Mood and Disorders: An Overview Presenter: Melissa Jadhav, LMHC Director of Outpatient Services Eliot Community Human Services Learning Objectives

 Overview of linkage between childhood maltreatment and cognitive and impairments – along with issues.

 Overview of most prevalent mood/anxiety disorders

 Types of Treatment

 Communication Tips Removed

https://www.youtube.com/watch?v=lOeQUwdAjE0 Removed Discussion

 What is your initial reaction to this video?  How did the history of this child impact her later behavior and interactions with others?  What triggers the fight/flight/freeze response in the child? Mood/Anxiety Disorders: The Beginning for Many… Effects of Maltreatment: Childhood and Adolescence

 Brain changes in development  Hyper arousal  Inability to regulate emotions  Disrupted Attachments  Learning Difficulties  Impulsive Behavior Effects of Maltreatment: Adulthood

 ACE Study  Children who scored 6 out of 10 experiences were 4000% more likely to use IV drug use after age 18  80% of 21 year old men and women who were abused and/or neglected as children meet criteria for a major psychological disorder  66% of people receiving treatment for substance abuse disorders report neglect and/or abuse as a child Mood Disorders

 Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a .

 The median age of onset for mood disorders is 30 years.

 Depressive disorders often co-occur with anxiety disorders and substance abuse. Mood Disorders

 General term encompassing the following disorders:  Bipolar Disorders  Major Depressive Disorder 

 Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year.

 The median age of onset for bipolar disorders is 25 years. Bipolar Disorder

 Generally 3 presentations   Hypomania  Mixed  Extreme Mania with psychotic features  Dramatic changes or extremes of mood Bipolar Disorders

 Bipolar I Disorder  Extreme mood swings and periods of even- keeled behavior  Inflated self-esteem, grandiosity  Decreased need for sleep  More talkative/pressure to keep talking  Racing thoughts  Highly genetic and generally begins in mid-20s  Can be the cause of devastating life events  Doesn’t have to experience a depressive episode  Bipolar II Disorder  Hypomanic episode – less severe than manic episode  Inflated self-esteem, grandiosity  Decreased need for sleep  More talkative/pressure to keep talking  Racing thoughts  Must have a major depressive episode What it’s like to have Bipolar Disorder

Artist Ellen Forney detailed her diagnosis with bipolar disorder in the graphic memoir Marbles: Mania, Depression, Michelangelo, and Me. Depressive Disorders

 Persistent feelings of sadness and hopelessness  Very common diagnosis, most people will experience a mild clinical depression at some point  Impacts thoughts, feelings, behaviors & physical health Major Depressive Disorder

 Leading cause of disability in the U.S. for ages 15-44.  Affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.  While major depressive disorder can develop at any age, the median age at onset is 32.  More prevalent in women than in men Major Depressive Disorder – Symptoms  Depressed mood most of day – everyday for 2 month period  Significant weight loss or gain  Sleep too much or not enough  Feelings of worthlessness/hopelessness  Lack of motivation/difficulty concentrating  Recurrent thoughts of death/suicide  Single Episode or Recurrent Episodes Differences in Depression Men/Women

 Men  Tired, irritable, lost interest in once-pleasurable activities, difficulty sleeping  May become frustrated, discouraged, irritable, angry. Some men may throw themselves into their work.  Women  Symptoms of sadness, worthlessness, and guilt  What it’s like to have Major Depressive Disorder

“I’m a firefighter and ex-Marine. I should be able to deal with anything. But I was sleeping poorly and always in a bad mood. My work was suffering because I couldn’t concentrate. I felt like I was just going through the motions and wondering what the point of it all was. I never considered that I might have an underlying condition. I figured this is just how life is.” What it’s like to have Major Depressive Disorder

“My friends keep asking what’s wrong with me. I have a great job and a wonderful family. But nothing seems fun anymore. I’m tired all the time. I’m trying to force myself to be interested in my kid’s activities, but I’m just not anymore. I feel lonely, sad, and don’t have the energy to get things done. I feel like I’m being a bad mom.” Difference in Depression Children/Teens

 Children

 Before puberty, girls & boys equally likely to develop

 A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.

