▪ DSM-IV-TR recognizes two broad types of mood disorders: those that involve only depressive symptoms (depressive disorders) and those involve manic symptoms (bipolar disorders).
▪ The symptoms of depression include profound sadness and/or an inability to experience pleasure.
▪ When people develop a depressive disorder, their heads may reverberate with self-recriminations. They may become focused on their flaws and deficits.
▪ Paying attention can be so exhausting that they have difficulty absorbing what they read and hear. They often view things in a very negative light, and they tend to lose hope.
▪ Physical symptoms of depression are also common, including fatigue and low energy as well as physical aches and pains. Depressive disorders
▪ Although people with depression typically feel exhausted – they may find it hard to fall asleep and may wake up frequently. Other people sleep throughout the day.
▪ They may find that food tastes bland or that their appetite is gone, or they may experience an increase in appetite.
▪ Sexual interest disappears.
▪ Thought and movement may slow for some (psychomotor retardation), but others can’t sit still – they pace, fidget, and wring their hands (psychomotor agitation).
▪ When people become utterly dejected and hopeless, thoughts about suicide are common. Depressive disorders
▪ Under depressive disorders, there are another two types of disorders as mentioned in DSM-IV-TR. They are:
1. Major depressive disorder (MDD)
2. Dysthymic disorder (also called dysthymia).
▪ The DSM-IV-TR diagnosis of major depressive disorder (MDD) requires depressive symptoms to be present for at least 2 weeks.
▪ As shown in the DSM-IV-TR criteria, at least 4 additional symptoms must be present. They are:
i. Changes in sleep
ii. Changes in appetite;
iii. Changes in concentration and decision-making
iv. Feeling of worthlessness; v. Suicidal
vi. Psychomotor agitation or retardation.
▪ MDD is called an episodic disorder – because symptoms tend to be present for period of time and then clear. Even though episodes tend to dissipate over time, an untreated episode may stretch on for 5 months or even longer.
▪ Major depressive episodes tend to recur – once given episode clear, a person is likely to experience another episode.
▪ Dysthymic disorder shares many of the symptoms of major depressive disorder but differ in its course. The symptoms are somewhat milder but remain relatively unchanged over long period of time, sometimes 20 or 30 years or more.
▪ Dysthymic disorder is defined as a persistently depressed mood that continues at least 2 years, during the patient cannot be symptom free for more than 2 months at a time.
▪ Dysthymic disorder differs from a major depressive episode only in the severity, chronicity, and number of its symptoms, which are milder and fewer but last longer.
▪ Typically, dysthymic disorder develops first, perhaps at an early age, and then one or more major depressive episodes occur later.
Bipolar disorders
▪ DSM-IV-TR recognizes 3 forms of bipolar disorders:
1. Bipolar I disorder
2. Bipolar II disorder
3. Cyclothymic disorder.
▪ Manic symptoms are the defining feature of each of these disorders.
▪ These disorders are labelled “bipolar” because most people who experience mania will also experience depression during their lifetime
▪ What is mania?
▪ People may experience with abnormally exaggerated elation, joy, or euphoria.
▪ In mania, individuals find extremely pleasure in every activity: they become extraordinary active (hyperactive), require little sleep, and may develop grandiose plan, believing they can accomplish anything they desire.
▪ Speech is typically rapid and may become incoherent (attempting to express so many exciting ideas at once: flight of ideas)
▪ Hospitalization may require – if individual was engaging self-destructive activities.
Bipolar I disorder
▪ In DSM-IV-TR, the criteria for diagnosis of bipolar I disorder (formerly known as manic-depressive disorder) include a single episode of mania or a single mixed episode during the course of a person’s life.
Bipolar II disorder
▪ DSM-IV-TR also includes a milder form of bipolar disorder, called bipolar II disorder.
Cyclothymic disorder
▪ A milder but chronic version of bipolar disorder called cyclothymic disorder is similar in many ways to dysthymic disorder.
▪ Cyclothymic disorder is a chronic alternation of mood elevation and major depression that does not reach the severity of manic or major depressive episodes.
▪ Individual who have this tend to be in one mood state or the other years with relatively few periods of neutral mood.
▪ Neurotransmitters:
▪ 3 neurotransmitters have been studied the most in terms of their possible roles in mood disorders:
▪ Norepinephrine;
▪ Dopamine;
▪ Serotonin.
