lecture 6 material Flashcards
Mood Disorders and Suicide
What are the ABC Characteristics of Major Depressive Episode
A) 5+ 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:
- depressed mood or
- loss of interest or pleasure
AND - Significant weight loss when not dieting or weight gain or decrease
or increase in appetite nearly every day - Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness, nearly
every day - 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 cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C) 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)
What are the ABCD Characterisations for Manic Episodes
A) A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is
necessary)
B) During the period of mood disturbance and increased energy or
activity, 3+ of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility, as reported or observed
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences
C) The mood disturbance is sufficiently severe to cause marked
impairment in social or occupational functioning or to necessitate
hospitalization to prevent harm to self or others, or there are psychotic features
D) The episode is not attributable to the physiological effects of a
substance or to another general medical condition
What is the difference between a manic episode and a hypomanic episode
A hypomanic episode is:
* Shorter, less severe version of a manic episode
* Lasts at least four days
* Has fewer and milder symptoms
* Associated with less impairment than a manic episode
* May not be problematic in and of itself, but usually
occurs in the context of a more problematic mood disorder
What are the two categories of mood disorders
unipolar mood disorders and bipolar mood disorders
What are the differences between Unipolar and Bipolar mood disorders
Unipolar mood disorder: Only one extreme of mood is
experienced
- e.g. only depression OR only mania
- Depression alone is = more common than mania alone
Bipolar mood disorder: Both depressed and elevated moods are experienced
- e.g. some depressive episodes and some manic or hypomanic episodes
What are the DSM-5 Classified Depressive Disorders
- Major Depressive Disorder
- Persistent Depressive Disorder
- Premenstrual Dysphoric Disorder
- Disruptive Mood Dysregulation Disorder
What are the ABC characteristics of Major Depressive Disorder (MDD)
A) At least one major depressive episode
B) The occurrence of the major depressive episode is not
better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other
specified and unspecified schizophrenia spectrum and other psychotic disorders
C) There has never been a manic episode or hypomanic
episode
What are ways to classify the status of a depressive episode
- single episode or recurrent episode
- mild, moderate, severe
- With anxious distress; With mixed features; With melancholic features; With atypical features; With moodcongruent psychotic features; With mood-incongruent
psychotic features; With catatonia; With peripartum onset; With seasonal pattern (recurrent episode only)
What does it mean if MDD has anxious distress specifiers
Anxious Distress Specifier = Depression is accompanied by several significant symptoms of anxiety
What does it mean if MDD has mixed features specifiers
Mixed features specifiers = Depressive episodes which also include several
manic symptoms
What does it mean if MDD has melancholic features specifiers
Melancholic features specifiers = Major depressive episode accompanied by additional severe symptoms such as early morning awakenings,
lack of reactivity to positive stimuli
What does it mean if MDD has atypical features specifiers
Typical features specifiers = Presence of several symptoms less common in depression, including oversleeping and overeating
What does it mean if MDD has psychotic features specifiers
Psychotic features specifiers = Major depressive episodes which also include some
psychotic features
- Hallucinations: Sensory experience in the
absence of sensory input - Delusions: Strongly held inaccurate beliefs
What does it mean if MDD has peripartum onset specifiers
Peripartum onset specifiers = Depression occurring around the time of giving birth
What does it mean if MDD has seasonal pattern specifiers
Seasonal pattern specifiers = Depression occurring primarily in certain seasons (usually winter)
- Result of phase-delayed circadian misalignment,
meaning that the patient’s circadian rhythm is misaligned with the environmental day-night cycle
What does it mean if MDD has catatonic features specifiers
Catatonic features specifiers = Extremely rare muscular symptoms such as
remaining in a still stupor, “
waxy ” limbs that remain in place when manipulated, repetitive or purposeless
movement
How are the A-H Characterisations of Persistent Depressive Disorder (Dysthymia)
A) Depressed mood (irritable for kids), most of the day, more days than not – at least 2 years (1 year for kids)
B) Two or more of:
1.Poor appetite or overeating
2.Insomnia or hypersomnia
3.Fatigue or loss of energy
4.Low self esteem
5.Poor concentration or indecisiveness
6.Feelings of hopelessness
C) < 2 months without symptoms
D) May have MDD at same time
E) No manic or hypomanic episode ever
F) Not better explained by persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other specified or
unspecified schizophrenia spectrum and other psychotic
disorder
G) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism)
H) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
What are the specifications needed to be made for Persistent Depressive Disorder (Dysthymia)
Specify if: disorder is With anxious distress; With mixed features; With melancholic features; With atypical features; With moodcongruent psychotic features; With mood-incongruent
psychotic features; With peripartum onset
Specify if: Early onset: onset before age 21 OR Late onset:
onset after age 21
If full criteria are met, specify if disorder is: mild/moderate/severe
If full criteria is NOT met, specify if disorder is: In partial remission/in full remission
What are the ABCD characteristics of Premenstrual Dysphoric Disorder
A) 5+ symptoms (at least 1 from B and 1 from C); occur week before
menses; majority of cycles; improve with menses; (almost) disappear after
menses
B) One or more of:
1. Marked affective lability (e.g., mood swings, crying, sensitivity)
2. Marked irritability or anger
3. Marked depressed mood, hopelessness, self-deprecation
4. Marked anxiety, tension, on edge
C) one or more of:
1. Decreased interest
2. Difficulty concentrating
3. Lethargy, lack of energy
4. Marked change in appetite
5. Hypersomnia or insomnia
6. Feeling overwhelmed or out of control
7. Physical symptoms (e.g., breast tenderness, muscle pain, weight
gain)
D) Cause clinically sig distress or impairment
E) Not due to another mental disorder
F) Criterion A must be confirmed by prospective daily ratings
G) Symptoms not due to substance use or other medical condition
What are the A-I characterisations of Disruptive Mood Dysregulation Disorder
A) Severe, recurrent temper outbursts – out of proportion to the situation
B) Developmentally inconsistent
C) Occur 3+ times per week (average)
D) Persistent anger and irritability, most of the day, between outbursts
E) 12 months or more and < 3 months without
F) Present in at least 2 of: home, school, peers
G) Can only be applied to 6-18 y.o.
H) Age of onset < 10 years.
I-J. Not manic or major depressive episode. Cannot co-exist with ODD, Intermittent Explosive Disorder, or Bipolar Disorder