Mood Disorders

Level of analysis

• Depression as a symptom

• Depression as a syndrome

• Depression as a disorder

Dimensions of Depression

• cognitive

• behavioral

• physiological

Categories

• major depressive disorder • major depressive episode • dysthymic disorder • depressive disorder NOS • bipolar disorder • manic episode • cyclothymic disorder • hypomanic episode • bipolar disorder NOS • mood disorder due to a general medical condition • substance-induced mood disorder • mood disorder NOS

Depression

• A. At least one of the following three abnormal moods which significantly interfered with the person's life:– 1. Abnormal depressed mood most of the

day, nearly every day, for at least 2 weeks.– 2. Abnormal loss of all interest and

pleasure most of the day, nearly every day, for at least 2 weeks.

– 3. If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least 2 weeks.

Major Depressive Disorder

• Persists for two weeks and causes significant personal distress or functional impairment.

• Major Depression: 5 of 9 symptoms, which must include either:

1. Depressed mood or2. Anhedonia.

Major Depression Diagnostic Criteria (cont’d)

• B. At least five symptoms have been present during the same 2-week period.– 1. Abnormal depressed mood (or irritable

mood if a child or adolescent) .– 2. Abnormal loss of all interest and pleasure.– 3. Appetite or weight disturbance, either:

• Abnormal weight loss or decrease in appetite.• Abnormal weight gain or increase in appetite.

Major Depression Criteria (cont’d)

– 4. Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.

– 5. Activity disturbance, either abnormal agitation or abnormal slowing (observable by others).

– 6. Abnormal fatigue or loss of energy.– 7. Abnormal self-reproach or

inappropriate guilt.– 8. Abnormal poor concentration or

indecisiveness.– 9. Abnormal morbid thoughts of death

(not just fear of dying) or suicide.

Major Depression Criteria (cont’d)

• C. The symptoms are not due to a mood-incongruent psychosis.

• D. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.

• E. The symptoms are not due to physical illness, alcohol, medication, or street drugs.

• F. The symptoms are not due to normal bereavement.

Essential Features

• Not due to “rule-outs”• Abnormal depressed mood

– Persists continuously for at least 2 weeks.

– Causes marked functional impairment.

– Causes disabling physical symptoms.– Causes disabling psychological

symptoms.

Essential Features (cont’d)

• Abnormal loss of interest and pleasure mood:– Reduced capacity to experience

pleasure (anhedonia).– Result=lack of motivation.– Abnormal irritable mood:

• May present primarily with irritable, rather than depressed or apathetic, mood.

• Unfortunately, irritability=alienating loved ones with their cranky mood and constant criticisms.

Essential Features (cont’d)

• Physical symptoms

– Abnormal appetite

– Abnormal sleep

– Fatigue or loss of energy

– Agitation or slowing

Essential Features (cont’d)

• Cognitive symptoms

– Abnormal self-reproach or inappropriate guilt

– The "negative thinking" – Abnormal poor concentration or

indecisiveness– Marked forgetfulness – Abnormal morbid thoughts of death

(not just fear of dying) or suicide

Comorbidity

• 40-70% meet criteria for another disorder; 20-50% have 2 or more comorbid disorders

• Most common:– Anxiety Disorders– Disruptive Behavior Disorders– Substance Abuse Disorders

Dysthymia

• Chronic – at least 2 years in adults, – 1 year in children.

• Milder depression than Major Depressive Disorder.

Dysthymia Diagnostic Criteria

• A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years.

• Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

Dysthymia Diagnostic Criteria (cont’d)

• B. Presence, while depressed, of two (or more) of the following:– 1. poor appetite or overeating– 2. insomnia or hypersomnia– 3. low energy or fatigue– 4. low self-esteem– 5. poor concentration or difficulty

making decisions– 6. feelings of hopelessness

Dysthymia Diagnostic Criteria (cont’d)

• C. The person has never been without the symptoms in Criteria A and B for more than 2 months at a time.

• D. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents– Note: There may have been a previous Major Depressive

Episode provided there was a full remission before development of the Dysthymic Disorder.

– After the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.

Dysthymia Diagnostic Criteria (cont’d)

• E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.

• F. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder.

• G. The symptoms are not due to the direct physiological effects of a substance.

• H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Bipolar Disorder

• Individual experiences depressed episode followed by manic episode.

• Lifetime prevalence ~1%• Male=Female• Age of onset: Usually late teens to mid

30s• Extremely controversial in children

Manic Episode

• Manic Episode=period (at least 1 week) of elevated, expansive, or irritable mood including 3 of 7 symptoms. – 1. inflated self-esteem or grandiosity– 2. decreased need for sleep – 3. more talkative than usual or pressure to keep

talking– 4. flight of ideas or subjective experience that

thoughts are racing– 5. distractibility – 6. increase in goal-directed activity or psychomotor

agitation– 7. excessive involvement in pleasurable activities

that have a high potential for painful consequences

Manic Episode (cont’d)

• C. The symptoms do not meet criteria for a Mixed Episode.

• D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

• E. The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

Child Assessment Methods for Depression

• Clinical interviews (parent, child)– Meet diagnostic criteria?– Assess associated features (e.g., social funct.)– Suicidal and/or homicidal ideation?– Check for “rule-outs”

• Self-report measures– Children’s Depression Inventory– Broadband measures (e.g., BASC-2, ASEBA)

• Projective testing• Refer for medical evaluation?• Direct Observations

Adolescent Assessment Methods for Depression

• Clinical interviews (adolescent, parent)– Ditto child

• Self-report measures– Reynolds Adolescent Depression Scale-2– Broadband measures (e.g., BASC-2,

ASEBA)• Projective testing• Refer for medical evaluation?• Lab testing• Observations

Child Treatment Methods for Depression

• Cognitive-behavioral therapy– (e.g., Primary and Secondary Control

Enhancement Training)

• Interpersonal therapy• Family therapy

• Psychodynamic therapy• Psychopharmacological intervention

Adolescent Treatment Methods for Depression

• Cognitive-behavioral therapy• Interpersonal therapy• Family therapy• Milieu therapy• Integrated treatment (Adolescent Coping

with Depression Course)• Inpatient treatment

• Psychodynamic therapy• Psychopharmacological intervention