▪ Original models suggested that depression would be tied to low levels of norepinephrine and dopamine.
▪ Mania would be tied to high levels of norepinephrine and dopamine
▪ Mania and depression were also both posited to be tied to low levels of serotonin.
▪ Researchers initially believed that mood disorders would be explained by absolute levels of neurotransmitters in the synaptic cleft that were either too high or too low.
▪ Brain imaging studies suggest that episodes of MDD are associated with changes in many of the brain systems that are activated when a person without symptoms of depression experiences strong emotions.
▪ As one might expect, many different brain structures become involved when a person experiences emotion: the person needs to attend to and interpret the stimuli that are causing the emotion and then must make plans to deal with those stimuli.
▪ Various aspects of personality and its development appear to be integral to the occurrence and persistence of depression.
▪ Although depressive episodes are strongly correlated with adverse events, a person's characteristic style of coping may be correlated with his or her resilience.
▪ In addition, low self-esteem and self-defeating or distorted thinking are related to depression.
▪ Social:
▪ Poverty and social isolation are associated with increased risk of mental health problems in general.
▪ Child abuse (physical, emotional, sexual, or neglect) is also associated with increased risk of developing depressive disorders later in life.
▪ Abuse of the child by the caregiver is bound to distort the developing personality and create a much greater risk for depression and many other debilitating mental and emotional states.
▪ Disturbances in family functioning, such as parental (particularly maternal) depression, severe marital conflict or divorce, death of a parent, or other disturbances in parenting are additional risk factors.
▪ Medications:
▪ The effectiveness of antidepressants is none to minimal in those with mild or moderate depression but significant in those with very severe disease.
▪ The effects of antidepressants are somewhat superior to those of psychotherapy, especially in cases of chronic major depression.
▪ Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation is recommended
- Electroconvulsive therapy (ECT) is a procedure whereby pulses of electricity are sent through the brain via two electrodes, hospital psychiatrists may recommend ECT for cases of severe major depression that have not responded to antidepressant medication or, less often, psychotherapy or supportive interventions.
- ECT can have a quicker effect than antidepressant therapy and thus may be the treatment of choice in emergencies such as catatonic depression where the person has stopped eating and drinking, or where a person is severely suicidal.
▪ Psychological treatments for depression:
▪ Cognitive-Behavioral Therapy:
- Dealing with interpersonal role disputes – marital conflicts;
- Adjusting to the loss of a relationship;
- Acquiring new relationships;
- Identifying and correcting deficits in social skills.
Stress is your body's way of responding to any kind of demand.
It can be caused by both good and bad experiences.
When people feel stressed by something going on around them, their bodies react by releasing chemicals into the blood.
These chemicals give people more energy and strength, which can be a good thing if their stress is caused by physical danger.
But this can also be a bad thing, if their stress is in response to something emotional and there is no outlet for this extra energy and strength
Many different things can cause stress.
From physical (such as fear of something dangerous) to emotional (such as worry over your family or job) – these often referred as “stressors.”
Survival Stress - You may have heard the phrase "fight or flight" before. This is a common response to danger in all people and animals. When you are afraid that someone or something may physically hurt you, your body naturally responds with a burst of energy so that you will be better able to survive the dangerous situation (fight) or escape it all together (flight). This is survival stress.
Internal Stress - Have you ever caught yourself worrying about things you can do nothing about or worrying for no reason at all? This is internal stress and it is one of the most important kinds of stress to understand and manage. Internal stress is when people make themselves stressed. This often happens when we worry about things we can't control or put ourselves in situations we know will cause us stress. Some people become addicted to the kind of hurried, tense, lifestyle that results from being under stress. They even look for stressful situations and feel stress about things that aren't stressful.
Environmental Stress - This is a response to things around you that cause stress, such as noise, crowding, and pressure from work or family. Identifying these environmental stresses and learning to avoid them or deal with them will help lower your stress level.
Fatigue and Overwork - This kind of stress builds up over a long time and can take a hard toll on your body. It can be caused by working too much or too hard at your job(s), school, or home. It can also be caused by not knowing how to manage your time well or how to take time out for rest and relaxation.
So if stress can be so bad for you, how can there be "good" or "positive" stress?
If you are suffering from extreme stress or long-term stress, your body will eventually wear itself down. But sometimes, small amounts of stress can actually be good.
