Mood Disorders Flashcards
What are the criteria for a manic episode?
The DSM-5 criteria for a manic episode require the presence of an abnormally elevated, expansive, or irritable mood lasting at least 1 week plus three of seven characteristic symptoms:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal directed activity).
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
Describe the Course and Outcome from a Manic Episode
The onset of mania is frequently abrupt, although it may begin gradually over the course of a few weeks. The episodes usually last from a few days to months
Although the prognosis for any particular episode is reasonably good, especially with the availability of effective treatments such as lithium and antipsychotics, the risk for recurrence is significant. Often followed by an episode of depression.
The complications of mania are primarily social: marital discord, divorce, business difficulties, financial extravagance, and sexual indiscretions. Drug or alcohol abuse may occur during a manic episode. When mania is relatively severe, the patient may be almost completely incapacitated and require protection from the consequences of poor judgment or hyperactivity.
A manic syndrome can switch rapidly to depression, and the risk for suicide is heightened when the patient becomes remorsefully aware of inappropriate behavior
Describe a manic episode “with mixed features”
Some patients present with a mixture of manic and depressive symptoms within a single episode of illness. Typically, the patient with this presentation will have a full manic syndrome that is accompanied by some depressive symptoms. The clinical presentation can be quite confusing because the patient’s mood and symptom picture tend to alternate rapidly. The patient at one moment will be talkative, energetic, and expansive, yet minutes later may burst into tears and complain of feeling hopeless and suicidal. The presence of mixed features has been associated with course (earlier onset), greater number of episodes, higher likelihood of alcohol abuse and suicide attempts, greater likelihood of rapid cycling, and greater likelihood of a lifetime diagnosis of bipolar disorder. Therefore, it is important that mixed states be recognized when present
What is the difference between a manic episode and hypomania?
Hypomania is milder and briefer. Includes symptoms that define mania, but they are not accompanied by delusional beliefs or hallucinations, and they are not severe enough to require hospitalization or to markedly impair social and occupational functioning.
Describe Bipolar II
Bipolar II disorder is characterized by periods of hypomania that typically occur either before or after periods of depression but also may occur independently. These mild manic episodes are not sufficiently severe to require hospitalization, although they can lead to personal, social, or work difficulties.
During the mild bipolar phase, the patient is upbeat, shows signs of poor judgment, and has other indices of mania such as increased energy or insomnia, but the symptoms do not meet full criteria for a manic episode.
Bipolar II disorder appears to breed true within families, in that relatives of bipolar II patients themselves have higher rates of bipolar II disorder than either bipolar I (i.e., criteria are met for a full manic episode) or unipolar major depression.
Bipolar II disorder also tends to have a high rate of comorbidity with other disorders, such as substance abuse. Patients with bipolar II tend to experience a greater burden of depressive symptoms than their bipolar I counterparts.
Describe Bipolar I
Bipolar I disorder is defined by the occurrence of at least one manic or mixed episode. Typically, bipolar I disorder is characterized by recurrent episodes of both mania and depression, which can be separated by intervals of months to years.
Although the episodes may lead to psychosocial morbidity because of the effect of a severe recurrent illness on interpersonal relationships or work functioning, interepisode functioning may be good or even excellent.
Describe Cyclothymic Disorder
Cyclothymic disorder is the mildest form of bipolar disorder and is a condition in which the patient has mild swings between the two poles of depression and hypomania.
Thus, the individual with cyclothymic disorder tends to swing from high to low with a chronic mild instability of mood
Diagnostic criteria for Disruptive Mood Disregulation Disorder
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
E. Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A–D.
F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.
H. By history or observation, the age at onset of Criteria A–E is before 10 years.
I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Major Depressive Disorder Criteria
Depression Is Worth Studiously Memorizing Extremely Grueling Criteria. Sorry
A. Five (or more) 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 (1) depressed mood or (2) loss of interest or pleasure.
- Depression - Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Interest - Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Weight - Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or
increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) - Sleep - Insomnia or hypersomnia nearly every day.
- Motor Activity - Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
- Energy - Fatigue or loss of energy nearly every day.
- Guilt - Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or
guilt about being sick). - Concentration - Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Suicide - Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Persistent Depressive Disorder (Dysthymia) Criteria
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance,
the individual has never been without the symptoms in Criteria A
and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for
2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria
have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective
disorder, schizophrenia, delusional disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic disorder.
Premenstrual Dysphoric Disorder Criteria
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present:
- Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).
- Marked irritability or anger or increased interpersonal conflicts.
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.
- Decreased interest in usual activities (e.g., work, school, friends, hobbies).
- Subjective difficulty in concentration.
- Lethargy, easy fatigability, or marked lack of energy.
- Marked change in appetite; overeating; or specific food cravings.
- Hypersomnia or insomnia.
- A sense of being overwhelmed or out of control.
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
Describe Anxious Distress
Anxious distress has been noted as a prominent feature of both bipolar and major depressive disorders in primary care and mental health settings. High levels of anxiety have been associated with higher suicide
risk, longer duration of illness, and greater likelihood of treatment nonresponse. As a result, it is clinically useful to specify accurately the presence and severity levels of anxious distress for treatment planning
and monitoring of response to treatment.
