33 Happy Moments

•Write 33 Happy Moments!

•Background of “33 Happy Moments” Chin Shengt'an's Thirty Three Happy Moments (17th century), "moments when the spirit is inextricably tied up with the senses." (Supposedly written while Chin was stuck in a temple for 10 days due to rain.)

Referred to in Lin Yutang’s The importance of living (1937) in which Lin describes happiness as “sensuous” – meaning coming from the senses. And that we recognize that we must enjoy/honor the senses throughout our lives (30,000 mornings).

Relate this to Kathe’s talk

Unipolar - Bipolar Chronic - Acute Agitated – Slow Neurotic – Psychotic

Unipolar - Bipolar Chronic - Acute Agitated – Slow Neurotic – Psychotic

The continuums of Mood Disorders

Depression symptoms

Diagnostic Exercise

What are the symptoms and diagnosis?

a. Case studies on the video clips

1. VHS -- Program 8 (Mood Disorders)

2. Faces DVD

Depression symptoms

• Cognitive • Poor concentration, indecisiveness, poor self-esteem, hopelessness, suicidal thoughts, delusions, memory problems

• Physiological and Behavioral

• Sleep or appetite disturbances, psychomotor problems, fatigue,

• Emotional • Sadness,anhedonia (loss of interest or pleasure in usual activities), irritability

Major Depression

Dysthymic Disorder

5 or more symptoms including sadness or loss of interest or pleasure

3 or more symptoms including depressed mood

At least 2 weeks in duration

At least 2 years in duration

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Severity and diagnosis

DysthymiaDysthymia

MajorDepression

MajorDepression

DysthymiaDysthymia

Clinical Description Clinical Description

Melancholic– Occurs within Major Depressive Episode – Near-complete absence of the capacity for pleasure– Strong biological component (e.g., psychomotor

retardation; early morning awakening; significant anorexia)

Melancholic– Occurs within Major Depressive Episode – Near-complete absence of the capacity for pleasure– Strong biological component (e.g., psychomotor

retardation; early morning awakening; significant anorexia)

Feature Specifiers in Mood Disorders

– Onset within four weeks following birth– Spontaneous crying long after the usual duration

of “baby blues” (3-7 days postpartum)– Lability of mood -- can be of a psychotic nature– Suicidal ideation

– Onset within four weeks following birth– Spontaneous crying long after the usual duration

of “baby blues” (3-7 days postpartum)– Lability of mood -- can be of a psychotic nature– Suicidal ideation

Postpartum Onset

– SAD– Episodes during certain seasons (usually winter)– Typically characterized by anergy, hypersomnia,

overeating, weight gain, and a craving for carbos

– SAD– Episodes during certain seasons (usually winter)– Typically characterized by anergy, hypersomnia,

overeating, weight gain, and a craving for carbos

Seasonal Pattern

Major Features Major Features Experience Both

– Manic Episodes

– Major Depressive Episodes

Roller Coaster of Mood

Experience Both– Manic Episodes

– Major Depressive Episodes

Roller Coaster of Mood

Mania and Hypomania Mania and Hypomania

Elevated Mood Decreased need for sleep

Elevated Mood Decreased need for sleep

Grandiosity Grandiosity

Increased Activity Increased Activity

More talkative More talkative

Causes of Mood Disorders

Biological

Psychological

Socio-cultural

• Genetic contribution (heritable vulnerability in mood disorders). Example: Bipolar

Biological Factors in Mood Disorders

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MZ twins DZ twins Sibs, parents,children

Biologicalparents of BP

adoptees

Second-degreerelatives

Generalpopulation

• Neurotransmitters

•Monoamines – Dopamine, Norepinephrine, Serotonin

• Evidence

•Reserpine (hypotensive agent) breakdown of monoamine storage in

vesicles depression

•Antidepressants work on increasing MAs

•MAO Inhibitors

•SSRIs

•Decreased CSF levels of 5-HIAA in patients with severe depression

(and in completed suicides, post-mortem analysis)

Biological Factors in Mood Disorders

• Endocrine Factors

•Stress and its neurochemical impacts

•Chronic glucocorticoid exposure monoamine depletion &

hippocampal cell atrophy (memory dysfunction)

Biological Factors in Mood Disorders

• Brain factors

•Activity in the multi-nodal depression “circuit” (i.e.,

connections between and among the PFC, nucleus

accumbens, overactive anterior cingulate cortex [Cg25])

Biological Factors in Mood Disorders

Deep Brain Stimulation for Treatment-Resistant DepressionHelen S. Mayberg, Andres M. Lozano, Valerie Voon, Heather E.

McNeely, David Seminowicz, Clement Hamani, Jason M. Schwalb, and Sidney H. Kennedy

Neuron, Vol 45, 651-660, 03 March 2005

• Brain factors

• Effort-driven Rewards Center

• Nucleus accumbens-striatum-PFC (emotion-movement-

thinking)

• Lifestyle-depression link (hypothesis regarding increasing

depression with decreasing effort / use of our hands)

Biological Factors (in concert with behavioral factors) in Mood Disorders

www.kellylambert.com

Stressful Life Events Learned Helplessness Rumination Attributional Style / Negative

cognitions

Stressful Life Events Learned Helplessness Rumination Attributional Style / Negative

cognitions

Internal (“I blew it”) Stable (“I’ll blow it again”) Global (“”I blow it in tons of situations”)

Internal (“I blew it”) Stable (“I’ll blow it again”) Global (“”I blow it in tons of situations”)

CD Article (neighborhood characteristics)

CD Article (neighborhood characteristics)

Social-cultural support

• Men get depression DVD clips (treatment section)

Treatments for Mood Disorders

• Medication (prescribed and herbal)

• Electroconvulsive therapy (ECT)

• Repetitive transcranial magnetic stimulation

• Vagus nerve stimulation

• DBS

• Light therapy

• Exercise

Biological Treatments for Mood Disorders

                                             

See “Manufacturing Depression”

Medications Medications Tricyclic Antidepressants MAOI’s SSRI’s Herbal (e.g., St. John’s Wort) Lithium Anti-convulsants

Tricyclic Antidepressants MAOI’s SSRI’s Herbal (e.g., St. John’s Wort) Lithium Anti-convulsants

Psychological Treatments for Depression

• Behavioral Therapy– Increase positive reinforcers and decrease aversive events by teaching the

person new skills for managing interpersonal situations and the environment

• Cognitive-Behavioral Therapy– Challenge distorted thinking and help the person learn more adaptive ways

of thinking and new behavioral skills

• Interpersonal

• Existential

• Psychodynamic Therapy– Help the person gain insight to unconscious factors to facilitate change in

self-concept and behaviors

Cycle of Psychological TreatmentsThe risk of suicide and life interference can be reduced by shortening

the duration of MDEs with effective acute-phase treatments, including pharmacotherapy, interpersonal psychotherapy, and cognitive–behavioral therapy . We define acute-phase treatments as those applied during an MDE with the goal of reducing depressive symptoms and producing initial remission. Responders to some acute-phase treatments (e.g., CT) may receive some protection from relapse–recurrence , but prevalent relapse–recurrence after successful antidepressant treatments has long been recognized as a serious limitation of these interventions Consequently, continuation-phase treatments (e.g., pharmacotherapy, interpersonal psychotherapy, CT) may be applied to sustain remission of an MDE and reduce the probability of relapse–recurrence. Continuation-phase treatments can match the “modality” used in the acute phase or differ in modality compared with the acute-phase treatment (e.g., acute-phase pharmacotherapy followed by C-CT

Vittengl et al., JCCP, Vol 75(3), Jun 2007. pp. 475-488.