Understanding your stress level is important. If nothing in your life causes you any stress or excitement, you may become bored or may not be living up to your potential. If everything in your life, or large portions of your life, cause you stress, you may experience health or mental problems that will make your behavior worse.
The body pays a price if must constantly adapt to stress.
This ‘price’ can be expressed in terms of what is referred to as allostatic load - (allostatic (or allotasis) - is the process of achieving stability, or homeostasis, through physiological or behavioral change).
If the body is exposed to high levels of stress hormones such as cortisol and becomes susceptible to disease because of altered immune system functioning – a high allostatic load.
Psychodynamic perspectives:
Franz Alexander (1950) – repressed emotional impulses created a chronic negative emotional state that impacted health, thus setting the stage for problems like ulcers, asthma, or essential hypertension.
Cognitive and personality perspectives:
Physical threats obviously create stress – so do negative emotions such as resentment, regret, and worry.
Negative emotions stimulate sympathetic nervous system activity and may keep the body’s stress systems aroused and the body in a continual state of emergency, sometimes for far longer than it can bear, as suggested by the notion of allostatic load.
Personality traits have been linked to immune system functioning – e.g. negative emotions linked to slow antibody production.
Often occurring in quick 'bursts' in reaction to something in your environment, short-term stress can affect your body in many ways. Some examples:
While this burst of energy may help you in physical situations where your body needs to react quickly, it can have bad effects on your mind and performance if there is no outlet or reason for your stress. These effects may include:
Long-term stress or stress that is occurring over long periods of time can have an even greater effect on your body and mind. Long-term stress can affect your body by:
Long-term stress can also have serious effects on your mental health and behavior:
Relaxation training – the most common form of relaxation training is progressive muscle relaxation, which involves systematically tensing and then relaxing each major muscle group in the body.
Cognitive restructuring – includes approaches to alter people’s belief systems and reduce the negativity of their interpretations of experience.
Behavioral skills training – practice in skills such as time management
and effective prioritizing.
- Place one hand on your chest and the other on your abdomen. When you take a deep breath in, the hand on the abdomen should rise higher than the one on the chest. This insures that the diaphragm is pulling air into the bases of the lungs.
- After exhaling through the mouth, take a slow deep breath in through your nose imagining that you are sucking in all the air in the room and hold it for a count of 7 (or as long as you are able, not exceeding 7).
- Slowly exhale through your mouth for a count of 8. As all the air is released with relaxation, gently contract your abdominal muscles to completely evacuate the remaining air from the lungs. It is important to remember that we deepen respiration not by inhaling more air but through completely exhaling it.
- Repeat the cycle four more times for a total of 5 deep breaths and try to breathe at a rate of one breath every 10 seconds (or 6 breaths per minute). At this rate our heart rate variability increases which has a positive effect on cardiac health.
Ramai orang yang telah didiagnosis dengan penyakit mental mendapat kekuatan dan penyembuhan melalui penyertaan dalam terapi individu atau kumpulan yang diprogramkan. Pilihan terapi adalah banyak dan berbeza dari seorang ke seorang. Walaupun tiada satu terapi berkesan untuk semua orang, orang ramai boleh memilih rawatan, atau gabungan terapi, yang mereka percaya paling berkesan untuk mereka.
Apabila kita pergi ke gangguan kecemasan. Terdapat beberapa cara yang boleh dilakukan untuk menguruskan psikoterapi gangguan kecemasan ini. Psikoterapi sering dikenali sebagai terapi bercakap atau kaunseling psikologi, adalah usaha kolaboratif antara anda dan ahli terapi untuk mengurangkan gejala kebimbangan anda. Ia berpotensi untuk menjadi terapi kebimbangan yang berkesan.
Pakar psikologi telah memberikan petua dan peranan untuk mencegah atau mengawal jika seseorang itu mengalami kebimbangan seperti mengekalkan tahap aktiviti fizikal yang sihat setiap hari. Elakkan mengambil minuman beralkohol dan menggunakan dadah rekreasi untuk memastikan badan anda kekal sihat dan juga merokok harus dielakkan, dan minuman berkafein harus dikurangkan atau dielakkan sama sekali. Selain itu, pengurusan tekanan dan strategi relaksasi harus digunakan untuk melaksanakan setiap hari.
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| Bandung 2020 |
Diagnosis Awal dan Tepat:
