1. Mood Disorders
Chapter 6

2. Major Depressive Episode
Most of the day nearly every day for at least 2 weeks
One of- Depressed mood or anhedonia
Other symptoms-
Weight loss/weight gain (significant change in weight) or significant increase/decrease in appetite (change in appetite)
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feeling worthless or excessive guilt
Problems concentrating or making decisions SI
Distress/impairment
Not due to substance other condition

3. Depressive Episode Cognitive symptoms Disturbed physical functioning
Everything effort
Loss of interest
Inability to experience pleasure
Low positive affect, not just high negative affect
4-9 months untreated

4. Mania
A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week
Significant degree of at least 2- inflated self-esteem, decreased need for sleep, excessive talkativeness, racing thoughts, distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in high-risk behaviors
Impairment or requires hospitalization or psychotic features
Not substance or other condition

5. Major Depressive Disorder
One MDE and absence of manic or hypomanic episode before or during
2 or more with separation of at least 2 months- recurrent
Cycling in and out of episodes

6. Persistent depressive disorder
Differs in course
May have fewer symptoms
Unchanged over long periods
Depressed mood that continues at least 2 years where patient is not symptom free for more than 2 months at a time
(Dysthymia and chronic major depression)

7. Double Depression
Both MDE and persistent depression with fewer symptoms
Bad sign for treatment and course

8. Early onset Not a good sign
Genetic, long course, poor response to treatment, lots of comorbidity

9. Beck’s Cognitive Triad
Negative cognitions about
Self
World
Future
Father of cognitive therapy
Cognitive errors

10. Worry Chain of thoughts and images Negatively affect-laden
Uncontrollable
Mental problem solving on an issue that is uncertain-
Possibility of more than one negative outcome

11. Worry Living in the future
Feels like problem solving but actually can’t do anything
Almost superstitious- if don’t worry, something bad might happen, like the worrying keeps the probability that it will happen down
Waste of time- likelihood what we worry about actually happens
Once its past, didn’t happen, spent all that time worrying
Avoiding something- what is feared to happen, what if it does happen, worst thing in the world?

12. Rumination
Behaviors and thoughts that passively focus one’s attention on one’s depressive symptoms and the implications of these symptoms
Distraction may be good here- just dwelling on negative feelings and symptoms doesn’t do any good here
Blocks coping?
Part of a cycle? Rumination then worry etc

13. Disruptive Mood Dysregulation Disorder
Severe temper outbursts occurring 3 or more times per week for at least a year
Out of proportion in intensity or duration to the situation
Inconsistent with developmental level
Mood between temper outbursts is persistently irritable or angry most of the day, nearly every day and observed in at least 2 of 3 settings, severe in one of these settings
DX btwn 6-18
NO mania or hypomania
Not result of anything else

14. Bipolar I versus II Bipolar II- hypomanic states instead of mania
Bipolar I- full manic episode
Hypomania-
Does not cause marked impairment in functioning
4 days instead of full week

15. Cyclothymic Disorder
2 years- numerous periods with hypomanic symptoms, numerous periods with depressive symptoms that do not meet criteria for MDE
Person not without symptoms for more than 2 months at a time
No MDE, manic, or hypomanic episode present during first 2 years
Not from another issue
Impairment in functioning
Like pervasive depressive disorder
“moody”

16. Depressive attributional style
Internal- negative life events are due to personal failure
Stable- even after negative event passes, additional bad things will always be my fault
Global- extend across a variety of issues
Stressful early life events- more likely to develop negative attribution style, lead to later depression
Also associated with anxiety

17. Medication Depression-
SSRIs- block reuptake of serotonin
MAOi’s- inhibit MAO which is an enzyme (don’t break down norep and serotonin, more in the synapse): effective for more atypical depression
Tricyclics
Block reuptake
Worse side effects
Relieve symptoms in 50% but eliminate in only about 25 to 30%
Bipolar- lithium (50% respond), also anticonvulsants, calcium channel blockers
70% relapse on lithium in 5 years

18. ECT Treats really resistant depression Safer and reasonable effective
50% of those not responding to meds will benefit
60% or higher relapse rates
Memory loss and confusion
Transcranial magnetic stimulation
Less side effects