1. Chapter 6 Psy 303 Abnormal Psych
PART
MOOD DISORDERS

2. Mood disorders
Disturbances in emotion that cause discomfort or hinder functioning
Rank among the top 10 causes of worldwide disability
a leading cause of absenteeism and diminished productivity in workplace
prevalence for all mood disorders is 15 percent for males, 24 percent for females

3. Mood disorders: General Stats
Likelihood of recurrence is
50 percent after one episode
70 percent after two
90 percent after three
Women twice as likely as men to become depressed except for Bipolar 1

4. Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note:  Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. (1) depressed mood most of the day. Note: In children and adolescents, can be irritable mood. (2) markedly diminished interest or pleasure in all, or almost all, activities (3) significant weight loss when not dieting or weight gain, decrease or increase in appetite nearly every day. (4) insomnia or hypersomnia nearly every day (5) psychomotor agitation or retardation nearly every day (6) fatigue or loss of energy nearly every day (7) feelings of worthlessness or excessive or inappropriate guilt (8) diminished ability to think or concentrate, or indecisiveness (9) recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

5. Major Depressive Episode cont’d
B. The symptoms do not meet criteria for a Mixed Episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Mixed episode changed to specifier: ‘mixed episode specifier’

6. Manic Episode:*** For a week, or less of manic symptoms (less only if symptoms are severe manic symptoms enough for hospitalization)
Affective symptoms: ELEVATED OR IRRITABLE MOOD (expansive mood, boundless energy, and enthusiasm)
Cognitive symptoms: Speech, attention, judgment
Behavioral symptoms:
Mania: more disruptive grandiosity, incoherent speech; hallucinations and delusions possible
Physiological symptoms: High arousal and decreased need for sleep, weight loss
Elevated mood, Expansiveness, Irritability, Hyperactivity
Elevated mood,
Expansiveness,
Irritability,
Hyperactivity
DMS5 ADDITION – EMPHASIS ON CHANGES IN ACTIVITY AND ENERGY

7. DSM IV Criteria for Manic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree.
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investment

8. Manic Episode
NOTE: The person may become involved in more activities than usual – starting new projects etc also shopping sprees, money on luxury items, reckless sexual behavior or driving etc….

9. Hypomanic Episodes – a minimum duration of four days
Less severe mania that does not cause impairment in social or occupational functioning
Overactive in behavior but no delusions like mania
IF THE DURATION CRITERIA IS NOT MET or too FEW SYMPTOMS– Other specified bipolar and related disorders

10. Classification of Mood Disorders: Depressive Disorders
Major depressive disorder (Single episode or recurrent)
Dysthymic disorder ***
Depressive disorder not otherwise specified
*** DSM-5: Chronic major depressive disorder and dysthymia falls now under PERSISTENT DEPRESSIVE DISORDER

11. Dsm-5 additions
Chronic major depressive disorder and dysthymia falls now under PERSISTENT DEPRESSIVE DISORDER
Premenstrual Dysphoric Disorder
Disruptive Mood Regulation Disorder
For children up to 18 years of age
Persistent irritability and frequent episodes of exterme behavioral dyscontrol
No exclusion criteria for bereavement (symptoms lasting for less than 2 months)

12. Classification of Mood Disorders: Bipolar Disorder Mood shifts between two emotional “poles”
Cyclothymic disorder (fluctuations between hypomanic and depressive symptoms)

13. Bipolar Disorder
Bipolar I (full blown mania alternates with episodes of major depression)
Bipolar II (hypomania mood elevation that is abnormal yet not severe enough to impair functioning or require hospitalization, at least one episode of hypomania and one episode of major depression
Bipolar II is more common than Bipolar I; however, because of the high levels of productivity and creativity associated with the hypomania, one may view the episodes in a more positive light.

14. Cyclothymic Disorder
A condition characterized by fluctuations that alternate between hypomania and depression
Episodes not as severe as with mania or major depression
Persist for at least two years
Puberty, premenstrual period, pregnancy, post partum period, and menopause are all considered risk factors for mood disorders.
Fact or fiction?
Yes, rates of depression do vary by age, but these reproductive events are all indentified as risk factors.

15. Classification of Mood Disorders: Other
Due to general medical condition
Substance induced

16. Course of Mood Disorders
Longitudinal course specifier
Past history of mood disturbance
History of recovery from depression and/or mania
Rapid cycling specifier -- Applies to Bipolar 1 and 2
Four or more mood disturbances within a year
Extreme cycling: multiple shifts within a single day
Seasonal pattern specifiers: Seasonal affective disorder
Fluctuations in melatonin (hormone secreted by the pineal gland)
Circadian rhythms

17. Comparison between depressive and bipolar disorders
Bipolar more genetically based
Bipolar much less common
Bipolar disorders equally affect males and females.
Onset of both bipolar and unipolar early twenties (bipolar a little earlier), but onset is acute in bipolar disorders
Bipolar displays psychomotor retardation and more suicide attempts
Completed suicides: four times higher than for MDD, recurrent (Brown et al., 2006)
Bipolar responds to Lithium

18. Approximately 80% of new mothers will develop the “baby blues.”
Sex, Race, and Ethnicity
Women are twice as likely to suffer from major depression (10%) than men (5%)
Common in lower SES
Impact of unemployment and lack of education and financial resources
Impact of reproductive events
Postpartum Depression (PPD)
Higher rates of depression in Whites at 17.9%
Approximately 80% of new mothers will develop the “baby blues.”

19. Mixed Anxiety and Depressive Symptoms
Anticipating the worst, worry, poor concentration, irritability, hypervigilance, unsatisfying sleep or insomnia, crying, guilt, fatigues, poor memory, worthlessness, hopelessness

20. Prevalence of Mood Disorders
Children and adolescents
Symptom presentations different from adults’
Gender ratio different from adults’
Consequences rather dramatic
In the Elderly (65 and higher)
Medical illnesses or dementia complicate the diagnosis
Sex ratio balanced

21. Prevalence of Mood Disorders
Overlap between anxiety and depression
Most depressed are also anxious.
Not all anxious individuals are depressed.
Mixed anxiety and depression symptoms