 Most chronic mood disorders, such as depression, begin as high levels of anxiety in children  Teens

 Sulk, get into trouble at school, be negative and irritable, and feel misunderstood.

 Understanding different between diagnosable depression and typical teenage mood swings Dysthymia

 Mild but long-term (chronic) form of depression.  Symptoms usually last for at least two years.  May lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy.  Often thought of as being overly critical, constantly complaining and incapable of having fun. Review of Mood Disorders

Artist Ellen Forney detailed her diagnosis with bipolar disorder in the graphic memoir Marbles: Mania, Depression, Michelangelo, and Me. Suicide and Mood Disorders

 Over 90% of people who commit suicide meet criteria for a mood disorder and/or substance abuse diagnosis Anxiety Disorders

 Anxiety is normal and adaptive, but a disorder is when it occurs out of context and/or impacts life  Major types

 Generalized - excessive worry, restlessness, fatigued, irritability, sleep disturbance, difficulty concentrating…  - of negative evaluations, scrutiny

 Sweating  short breath  heart pounding  chest pain  Dizziness What it’s like to have Panic Disorder

“One day, without any warning or reason, a feeling of terrible anxiety came crashing down on me. I felt like I couldn’t get enough air, no matter how hard I breathed. My heart was pounding out of my chest, and I thought I might die. I was sweating and felt dizzy. I felt like I had no control over these feelings and like I was drowning and couldn’t think straight.

After what seemed like an eternity, my breathing slowed and I eventually let go of the fear and my racing thoughts, but I was totally drained and exhausted. These attacks started to occur every couple of weeks, and I thought I was losing my mind.”

Phobias

 Marked fear about specific object/situation

- fear about being in open or enclosed spaces, being in crowds, using public transportation being outside of the home alone Claustrophobia

Acrophobia

Glossophobia Arachnophobia Hemophobia

Ophidiophobia Social Anxiety

 Fear of negative evaluations, scrutiny from others Obsessive Compulsive Disorder

 OCD  Obsessions and compulsions  Highly correlated with seizure, tic, and Tourette’s disorder  Hoarding

What It’s Like to Have OCD

“I couldn’t do anything without my rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times because three was a good luck number for me. It took me longer to read because I’d have to count the lines in a paragraph. When I set my alarm at night, I had to set it to a time that wouldn’t add up to a ‘bad’ number.” Getting dressed in the morning was tough because I had to follow my routine or I would become very anxious and start getting dressed all over again. I always worried that if I didn’t follow my routine, my parents were going to die. These thoughts triggered more anxiety and more rituals. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me. I couldn’t seem to overcome them until I got treatment.” Case Studies

 Jessica  Donald  Joe  What is the diagnosis for this person? What symptoms are present? Case Studies

