Mood Disorders Depressive Disorders Depressive Disorders –Major Depressive Disorder –Dysthymic Disorder

Mood DisordersMood Disorders

Depressive DisordersDepressive Disorders

– Major Depressive DisorderMajor Depressive Disorder

– Dysthymic DisorderDysthymic Disorder

Major Depressive DisorderMajor Depressive Disorder

A.A. At least one of the following three abnormal At least one of the following three abnormal moods which significantly interfered with the moods which significantly interfered with the person's life person's life (for at least 2 weeks, nearly every day)(for at least 2 weeks, nearly every day): :

1.1. Abnormal Abnormal depressed mooddepressed mood or dysphoric mood most or dysphoric mood most of the day. of the day.

2.2. Abnormal Abnormal loss of all interest and pleasureloss of all interest and pleasure most of the most of the day. day.

3.3. If 18 or younger, abnormal If 18 or younger, abnormal irritable moodirritable mood most of the most of the day. day.


B.B. At least five of the following symptoms have been At least five of the following symptoms have been present during the same 2 week depressed period. present during the same 2 week depressed period.

1.1. Abnormal Abnormal depressed mooddepressed mood (or (or irritable moodirritable mood if a child or if a child or adolescent).adolescent).

2.2. Abnormal Abnormal loss of all interest and pleasureloss of all interest and pleasure [as defined in [as defined in criterion A2]. criterion A2].

3.3. Appetite or weight disturbanceAppetite or weight disturbance, either: , either: 1.1. Abnormal weight loss (when not dieting) or decrease in appetite.Abnormal weight loss (when not dieting) or decrease in appetite.2.2. Abnormal weight gain or increase in appetite. Abnormal weight gain or increase in appetite.

4.4. Sleep disturbanceSleep disturbance, either abnormal insomnia or abnormal , either abnormal insomnia or abnormal hypersomnia. hypersomnia.


B.B. (cont’d)(cont’d)5.5. Activity disturbance, either abnormal agitation or Activity disturbance, either abnormal agitation or

abnormal slowing (observable by others). abnormal slowing (observable by others).

6.6. Abnormal Abnormal fatiguefatigue or loss of energy. or loss of energy.

7.7. Abnormal Abnormal self-reproachself-reproach or inappropriate guilt. or inappropriate guilt.

8.8. Abnormal poor concentration or indecisiveness. Abnormal poor concentration or indecisiveness.

9.9. Abnormal morbid thoughts of death (not just fear of Abnormal morbid thoughts of death (not just fear of dying) or suicidedying) or suicide


C.C. The symptoms are The symptoms are notnot due to a mood- due to a mood-inincongruent psychosis. congruent psychosis.

D.D. There has There has nevernever been a Manic Episode, a Mixed been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Episode, or a Hypomanic Episode.

E.E. The symptoms are The symptoms are notnot due to physical illness, due to physical illness, alcohol, medication, or street drugs. alcohol, medication, or street drugs.

F.F. The symptoms are The symptoms are notnot due to normal due to normal bereavement. bereavement.

AssessmentAssessment

Self-report instruments screening Self-report instruments screening » Beck Depression InventoryBeck Depression Inventory

» MMPI -2 MMPI -2

Clinical Interview Clinical Interview

Suicide RiskSuicide Risk

IncidenceIncidence

Males and females are equally affected by Males and females are equally affected by Major Depressive Disorder prior to Major Depressive Disorder prior to pubertypuberty

After puberty, this disorder is twice as After puberty, this disorder is twice as common in females as in malescommon in females as in males

Greatest incidence ages 25-44Greatest incidence ages 25-44 Up to 15% of patients with severe Major Up to 15% of patients with severe Major

Depressive Disorder die by suicideDepressive Disorder die by suicide

Treatment PlansTreatment Plans

PsychotherapiesPsychotherapies

Biological therapiesBiological therapies

Family therapiesFamily therapies

Suicide interventionSuicide intervention

Treatment Plans:Treatment Plans:

PsychotherapiesPsychotherapies CognitiveCognitive Rational Emotive Behaviour TherapyRational Emotive Behaviour Therapy Behaviour TherapyBehaviour Therapy Interpersonal PsychotherapyInterpersonal Psychotherapy Family TherapiesFamily Therapies


Suicide Intervention plansSuicide Intervention plans Active vs passive ideationActive vs passive ideation No-suicide contractsNo-suicide contracts Modify maladaptive cognitionsModify maladaptive cognitions


Biological TherapiesBiological Therapies Psychotropic medications:Psychotropic medications:

– SSRI’s (selective serotonin reuptake inhibitors)SSRI’s (selective serotonin reuptake inhibitors) Prozac, ZoloftProzac, Zoloft

– Tricyclic AntidepressantsTricyclic Antidepressants

– MAOI’s: (monomine oxidase inhibitors)MAOI’s: (monomine oxidase inhibitors) Electro-Convulsive TherapyElectro-Convulsive Therapy

Bipolar DisordersBipolar Disorders

A.A. Abnormally expansive, elevated or irritable moodAbnormally expansive, elevated or irritable moodB.B. At least three additional symptoms At least three additional symptoms ( 4 if irritable) ( 4 if irritable) during 1 week period:during 1 week period:

Inflated self-esteemInflated self-esteem Decreased need for sleepDecreased need for sleep Talkativeness (loud, nonstop, rapid)Talkativeness (loud, nonstop, rapid) Racing ideasRacing ideas High distractibilityHigh distractibility Increased goal-directed activity or physical agitationIncreased goal-directed activity or physical agitation Excessive involvement in sexual or other risk-related pleasurable activitiesExcessive involvement in sexual or other risk-related pleasurable activities

Manic Phase


A.A. Parallel manic episodesParallel manic episodesB.B. At least three additional symptoms At least three additional symptoms ( 4 if irritable) ( 4 if irritable) during a four day during a four day

period:period: Inflated self-esteemInflated self-esteem Decreased need for sleepDecreased need for sleep Talkativeness (loud, nonstop, rapid)Talkativeness (loud, nonstop, rapid) Racing ideasRacing ideas High distractibilityHigh distractibility Increased goal-directed activity or physical agitationIncreased goal-directed activity or physical agitation Excessive involvement in sexual or other risk-related pleasurable activitiesExcessive involvement in sexual or other risk-related pleasurable activities

Hypomanic Episodes


A.A. Both manic and depressive episodes nearly every day for at Both manic and depressive episodes nearly every day for at least a one-week period.least a one-week period.

B.B. Rapid cycling bipolarRapid cycling bipolar Bipolar I – a past or present manic episode despite past history Bipolar I – a past or present manic episode despite past history

of depressive episodesof depressive episodes Bipolar II – in absence of past manic episode or mixed episodes, Bipolar II – in absence of past manic episode or mixed episodes,

a person experiencing hypomania and a past major depressive a person experiencing hypomania and a past major depressive episodeepisode

Mixed Episodes

CyclothymiaCyclothymia

A.A. Sustained period of vacillation between Sustained period of vacillation between spirited & dispirited moodsspirited & dispirited moods

» Hypomania but not all the way to manic episodesHypomania but not all the way to manic episodes

» And numerous periods of sub-clinical depressionAnd numerous periods of sub-clinical depression

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Mood Disorders Depressive Disorders Depressive Disorders –Major Depressive Disorder –Dysthymic Disorder