Mood Disorders Flashcards
What defines a mood in the context of mood disorders?
A mood is a pervasive and sustained emotional response. Within individuals, it represents a change from their usual state.
Describe mania
elevated mood and inflated self-esteem: marking the “ups” in mood disorders.
What is hypomania?
A clinical expression of increased energy that has less severe features than mania.
Define euphoria.
An intense feeling of well-being, excitement, and over-optimism without any obstacles to one’s goals.
What does euthymia refer to?
A ‘normal’ mood, neither depressed nor elevated.
What is dysphoria/dysthymia?
It’s the experience of an unpleasant (usually low) mood that, when worsened, can lead to depressed mood.
What distinguishes depression from normal sadness?
Depression is pervasive and persistent relative to ‘normal’ sadness.
Mood change may occur without a precipitating event or it may appear disproportionate for the circumstances.
Depression is usually accompanied by cognitive, somatic, and behavioural signs that impair functioning.
Mood change is not enough to warrant a diagnosis.
Mood Disorders impact 4 domains; emotional, cognitive, somatic, and behavioural/affective.
What are some emotional impacts?
Dysphoria/Euphoria (and associated mood extremes)
Mood Disorders impact 4 domains; emotional, cognitive, somatic, and behavioural/affective.
What are some Cognitive impacts?
Abilities - disturbed concentration
Appraisals;
a. grandiosity and inflated self-esteem
b. depressive/’negative’ triad: hopeless view of self, environment, future
Thinking processes can change
Mood Disorders impact 4 domains; emotional, cognitive, somatic, and behavioural/affective.
What are some Somatic impacts?
Fatigue
changes in energy levels, appetite, and sleep
pain threshold is lowered/increased
Mood Disorders impact 4 domains; emotional, cognitive, somatic, and behavioural/affective.
What are some Behavioural/Affective impacts?
Psychomotor slowing versus agitation; limited behaviours vs. careless activities
Might be symptomatic or emblematic of the affective state
The amount of behaviour and how it manifests can be an indicator of the internal state.
What does the relationship between mood and affective disorders in the DSM-5 tell us? why would this be important?
There are some symptom overlaps between depressive disorders and bipolar disorders, meaning they are related in some way. This could be important when doing a differential diagnosis.
What is the common feature across all of the depressive disorders and how do they differ?
note. This is all of the depressive disorders in the DSM-5 chapter
Presence of sad, empty or irritable mood, accompanied by somatic and cognitive changes.
What differs is their duration, timing, severity, and presumed aetiology.
The DSM-5 introduced some new changes into the categorisation of mood disorders in the new publication. What two new disorders were introduced, and why were they controversial?
- Disruptive Mood Dysregulation Disorder
- Premenstrual Dysphoric Disorder
Both disorders are considered controversial due to over-pathologising and over-medicalisation of behaviour and hormonal responses that could be a part of normal developmental or biological processes.
Alongside MDD, what was the other disorder that was included alongside it? what was the difference between MDD and this added disorder?
Major Depressive Episode
MDE rarely occurs on its own so was included with MDD, the difference between these two is MDD has recurrent episodes.
What was dysthymia renamed to in the DSM-5?
Persistent Depressive Disorder
The DSM-5 added the “catch-all” category for depressive disorders, whereby the primary impairment for mood disorders is present however considered secondary. What are the three reasons a mood disorder may be considered secondary as categorised by the DSM-5?
- Another medical condition, or
- Substance or medication induced, or
- We cannot tell how to specify the disorder
How does the DSM-5 categorise disorders that it cannot label yet? use the mood disorders as an example.
It categorises it as, not-otherwise-specified (NOS)
Thus, the mood disorder example would be depressive disorder NOS
The DSM-5 added “unspecified mood disorder”, when would you apply this diagnosis?
When the presentation does not meet criteria for any specific mood disorder and when it is difficult to choose between unspecified depressive disorder or, depressive disorder NOS and unspecified bipolar disorder, or bipolar NOS.
In terms of the “unspecified mood disorder” diagnosis that was added to the DSM-5, if you were to think critically about this, what might this reveal about categorising and the conceptual thinking of bipolar and depressive disorder?
This diagnosis means that conceptually, bipolar and depressive disorder are related in some way, tat they are not entirely split or divided.
Meaning there is a merged disorder category that tries to capture the full spectrum of presentations we may see clinically.
In criterion A of MDE/MDD, the DSM-5 is trying to categorise the scope of this disorder through a syndrome. How does this criterion capture the primary feature, pervasive and/or sustained mood state, of this disorder?
Every symptom except for symptom 9 has a durational component that attempts to operationalise the primary feature by labelling the symptoms as being “every day” or “nearly every day”.
Thinking about the four domains of an individual that are affected by mood disorders, i.e. emotional, cognitive, behavioural, and somatic.
How is the emotional domain mapped onto the 9 symptoms of MDE/MDD?
Symptom 1: Depressed mood most of the day, nearly every day (subjective or observed)
Symptom 7: Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Symptom 9: Recurrent thoughts of death, suicidal ideation, or suicide attempt
Thinking about the four domains of an individual that are affected by mood disorders, i.e. emotional, cognitive, behavioural, and somatic.
How is the cognitive domain mapped onto the 9 symptoms of MDE/MDD?
Symptom 8: Diminished ability to think or concentrate, or indecisiveness, nearly every day (subjective or observed)
Thinking about the four domains of an individual that are affected by mood disorders, i.e. emotional, cognitive, behavioural, and somatic.
How is the behavioural domain mapped onto the 9 symptoms of MDE/MDD?
Symptom 2: Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (observable through behavior)
Symptom 5: Psychomotor agitation or retardation nearly every day (observable)
Thinking about the four domains of an individual that are affected by mood disorders, i.e. emotional, cognitive, behavioural, and somatic.
How is the somatic domain mapped onto the 9 symptoms of MDE/MDD?
Symptom 3: Significant weight loss or weight gain, or changes in appetite nearly every day
Symptom 4: Insomnia or hypersomnia nearly every day
Symptom 6: Fatigue or loss of energy nearly every day
Bereavement has been a
contentious experience to classify within the DSM’s. What is stated about this experience in the DSM-5? and how does it relate to the mood disorder of MDE/MDD?
Bereavement may induce great suffering, however this does not typically result in MDE/MDD. However, it may co-occur with the disorder meaning if the diagnostic criteria is met it can be treated with anti-depressant medication.
In terms of thinking critically about the DSM-5’s classification system and the polythetic approach to diagnosis. What could this mean when diagnosticians or clinicians are trying to apply symptoms to an individuals experience?
Use MDD as an example and think about commonality of language which the DSM-5 tries to adhere to.
To diagnose someone with MDD they need ≥ 5 of 9 symptoms, two of which must be symptom 1 and 2.
The polythetic approach means that diagnosticians or clinicians may have different ideas, language, or understanding when applying the symptoms to an individuals experience. This also brings in complexities for reification.
The DSM-5-TR added prolonged grief disorder, however not as a mood disorder. How was grief categorised and what does this mean for pathology?
This disorder was added as a trauma and stressor related disorder rather than a mood disorder.
This brought up issues for over-pathologysing regular human experiences.
Persistent depressive disorder is considered a chronic disorder with a mild presentation, what is the period of time, and how many symptoms are needed to qualify for this diagnosis?
It is a period of 2 or more years, where depressed mood is exhibited for most of the day more days than not.
An individual must have 2 or greater of any 6 symptoms.
When would you NOT diagnose persistent depressive disorder?
- When symptoms are absent for more than 2 months at a time during the 2-year period.
- If at any time during the first 2 years MDE/MDD criterion is met.
- The presence of a manic episode
What is the difference between MDE/MDD and persistent depressive disorder?
The duration of PDD is longer, and the symptoms are more mild than MDD.
In terms of the polythetic approach to the DSM-5, a criticism has been of the differences in language across diagnosticians. In what case would the polythetic symptom approach be sensitive to ones experience?
Use MDD as an example.
Cultural Factors
Cultural presentations or notions of depression across the four domains could be represented differently than the western perspectives. Therefore, the polythetic approach might be helpful to understand the nuance of cultural presentations and how these conditions are experienced or expressed.
In cross-cultural considerations of MDD, the prevalence, risk factors, and greater somatic symptoms in some cultures may be different. What are some examples of symptoms of MDD in Chinese culture compared to Western culture according to the findings of Kleinman (2004).
Chinese:
Boredom, discomfort, feelings of inner pressure, pain, dizziness, and fatigue
West:
Crying, feeling sad or down, fatigue/decreased energy, change in appetite and sleep, loss of pleasure.
What are the features of disruptive mood dysregulation disorder?
Diagnosed in children
Chronic, severe, persistent irritability and frequent episodes of extremely out-of-control behaviour