Jessica is a 28 year-old married female. She has a very demanding, high stress job as a second year medical resident in a large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past. For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping. At home, Jessica’s husband has noticed changes as well. She’s shown little interest in sex and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He’s overheard her having frequent tearful phone conversations with her closest friend, which have him worried. When he tries to get her to open up about what’s bothering her, she pushes him away with an abrupt “everything’s fine”. Although she hasn’t ever considered suicide, Jessica has found herself increasingly dissatisfied with her life. She’s been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet can’t seem to shake the sense of doom and gloom that has been clouding each day as of late. Donald is a 54- year male who lives with his wife of 30 years with whom he has three adult children and 7 grandchildren. Donald experienced the onset of problems with worry during his first few years of marriage when he would worry excessively about finances, his job security and performance, fixing up the house, his children and their futures, and his parent's health. Since that time he has also worried uncontrollably about the car breaking down, his grandchildren being harmed, saving enough for retirement, his own health and his wife's health. Donald's worry has interfered with his ability to enjoy his life including holidays and special occasions, as he always feels tense, restless, and on guard. His back and neck constantly ache from the tension. His worrying has also led to long-term problems falling asleep. He has become dependent upon sleeping pills and still feels easily fatigued most days. Friends and family complain that he is always on the go and never sits still, but this is the only way he knows how to block the worries from his mind. Around times of stressful life events (e.g., during his daughter's divorce) Donald tends to experience an increase in his worrying frequency and intensity but his reaction is always stronger than other people's. After a bad period of worry he often feels depressed for weeks afterwards including no pleasure or interest in his usual activities. Donald feels envious of the enjoyment and relaxation other people seem to get from life and he often feels hopeless when it comes to managing his worry. He is very concerned that he may develop health problems due to his excessive worrying and he sometimes wonders whether his worrying actually increasing the odds of bad things happening to him. Joe is a 41-year-old self-employed gentleman, presenting with eight year history of depression and mood instability. The depression was exacerbated two years ago, after having been made redundant and had his house repossessed. Symptoms described included persistent low mood, and feeling like he wants to “curl up and die”. He had lost motivation in completing his college course, and partaking in other activities of interest. He was also noticed to become increasingly socially withdrawn. Somatic symptoms include sleep-onset insomnia; night time awakenings, loss of appetite and weight. Further consultations over the course of one year elicited periods of elevated mood. These included overspending money; inappropriate social behaviors, such as calling friends at early hours of the morning and getting himself into embarrassing situations. He also described staying awake for up to 72 hours due to constant thoughts running through his mind, and works very effectively on his website during this time. These elevated moods can last up to 10 days in duration. In between the high and low moods, he describes feelings of intense anger, when he can attempt to be physically violent towards his mother. Hope!

 Things can improve  ACE versus HOPE  Healthy Outcomes from Positive Experiences  Mitigate & decrease symptoms/issues with social supports, positive interactions, sense of mastery, sense of belonging Treatment  Medications

 Psychotherapy

 Cognitive Behavior Therapy (CBT)

 The way that individuals perceive a situation is more closely connected to their reaction than the situation itself.

 Change their unhelpful thinking and behavior that lead to enduring improvement in their mood and functioning.

 Dialectical Behavior Therapy (DBT)

 Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness.

 Motivational Interviewing (MI)

 Exploring and resolving ambivalence and centers on motivational processes within the individual that facilitate change. Treatment Continued

 Crisis Management

 Family Engagement

 Especially with youth/young adults, as well as those who live with family

 Vocational Rehabilitation

 Focus on finding & maintaining employment

 Sometimes this can be the most helpful

 Psychiatric Rehabilitation

 The goal to help individuals develop the emotional, social and intellectual skills needed to live, learn and work in the community with the least amount of professional support as necessary. Treatment Continued

 Treating the Underlying Cause  CR/EMDR – PTSD  Recovery Coaches – Substance Use  CSP/EOT- housing, homelessness, finances, medical needs

Brain scan at beginning, during & end of CBT treatment for OCD Barriers of Engagement and Listening

1. Prejudging 2. Not listening/being distracted 3. Criticizing 4. Name calling 5. Engaging in a power struggle 1. Ordering 2. Threatening 3. Minimizing 4. Arguing Communication Tips

 Be conscious of your emotional response to what the person is saying or doing

 Ask yourself: “Is this really about me or is the person’s life story, possible difficulties communicating effectively, or physical/emotional pain playing a role in what is happening for them right now?”

 Ask yourself: Do I want to be EFFECTIVE or RIGHT? Communication Tips

 Reflect and validate the person’s concern regardless of the content or whether you agree with them. Do this throughout the discussion

 Collaborate with the person to explore the underlying cause of their frustration… it can be deeper than what the presenting concern is

 Collaborate with the person to explore short and long term ways to address the presenting concern. Thank You! Contact Information: Melissa Jadhav, LMHC [email protected]