2. Mood Disorders: Overview
Chapter 6

3. 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

4. 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

5. 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

6. 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)

7. 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

8. 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%

9. 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

10. 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%

11. 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

12. 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

13. 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

14. 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