separating your rhythms from the blues: normal … · 1 sadness or depression? separating your...
Post on 01-Sep-2018
222 Views
Preview:
TRANSCRIPT
1
Sadness or Depression?
Separating Your Rhythms from the Blues:Normal Moods and Seasonal Depression
2
About “10% of the US population” experience “some form of
Seasonal Affective Disorder (SAD)” but “only one or two percent of
people experience symptoms severe enough to warrant medical care
U.S. Department of Health and Human Services regards the
“Winter Blues” as “a general term, not a medical diagnosis,” “fairly common” and “more mild than serious.”
Winter Blues are known to usually clear up on their own
“Winter Blues” are often linked to specific things, such as “stressful holidays,
reminders of absent loved ones” or even slight symptoms of SAD that do not fully develop (News in Health).
SAD “Winter Blues”
7.2% 20.2 %
6.1% 17.1%
5.0% 13.9%
3.9% 10.6%
2.8% 7.5%
3
People living at higher latitudes have shorter days in the winter and
report more seasonal depression and more winter blues
Basic Questions /Vocabulary
What is Mood ?
What is Normal Mood ?
What is Abnormal Mood ?
What is a Mood Disorder ?
How are Mood Disorders Diagnosed ?
What is Mood ?
Affect vs Mood
•Subjective feeling state
•Experience reported
•Long Lasting
•Objective feeling state
•Experience observed
•Variable overs seconds
Like the Weather Like the Climate
Normal Mood is
• Reactive to events with
–Amplitude
–Duration
–Direction
appropriate to the meaning of the event for that individual
Understanding Abnormal Mood states:
Depression:
Diminished ability to
respond positively to
pleasurable events
Mania:
Diminished ability to
respond appropriately
to negative events
Slowed Speechor Movement
Agitation
Distractibility
Decreased Concentration
Excessive Guilt
Low Self Esteem
Depressed Mood
Diminished Interest in
Pleasurable Activities
AppetiteIncrease orDecrease
SuicidalIdeation
Sleep disturbanceIncrease orDecrease
Diagnosing Clinical Depression
Plus
Constellationof associated symptoms
AbnormalMood state
Decreased EnergyFatigue
Requires 5 symptoms present to a significant degree
nearly every day during a two week period
Diagnosing Clinical Major DepressionMDE
Requirement
≥ 5
DSM 5 Criteria
Present to a significant degree nearly
every day during a two week period
Abnormal mood
state
≥ 1
Depressed Mood
Decreased interest/ diminished pleasure
+ +
Associated
Symptoms
Sleep Disturbance
Low Self Esteem/Guilty
Decrease energy/Fatigue
Concentration difficulty
Appetite Disturbance
Psychomotor agitation/retardation
Suicidal ideation/morbid thinking
Seasonal Affective Disorder specifies a pattern in DSM 5
Episodes meet full criteria for major depression
and
• Coincide with specific seasons (appear in winter or summer months) for at least 2 years.
• Seasonal depressions must be much more frequent than any non-seasonal depressions.
Winter Summer•Low energy
•Hypersomnia
•Overeating
•Weight gain
•Craving for carbohydrates
•Social withdrawal (feel like “hibernating”)
•Poor appetite with associated weight loss•Insomnia•Agitation•Restlessness•Anxiety•Episodes of violent behavior
Most Common Symptom Pattern of SAD
CZ001060-SERO, March 200915
• Genes
• Environment
• Stress
• Social defeat
• Neurotransmitters
• Receptors
• Transporters
• 2nd messengers
• Oxidative stress
• Cytokines
Putative Causes of Mood Disorders
• Nutrition
• Mitochondrial dysfunction
• Circadian disruption
• Decreased neuropil
• HPA axis dysfunction
• Disconnection syndrome
• Cognition
• Temperament
• Nonadherence
CZ001060-SERO, March 2009
Light is a potent zeitgeber (time giver)
Zeitgebers: Tell the brain’s clock (suprachiasmatic nucleus) what time it is
“Entrained”by Zeitgeberto 24 hr cycle
“Free Running”No Zeitgeber
25 hr cycle
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
Fall sleep Wake-up
Rhythms with common cycle length = Synchronized
“Un-entrained”Desynchronized
e.g. 24 hr and 30 hr cycles
Un-entrained“Free Running”Desynchronized
e.g. 25 hr and 27 hr cycles
Day 1
Day 2
Day 3
Day 4
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
* TMin
Fall sleep Wake-up
Day 7
Rhythms with different cycle length drift = Desynchronized
22
Entrained RhythmsYour Body’s Many Separate Organs Function like an Orchestra
Synchrony maintained byFollowing the same biological clock
Self-management strategiesto help stabilize circadian rhythms
Re- enforce your Zeitgebers• Good sleep hygiene• Intentionally couple activity with your sleep
wake cycle• Manage light exposure• Honor social routinesCommon sense consumptionMeasure what you want to manage
• Sleep• Weight• Activity• Mood
Transform Your Engagement into Guidance
Put more into your care→ get more out
Give yourself the gift of Measure-based Guidance
at no cost
Create and Share Pre-assessment Reports
1. Visit: EngagedPractice.com2. Enter access code: engage2
A service provided by Collaborative Care Initiative
Engaged Practice Work Flow: Formal Measures Tab*
*This is an example of software that can aid in patient assessment. There are other similar software available.
