PSY 436 Instructor: Emily Bullock Yowell, Ph.D. Mood Disorders PSY 436 Instructor: Emily Bullock Yowell, Ph.D.

Mood Disorders Mood Disorders: disturbances in mood that are unusually severe or prolonged and impair their ability to function in meeting their normal responsibilities

DSM-IV-TR Mood Disorders Major Depressive Disorder Dysthymic Disorder Depressive Disorder NOS Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Bipolar Disorder NOS Mood Disorder due to general medical condition Substance-induced mood disorder Mood Disorder NOS

Episode First must understand the criteria for: Major depressive episode Manic episode Mixed episode hypomanic episode

Major Depressive Episode Depressed mood most of the day Markedly diminished interest or pleasure in all, or almost all activities, most of the day Significant weight loss when not dieting or weight gain Insomnia or hypersominia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate or indecisiveness Recurrent thoughts of death, suicidal ideation/attempt

Manic Episode Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas, racing thoughts Distractibility Increased in goal-directed activity Excessive involvement in pleasurable activities that have a high potential for painful consequences

Mixed Episode Criteria are met both for a manic episode and a major depressive episode (except for duration) nearly every day during at least a 1 week period

Hypomanic Episode Same symptoms as a manic episode but less time of symptoms, less severity, and less impairment in functioning is required to diagnose

Major Depressive Disorder Presence of at least one major depressive episode Not better accounted for by other axis I diagnoses There has never been a manic episode, mixed episode, or hypomanic episode

Major Depressive Disorder Specifiers Mild, moderate, severe without psychotic features/severe with psychotic features Chronic With catatonic features With melancholic features With atypical features With postpartum onset With or without interepisode recovery With seasonal pattern

Prevalence of Major Depressive Episodes by Gender

Dysthymic Disorder Depressed mood for most of the day, for more days than not, for at least 2 years Presence of at least two of the following Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self esteem Poor concentration or difficulty making decisions Feelings of hopelessness Person is not without two of above symptoms for more than 2 months during a 2 year period

Dysthymic Disorder (criteria cont.) No major depressive episode during the first two years of the disturbance Not better accounted for by other mood disorder No history of manic or mixed episode Symptoms did not occur during the course of a psychotic disorder Not due to a substance or general medical condition Cause clinically significant distress or impairments

Bipolar I Disorder--Types Single Manic Episode Presence of only one manic episode and no past major depressive episode Most Recent Episode Hypomanic Currently or most recently in a hypomanic episode There has previously been one manic episode Most Recent Episode Manic Currently (or most recently) in a manic episode There has previously been at least one major depressive episode, manic episode, or mixed episode

Bipolar I Disorder--Types Most Recent Episode Mixed Currently or most recently in a mixed episode There has previously been at least one major depressive episde, manic episode, or mixed episode Most Recent Episode Depressed Currently or most recently in a depressed episode There has previously been at least one manic episode or mixed episode Most Recent Episode Unspecified

Bipolar II Disorder Presence or history of one or more major depressive episodes Presence or history of at least one hippomanic episode There has never been a manic episode or mixed episode

Cyclothymic Disorder For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode During the 2 yr period, the person has not been without the symptoms in criteria A for more than 2 months at a time No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first two years of the disturbance

Treatment of Mood Disorders Psychodynamic Approaches Interpersonal psychotherapy (IPT) Behavioral Approaches What is learned can be unlearned Learned helplessness Cognitive Approaches Negative thinking/cognitive distortions

Treatment of Mood Disorders Biological Approaches Antidepressant Drugs Drug Treatments for Bipolar Disorder Electroconvulsive Therapy (ECT)

Suicide Who Commits Suicide? Why Do People Commit Suicide? Perspectives on Suicide Predicting Suicide

Suicide Rates According to Age

Suicide Suicide Prevention Ask how attempt is to be made Draw the person out Be sympathetic Suggest means to work out problems Accompany person to a professional Don’t say “You’re talking crazy”