Mood Disorders

Major Depressive Episode (building block)A. During the same 2-week period, five or more

of the following symptoms including either 1 or 2 have been present (must be a change in functioning)

1. Depressed mood most of the day, nearly everyday2. Diminished interest or pleasure in all, or almost all,

activities3. Significant changes in appetite and/or weight4. Significant changes in sleep patterns5. Psychomotor retardation or agitation6. Fatigue or loss of energy7. Feelings of worthlessness or inappropriate guilt8. Diminished ability to concentrate or make decisions9. Recurrent thoughts or death or suicide

Major Depressive Episode (building block)B. The criteria do not meet criteria for a

Mixed Episode

C. The symptoms cause clinically significant distress or impairment in functioning

D. Not due to a GMC or substance

E. The symptoms are not better accounted for by Bereavement

Manic Episode (building block)A. Distinct period of abnormally and persistently

elevated, expansive, or irritable mood, lasting at least 1 week

B. During the mood disturbance, 3 or more of the following symptoms have persisted (4 or more if the mood is only irritable)

1. Inflated self-esteem or grandiosity2. Decreased need for sleep3. More talkative than usual, or pressure to keep talking4. Racing thoughts (“flight of ideas”)5. Distractibility6. Increase in goal-directed activity7. Excessive involvement in pleasurable activities that

have the potential for negative consequences

Manic Episode (building block)C. The symptoms do not meet criteria for a

Mixed Episode

D. The symptoms cause significant impairment in functioning or necessitate hospitalization to prevent harm to self or others

E. Not due to a GMC or substance

Mixed Episode (building block)A. The criteria are met for both a Manic

Episode and a Major Depressive Episode (except duration) nearly every day during at least a 1-week period

B. The symptoms cause significant distress or impairment in functioning

C. Not due to a GMC or substance

Hypomanic Episode(building block)A. Distinct period of persistently elevated,

expansive, or irritable mood lasting at least 4 days

B. During the mood disturbance, 3 (or more) of the following symptoms have been present (4 or more if mood is only irritable)

1. Inflated self-esteem or grandiosity2. Decreased need for sleep3. More talkative than usual, or pressure to keep talking4. Racing thoughts (“flight of ideas”)5. Distractibility6. Increase in goal-directed activity7. Excessive involvement in pleasurable activities that

have the potential for negative consequences

Hypomanic Episode(building block)C. The episode is associated with an unequivocal

change in functioning that is uncharacteristic of the person when not symptomatic

D. The mood disturbance and change in functioning are observable to others

E. The episode is not severe enough to cause marked distress or impairment in functioning and does not require hospitalization

F. Not due to a GMC or substance

Mood Episodes

Depression

Mania

Hypomania

Mixed Episode

Normal Mood

Major Depressive Disorder One or more Major Depressive Episodes

AND No history of mania or hypomania

Specify: Single Episode

Recurrent

Major Depressive Disorder

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

MDD, single episode MDD, recurrent episodes

Major Depressive Disorder: Types Melancholic

Catatonic

Atypical

Seasonal Pattern

Post-partum onset

Facts about Major Depressive Disorder Prevalence:

Gender:

Culture:

Facts about Major Depressive Disorder Age of Onset:

Course:

Likelihood of having another Major Depressive Episode if you’ve had…

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

1 episode 50%

2 episodes70%

3 episodes 90%

DysthymiaA. Depressed mood most of the day, more days than

not, for at least 2 yearsB. Presence, while depressed, of 2 (or more) of the

following:1. Poor appetite or overeating2. Insomnia or hypersomnia3. Low energy or fatigue4. Low self-esteem5. Poor concentration or difficulty making decisions6. Feelings of hopelessness

