Mood Disorders: Overview Chapter 6

An Overview of Mood Disorders Extremes in Normal Mood Nature of depression Nature of mania and hypomania Types of DSM-IV Depressive Disorders Major depressive disorder Dysthymic disorder Double depression Types of DSM-IV Bipolar Disorders Bipolar I disorder Bipolar II disorder Cyclothymic disorder

Nature of Depressive Episodes Major Depressive Episode Extremely depressed mood state lasting at least 2 weeks Cognitive symptoms Feelings of worthlessness, inappropriate guilt, diminished concentration or thinking, and preoccupation with death Vegetative or somatic symptoms Change in weight or appetite, change in sleep, psychomotor changes, and fatigue Anhedonia – Loss of pleasure/interest in usual activities

Nature of Manic Episodes Distinctly elevated or irritable mood lasting at least one week Three or more of the following: Inflated self-esteem or grandiosity Decreased need for sleep Talkativeness, pressured speech Flight of ideas or racing thoughts Distractibility Increased goal-directed activity or agitation Excessive involvement in pleasurable activities that are likely to have painful consequences

Nature of Hypomanic and Mixed Episodes Hypomanic episodes Same criteria as manic episodes, but duration only 4 days, and does not require clinical impairment of functioning Mixed episodes Meet criteria for both depressive and manic episode (except duration)

Major Depressive Disorder: Overview Requires presence of major depressive episode No history of manic, hypomanic, or mixed episode Single episode – Highly unusual Recurrent episodes – More common Statistics Point prevalence peaks in middle adulthood (7.5%) Lifetime prevalence 10-25% for women, 5-12% for men

Dysthymia: An Overview Overview and Defining Features Defined by persistently depressed mood that continues for at least 2 years Symptoms of depression are milder than major depression Symptoms can persist unchanged over long periods (e.g., 20 years or more) Facts and Statistics Late onset – Typically in the early 20s Early onset – Before age 20, greater chronicity, poorer prognosis Lifetime prevalence 6%, point prevalence 3%

Double Depression: An Overview Overview and Defining Features Person experiences major depressive episodes and dysthymic disorder Dysthymic disorder often develops first Facts and Statistics Associated with severe psychopathology Associated with a problematic future course

Bipolar I Disorder: An Overview Overview and Defining Features Alternations between full manic episodes and depressive episodes Facts and Statistics Average age on onset is 18 years, but can begin in childhood, rarely after age 40 Tends to be chronic Suicide is a common consequence (9-60%, average estimate 19%) Lifetime prevalence 0.4 – 1.6%

Bipolar II Disorder: An Overview Overview and Defining Features Alternations between major depressive episodes and hypomanic episodes Facts and Statistics Average age of onset is 22 years, but can begin in childhood Only 10 to 13% of cases progress to full bipolar I disorder Tends to be chronic

Cyclothymic Disorder: An Overview Overview and Defining Features More chronic version of bipolar disorder Manic and major depressive episodes are less severe Manic or depressive mood states persist for long periods Pattern must last for at least 2 years (1 year for children and adolescents) Facts and Statistics Average age of onset is about 12 or 14 years Cyclothymia tends to be chronic and lifelong Most are female High risk for developing bipolar I or II disorder

Additional Defining Criteria for Mood Disorders Symptom Specifiers Melancholic (40-60%) Depression worse in the morning, insomnia with early waking, anorexia and significant weight loss, anhedonia Atypical (15%) Depression worse at night, oversleeping, overeating and significant weight gain Chronic – Major depression only, lasting 2 years Catatonic – Very serious condition, absence of movement Psychotic – Mood congruent/incongruent hallucinations/delusions Postpartum – Severe manic or depressive episodes post childbirth

Additional Defining Criteria for Mood Disorders (cont.) Course Specifiers Longitudinal course – Past history and recovery from depression and/or mania Rapid cycling pattern – Applies to bipolar I and II disorder only Seasonal pattern – Whether episodes are more likely during a certain season