually not psychotic
22
Q
What is the difference between Bipolar I and Bipolar II?
A
- Bipolar I involves episodes of depression and mania, while Bipolar II involves less severe episodes of mania called hypomania.
23
Q
Categories of Depression
Exogenous
A
- Reactive Depression
- Something has happened in the environment.
- Ex. bad marriage, lost job
- Talk during therapy can help this category
24
Q
Categories of Depression
Endogenous
A
- Biological Depression
- Nothing has gone wrong in the environment; it is biological- biochemical. Serotonin level is depleted so depression occurs.
- Life is great, however, the biochemical process of production serotonin isn’t there- so you’re depressed.
- All the talk in the world during therapy will not help this
- Client will need medication
- Less common
- More severe
- Most severe in morning
- treated differently than Endogenous/Biological Depression in therapy.
25
# Typical Symptoms of a Mood Disorder
Emotional
* Guilt
* Anger
* Irritability
* Social and marital distress
26
# Typical Symptoms of a Mood Disorder
Behavioral
* Crying
* Neglect of appearance
* Withdrawal (social)
* Dependency (behaviorally)
* Reduced activity
* Poor social skills (skills had have been lost due to social isolation and don’t feel like those skills are there anymore)
27
# Typical Symptoms of a Mood Disorder
Attitude
* (systematic way of thinking, feeling, and reacting. The way you deal with life)
* Pessimistic
* Helpless
* Suicidal ideation
28
# Typical Symptoms of a Mood Disorder
Cognitive
* Indecisive
* Reduced concentration
* Cognitive distortions
29
# Major Depressive Disorder: Etiology
Psychodynamic Model
* Symbolic loss of love object associated with anger turned in on self or toward parents and self (often hear that depression and anger are two sides of the same coin).
30
# Major Depressive Disorder: Etiology
Social Learning Model
* A response that a person learned or reinforced. The reward (attention) outweighs the depressed mood
31
# Major Depressive Disorder: Etiology
Cognitive Model
* Faulty logic and having a negative set of cognitions
32
# Major Depressive Disorder: Etiology
Behavioral Model
* Poor social and other skills and therefore little positive social reinforcement occurs
33
# Major Depressive Disorder: Etiology
Interpersonal Model
* Dependent on others leads to no sense of self, conflict, and inadequate communication
34
# Major Depressive Disorder: Etiology
Developmental Model
35
Biological Model
* Depletion of serotonin
* scientific fact
* it results in biochemical changes and is common to all cases.
* When we increase serotonin levels depression goes away.
* Neural decline and neural decay occurs with depression which causes less neural connectivity in the brain.
* Hippocampus is smaller in people with depression versus those who do not have depression.
* *Depression should ALWAYS be treated with medication.**
* Psychotherapy can increase serotonin levels; however, the issue is time. Medication is given to speed up the progress of therapy, which should be about correcting cognitive distortions.
36
Dysthymia Disorder
* Persistent depressive disorder
* chronic depressed mood
* “Down in the dumps”
* Increase self-criticism, see themselves as uninteresting, incapable
* A long-standing condition – “I have always felt this way.” “This is how I am.”
* “Double Depression” – After two years of Dysthymic Disorder, a patient may also have a Major Depressive Episode. Then both Dysthymic Disorder and Major Depressive Disorder are diagnosed.
* Specify either:
* Early onset - before 21
* Late onset – after 21
37
What is the difference btw major depressive and persistent depressive?
* Major depressive min 2-4 weeks
* persistant 2 years
38
Mood Disorders and the therapist
* Take a directive clinical role
* not client centered because it fosters helplessness
DSM
flashcards
Decks in class (7)
# Cards