C. During the 2-year period, the person has never been without the symptoms for more than 2 months at a time

DysthymiaD. Not better accounted for by Major

Depressive Disorder

E. There has never been a Manic, Mixed, or Hypomanic episode

F. Not better accounted for by another disorder

G. Not due to a GMC or substance

H. Symptoms cause clinically significant distress or impairment in functioning

Major Depression vs. Dysthymia

RecurrentMajor

DepressiveEpisodes

Dysthymia

Major Depression: Interepisode Recovery

Recurrent, FullInterepisode

Recovery

Recurrent,Without Full Interepisode

Recovery

Major Depression vs. Dysthymia

Recurrent, FullInterepisode

Recovery, withDysthymia

Recurrent,Without FullInterepisode

Recovery, withDysthymia

Facts about Dysthymia Prevalence:

Gender:

Age of Onset:

Course:

Unipolar Depression – Possible Causes Stressful life events

Learned Helplessness

Depressogenic Schemas

Neurotransmitters

Genetic Factors

Unipolar Depression - Treatment Mild Depression

Electroconvulsive Therapy

Pharmacotherapy

Unipolar Depression - Treatment Cognitive Behavioral Therapy

Identify and challenge depressogenic assumptions

Identify more adaptive coping mechanisms

Encourage client to actively engage in life and relationships

Mindfulness

At least as effective as antidepressants in reducing symptoms

More effective than antidepressants in preventing relapse

Bipolar DisorderTwo Main Distinctions

Bipolar I Disorder: Technically, this should mean Mania/Mixed +

Depression Actually, this means Mania/Mixed ±

Depression

Bipolar II Disorder: Hypomania + Depression (No mania ever)

Bipolar I Disorder

Major Depressive

Episode

Manicor Mixed Episode

Manic or Mixed Episode

One or more manic episode

OR Depressed and manic episodes

OR

Bipolar II Disorder

Major Depressive

Episode

Hypomanic Episode

Hypomanic Episode

One or morehypomanic episode OR Depressed and

hypomanic episodes

OR

Unipolar vs. Bipolar Disorder

Bipolar

Unipolar

Elevated Mood

Elevated Mood

Depressed Mood

Depressed Mood

Facts about Bipolar Disorders

Prevalence:

Gender:

Facts about Bipolar Disorders Age of Onset:

Course:

Culture:

Bipolar Disorders – Possible Causes Runs very strongly in families: 80-90% of

variance! Relatives show both depression and

bipolar disorderFamily History of Depression Family History of Bipolar Disorder

Bipolar Disorders - Treatment Lithium

Psychotherapy

Mood Disorders: Severity Mild

Moderate

Severe without Psychotic features

Severe with Psychotic features

Mood Disorders – Cultural Factors Demographic Differences in the U.S.

Unipolar Depressions Bipolar Disorders

Symptom Differences China and Japan – somatic symptoms more common

than psychological symptoms Aborigines – absence of guilt, attempted/completed

suicide Tribe in New Guinea – only 1 case, mainly physical

symptoms Prevalence Differences

Taiwan: 1.5% United States and Lebanon: 17-19%

Suicide Risk Factors:

Best predictor = Prior attempt Living alone, especially if divorced/separated Retired/unemployed Elderly Loss of a loved one Chronic illness Financial troubles Feelings of hopelessness Impulsivity Sexual identity difficulties

Suicide Suicide and Psychopathology

Bipolar Disorder > Major Depression

Melancholic Depression

Substance abuse/dependence

Insomnia

Delusions

Suicide Who attempts? Who completes?

Women: 3-4 times more likely to attempt suicide

Men: 3-4 times more likely to complete suicide

Ages 18-24: Peak age for attempting suicide

Ages 65+: Peak age for completing suicide

Method

Intent

Suicide Common Warning Signs

Symptoms of depression

Talking about death, disappearing, “ending it all”, etc., even just in passing

Writing letters, saying last goodbyes

Getting rid of personal effects, making a will

Arranging for the care of pets, plants, etc.

Extravagant spending

Suicide Prevention

Help the person regain ability to cope with immediate stressors

Maintaining supportive contact with the person Help the person realize that their distress is

impairing their judgment Help the person realize that the distress is not

endless Broad based programs focused on high-risk groups Crisis hotlines Call 911/ER

Suicide…interesting question…

Should suicide be prevented?