Depressive and Mood Disorders

Question 1

Disruptive Mood Dysregulation Disorder

Answer 1

Chronic, severe persistent irritability (characterized by two prominent
features – frequent severe tantrums and severe and persistent irritable or
angry mood usually between the outbursts) – which are developmentally
inappropriate.
 Category created in DSM-5 to reduce the high numbers of pediatric
bipolar disorder diagnosis. Also research showed most kids dx. With
pediatric BD did not develop BD as adults – mostly unipolar depression or
anxiety disorder.
 Still caution warranted to not confuse the two. Difficult but possible.
Primary focus is to not confuse severe non-episodic irritability with mania
and hypomania, two key features of bipolar disorder.
 Sxs. started by age 10. Occurs is at least two contexts (home, school, with
peers).
 CANNOT co-exist with ODD, Intermittent Explosive Disorder, or Bipolar
Disorder.
 CAN co-exist with Major Dep., ADD/ADHD, Substance Disorder, Conduct
Disorder among others.

Question 2

Major Depressive Disorder

Answer 2

1. Depressed mood (can be irritable mood in children)
2. Diminished interests or pleasures (anhedonia)
3. Significant weight loss or weight gain (5% change in a
   month and in kids, not making expected weight gain)
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive guilt
8. Diminished concentration or indecisiveness
9. Recurrent thoughts of death, suicide

Question 3

Persistent Depressive Disorder

Dysthymia

Answer 3

Depressed mood occurring for nearly
every day, for 2 or more years and 1 year
in children and adolescents
May be preceded by MDD
Both can co-occur (Double Depression) if
criteria for MDD are met for 2 years
Many people are well enough to
“function” but never quite feel “good.”
Thus may need to prompt these
individuals as they may acquiesce to the
condition.

Question 4

Premenstrual Dysphoric Disorder

Answer 4

Depressive / Dysphoric symptoms In the majority of menstrual cycles occurring a week or
so before onset of menses, start to improve within a few days after the onset of menses,
and become minimal or absent a week of so after.
▪ Key symptoms – mood lability (mood swings, sudden sadness and tearfulness, sensitivity to
feeling rejected).
▪ At least 5 symptoms must be present
▪ 1 or more of mood
▪ Marked Affective Lability, Marked irritability or anger or increased interpersonal
conflicts, Marked depressed mood, feelings of hopelessness, or self-deprecating
thoughts, anxiety/tension,
▪ 1 or more behavioral/physical
▪ Decreased interest in usual activities, subjective difficulty concentrating, lethargy, change in appetite, hypersomnia or insomnia, sense of “being overwhelmed or out of control”, physical symptoms such as breast tenderness or
swelling, joint or muscle pain, sensation of “bloating”
▪ Prospective daily ratings needed for 2 cycles

Question 5

Manic episode

Answer 5

Distinct period of abnormally and persistently elevated, expansive or irritable mood (or
any combination of these) AND increased activity (new in DSM-5 because it is more
clearly observable) lasting 1 week (any duration if hospitalization or ER treatment is necessary).
B. During Mood Disturbance at least three (four if mood is only irritable) of the following
present:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking (pressured
speech).
4. Flight of ideas; racing thoughts
5. Distractibility
6. Increase in “goal-directed” activity (new in DSM-5)
7. Excessive involvement in pleasurable activities
with high potential for painful consequences,
e.g. sexual indiscretions.

Question 6

Bipolar Disorder is a misnomer - Does not always have 2 poles. One
manic episode is enough to give the diagnosis. It may have been
preceded by and may be followed by hypomanic and/or major
depressive episodes.
- Many experience both manic and depressive episodes
over the course of the illness
2. Terms associated with Bipolar Disorder I
A. Mania
B. Depressive and manic episodes
C. Rapid Cycling – For Bipolar I or II when at least four mood episodes
in a year meet full criteria for manic, hypomanic or major depressive
episode.

Answer 6

Bipolar 1

Question 7

Bipolar 2

Answer 7

Must have at least one mood disturbance that met criteria for a manic
episode. Major Depressive Episodes (MDE) are common in, but not
required for the diagnosis of Bipolar I disorder.
B. For Bipolar II, must have met full criteria for at least one hypomanic episode
and full criteria for at least one major depressive episode , but never a
mood disturbance that met criteria for mania.
C. Incidence of bipolar II disorder is approximately 0.5% and higher in women
(DSM-5).

Question 8

CYCLOTHYMIC (THINK CYCLE) DISORDER

Answer 8

• A variant of bipolar disorder
• Two-year period in adults (1 in children and adolescents
comprising of numerous hypomanic and depressive
symptoms (not episodes).
• Over the course of the two years (1 in children and
adolescents), the individual has had sxs. for at least half of
the time, and never symptom free for more than 2
months.
• On the basis of symptom number, severity, pervasiveness,
or duration, criteria for a manic, depressive or
hypomanic episode have never been met.