DSM, Diagnostic and Statistical Manual of Mental Disorders; MADRS, Montgomery-Asberg Depression Rating Scale; PHQ-9, The Patient Health Questionnaire; QLESQ, Quality of Life Enjoyment Questionnaire; YMRS, Young Mania Rating Scale.
AT A GLANCE VIEW: REPORT 04/22/2016MADRS items Score
Reported Sadness 4
Observed Sadness 4
Inner Tension 6
Reduced Sleep 2
Reduced Appetite 3
Conc Difficulties 5
Lassitude 4
Inability to feel 5
Pessimistic Thoughts 4
SI/ Morbid Thoughts 2
MADRS total 39
YMRS items Score
Elevated Mood 2
Energy 3
Sexual Interest 0
Decreased need for sleep
1
Irritability 0
Speech 0
Language/thought process
0
Thought content 4
Disruptive/ Aggressive 0
Appearance 1
Insight 2
YMRS total 13
Self Reported items Score
Sleep 0
Ability to enjoy pleasant things/usual activities
-1.5
Self confidence/ Self Esteem -1.5
Energy -1. 5
Ability to concentrate -2.0
Distractibility 2.0
Appetite -.25
Physical restlessness/ agitation
1.5
Rate of movement or rate of speech
-1.5
Feel life isn’t worth living or suicidal thoughts
0
Talking -1.5
Racing Thoughts 0
Making plans or getting new projects started
-2.0
Behavior others regard as excessive, foolish or risky
0
PHQ-9 total 19
Q-LES-Q items Score
Physical Health 5
Mood 1
Work 1
Household Activities 2
Social Relationships 2
Family Relationships 4
Leisure Activities 2
Ability to Function 1
Sex drive and interest 1
Economic status 2
Living/Housing situation 2
Ability to get around physically
5
Vision in terms of ability to do work or hobbies
2
Overall sense of well being 2
Medication 2
Overall satisfaction and contentment
2
Q-LES-Q total 32.1%
DSM Graphic View Measure SummaryDSM Sensitive/Specific
Engaged Practice Work Flow: Formal Measures Tab*
Conc decision, concentration decision; Decr sleep, decreased sleep; Dep mood, depressed mood; DSM, Diagnostic and Statistical Manual of Mental Disorders; elev mood, elevated mood; FOI/RT, flight of ideas or racing thoughts; Guilt Dec SE, guilt or decreased self-esteem; Incr goal active, increased goal activities; Incr SE, increased self-esteem; MADRS, Montgomery-Asberg Depression Rating Scale; psychomotor agit, psychomotor agitation; SI morbid, suicidal ideation or
*This is an example of software that can aid in patient assessment. There are other similar software available.
30
Instant Training: Visual Screening for MDE*
Review process:*Count the criteria
with bars reaching DSM threshold:
• Most Sensitive: ≥ 5 • Most Specific: ≥ 5 with both bars
• Other: ≥ 5 of one source
Measure what you want to manageEngaged Practice : Formal Measures*
* This is an example of software that can aid in patient assessment. There are other similar software available.MADRS, Montgomery-Asberg Depression Rating Scale; QLESQ, Quality of Life Enjoyment Questionnaire; STEP-BD, Systematic Treatment Enhancement Program for Bipolar Disorder; Wk, week; YMRS, Young Mania Rating Scale.
A novel Mechanism of Action
can be attractive
Mechanism of Action
Be cautious with new antidepressant treatments (Especially those without FDA Approval)
35
Light Source
Pragmatics of Bright Light Treatment
-Light SourceIntensity: > 5000 Lux (1 Lux = light from 1 candle at 1 meter)
Spectrum: Full spectrum (white) preferable (not red or infrared, not incandescent)
-Distance: ≈ 1 meter (should be able to put your palm on the center of source)
-Position: Direct to eye (do not stare at source)
-Timing: Consistent time each day (morning may be best)
-Duration: 15-30 minutes
TIMING MATTERS ONLY AT THE START
INITIAL EXPOSURES: PHASE DEPENDENT SHIFTREPEATED EXPOSURES: NO FURTHER SHIFT ESTABLISH ZIETGEBER
1. Get a lot of natural, bright light during the day.
2. Maximize darkness around bedtime and during sleep• Avoid trolling through social media before bed• Use your cell phone’s “night shift” setting
“Paleo Lighting”
Links to Resources
Light Products • The Sunbox Company
• Sunbox.com• 800.548.3968
• Northern light Technologies• northernlighttechnologies.com• 800-263-0066
Mood MeasuresCollaborative Care Initiative
EngagedPractice.com (access code: engage2) FreeDBSA Wellness Tracker Free
DBSAlliance.org/site/PageServer?pagename=wellness_tracker
Activity and Sleep Monitoring Apps• Fitbit• Nokia Healthmate Free
Call 1.800.548.3968Call 1.800.548.3968
Call 1.800.548.3968
top related