Mood Disorders Bipolar Disorders Depressive Disorders

Episodes and Patterns n Major depressive episode n Manic episode n Mixed episode n Hypomanic episode n Cycling patterns

Major depressive episode n Five or more of the following, most of the day and/or nearly every day, including at least symptom 1 or 2: n 1. Depressed mood –Sad, empty, weepy; irritable, angry n 2. Loss of interest or pleasure in previously enjoyable activities n 3. Change in weight or appetite n 4. Sleep changes

More depressive symptoms n 5. Noticeable change in movement n 6. Fatigue n 7. Feelings of worthlessness or guilt n 8. Impaired cognition or volition n 9. Repeated thoughts of death or suicide, or planned or attempted suicide n The five symptoms must occur in the same two weeks

Manic episode n One week of persistently high, expansive, or irritable mood, and 3 of: n Grandiose self-esteem n Lower sleep need n Overly talkative n Racing thoughts n Easily distracted n Increased activity or agitation n High risk activities

Mixed episode n One week of both manic and major depressive symptoms with rapidly alternating moods n Common symptoms: –Agitation –Insomnia –Irregular appetite (binge-fast) –Delusions –Thoughts of suicide

Hypomanic episode n Four days of manic episode symptoms n Mood disturbance does not critically impair ability to work or maintain social responsibilities n Distinguished from mania by the absence of psychotic symptoms and grandiosity, and by its lesser degree of impact on functioning

Bipolar disorders n Bipolar I Disorder –One or more manic or mixed episodes –Usually one or more major depressive episodes –Subcategorized based on the character of the most recent episode Most recent episode depressed Most recent episode manic Most recent episode mixed

Bipolar disorders… n Bipolar II Disorder –One or more major depressive episodes –One or more hypomanic episodes –NO manic or mixed episode n Cyclothymic Disorder –Two years of alternating hypomanic and depressive symptoms –No remission of more than two months –NO major depressive, manic, or mixed episodes

Depressive disorders n No history of manic, hypomanic, or mixed episodes n Major Depressive Disorder –Current major depressive episode n Dysthymic Disorder –Two years of chronically depressed mood –Two additional depression symptoms (appetite, sleep, energy, concentration, low self-esteem, hopeless feelings)

Patterns of mood disorders Manic Hypo- manic De- pressed Weeks Identify episodes: Manic Mixed Hypomanic Major Depressive

More patterns... Manic Hypo- manic De- pressed

Etiology of mood disorders n Psychoanalytic theory: Evaluation of experiences n Cognitive theories: Thought patterns n Interpersonal theory: Rejection n Biological theories: Genes and NTs n Existential theory: Loss of meaning

Psychoanalytic theory n Oral fixation: Depends on others for self-esteem n Bereavement, introjection, and mourning work n Symbolic loss n But dream themes of depressed patients are of loss and failure, not anger and hostility (Beck and Ward, 1961) n Depressed people do express anger