Transcript How Dare You say I*m Moody

HOW DARE YOU SAY I’M
MOODY
KIM MARBEN AND ELLEN SNOXELL
WHAT IS DEPRESSION?
• Major Depressive Disorder
• Five or more of the following symptoms present over the same 2 week period and are nearly constant
• Depressed mood, diminished interest or pleasure in nearly all activities, significant weight change,
insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of
worthlessness or guilt, decreased concentration or indecisiveness, recurrent thoughts of death
• Symptoms cause significant distress or impairment in social, occupational or other important areas of
functioning
WHY SCREEN FOR DEPRESSION?
• Depressive symptoms can be fairly easily identified
• Depression can be effectively treated
• Untreated depression can exacerbate other medical conditions
• Best practice in Minnesota through MN Community Measurement
expects screening using Patient Health Questionnaire (PHQ)
• To determine if remission from depressive symptoms occurs and is
maintenance
IMPORTANCE OF SCREENING AND PHQ-9
N = 69 patients
Males:
10 completed
2 (20%) at-risk
Females: 16 completed
8 (50%) at-risk
Male = 26 (38%)
Female = 43 (62%)
PHQ-9
•
•
≤9 16 patients low risk
>9 10 patients at-risk
[1 patient no history of depression]
The literature reports:
25 - 44% with developmental
disability
(Pinto-Meza et.al., 2005)
25.8% with Spina bifida
(Dicianno et. al., 2015)
WHAT IS THE INCIDENCE OF
DEPRESSION IN INDIVIDUALS
WITH SPINA BIFIDA?
PHQ-2
•
•
43 (62%) patients no concerns
26 (38%) patients with
concerns
Show me the Data!
Average age 32.4 yrs
(Range 18-77)
PHQ-9 completed by 26 patients
Males = 29.9 yrs
Females = 33.9 yrs
TREATMENT OF DEPRESSION
• Medications
• Psychotherapy
MEDICATIONS
• Affect the neurotransmitters—serotonin, dopamine and norepinephrine—in the brain
• Tricyclic (examples—amitriptyline, nortriptyline)
• SSRI’s (examples—Prozac, Zoloft, Paxil, Lexapro, Celexa)
• SNRI’s (example—Cymbalta, Effexor, Fetzima, Pristiq)
• NDRI’s (example—Wellbutrin)
• Atypical (examples—Trazodone, Brintellix, Remeron, Viibryd)
WHO SHOULD PRESCRIBE?
• Primary care provider
• Psychiatrist/Nurse Practitioner or Physician’s Assistant with specialized training and expertise
• Other specialists have individually differing degrees of comfort prescribing
THE ALPHABET SOUP OF EVIDENCED BASED
PSYCHOTHERAPY
• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavior Therapy (DBT)
• Acceptance and Commitment Therapy (ACT)
CBT
MALADAPTIVE THOUGHTS AND UNREALISTIC
EXPECTATIONS
• Catastrophizing (Awfulizing)
• Illogical Assumptions
• Perfectionism
• Absolutism (black or white thinking)
DBT PHILOSOPHY
• People are doing the best they can and need to be more effective
• People may not have caused all their problems and yet they have to solve them
DBT SKILLS CATEGORIES
• Mindfulness
• Distress Tolerance
• Emotional Regulation
• Interpersonal Effectiveness
• Middle Path
ACT PHILOSOPHY
• Human suffering is to a great extent related to the verbal processes of experiential avoidance, cognitive
fusion, reason-giving and needing to be right
ACT STRATEGIES
• Goal Setting
• Recognizing and dealing with avoidance
• Cognitive de-fusion (Just because we have a thought doesn’t mean we have to believe it; Get off your
“buts”)