Mood Disorders (Week 3) Flashcards
Structure of Mood Disorders: Part 1
Unipolar disorders (at one ‘pole’) • Typically depression • Mania by itself is rare (> in adolescents?) so even then is classified as “bipolar” as most who experience mania will go on to develop depression
Structure of Mood Disorders: Part 2
Bipolar disorders
• Depression and mania alternates i.e. one pole to another – but misleading as not exactly at opposite ends – but independent
• Also Mixed features (at same time) can apply for either a depressive or manic episode e.g. being manic but also having symptoms of depression or depressed with symptoms of mania.
- MAJOR DEPRESSIVE EPISODE: Part 1
A. Five of more of the following present in same two weeks, representing a change from previous functioning, and at least one of the following:
- Depressed mood. Reports from self or others (sad, empty or appears tearful). May present as irritability
- Loss of interest in previously enjoyed activities
- Decrease or increase in appetite (weight loss or gain)
- Changes in sleep - too much or too little
- Restlessness (agitation) or lethargy (retardation) nearly every day
- Frequent fatigue or loss of energy
- MAJOR DEPRESSIVE EPISODE: Part 2
- Impaired concentration and memory. Indecisiveness
- Inappropriate feelings of guilt, blame and self-worthlessness
- Recurrent thoughts of death, suicidal thoughts, possibly with suicidal plan, or suicide attempt
B. Causes clinical significant distress or impairment in functioning (in milder cases functioning may appear normal but requires markedly increased effort)
C. Episode is not attributable to the physiological effects of a substance or another medical condition
Signs and Symptoms of Depression
FEEL:
>. Sad, Anxious, Worthless, Empty, Guilty, Irritable, Restless
THINK:
>. Poor memory, Concentration, Contemplate suicide, Hopeless, Helpless
BEHAVE:
Eat more/less, Sleep more/less, Lose interest, No pleasure, Attempt suicide
BODILY:
Fatigue, Low energy, Digestive problems, Aches, Pains
MOTIVATIONAL DIFFICULTIES
- Person presenting as increasingly bored and withdrawn
- Decreased interest in occupational/ academic activities
- Impaired work performance
- Helplessness, impaired, problem-solving skills
BEHAVIOURAL DIFFICULTIES
- Getting into fights and arguments
- Increase in occupational difficulties (e.g. lateness, absenteeism, failure to complete work)
- Impaired concentration/easily distracted
- Changes in social activities (e.g. spending increased time alone, break down in established relationships)
- Increased alcohol or drug use
- Increased recklessness (e.g. reports of dangerous driving, unsafe sex, criminal activity, etc)
- Self-harm (e.g. cutting, overdoses)
- Suicide attempts and other suicidal behaviours (e.g. threats, notes, etc)
RULE OUTS
Depression may be a feature of another a mental health problem (e.g. anxiety, schizophrenia, bipolar disorder, etc) – high co-morbidity.
Example:
Normal Grieving Process (e.g. Bereavement, break-
up of a relationship) – BUT depression can occur
subsequent to these events
HOW DO WE KNOW WHEN IT’S A DISORDER? Part 1
Context in classification:
• Variations in mood occur in response to life events and
is to be expected and normal (absence can be significant!)
• Pathological changes may occur ‘out of the blue’,
without a significant event that explains intensity, duration or onset i.e. out of context
HOW DO WE KNOW WHEN IT’S A DISORDER? Part 1
Context in classification:
• Variations in mood occur in response to life events and
is to be expected and normal (absence can be significant!)
• Pathological changes may occur ‘out of the blue’,
without a significant event that explains intensity, duration or onset i.e. out of context
HOW DO WE KNOW WHEN IT’S A DISORDER? Part 2
Continuum between normal and abnormal:
• Blurry, but consider intensity, duration – outside
boundaries of normal experience because of intensity
and duration; effect on functioning
• Depression is a feature of many disorders
- MANIC EPISODE: Part 1
A. A distinct period of abnormally or persistently elevated, expansive or irritable mood, and abnormally and persistently increased activity or energy, lasting at least a week and present most of the day, nearly every day (or any duration if hospitalization is necessary) (on top of the world, haphazard enthusiasm)
B. During the period, 3 or more of following symptoms (4, if the mood is only irritable) present to significant degree and represent a change in behaviour:
- MANIC EPISODE: Part 2
- Inflated self-esteem or grandiosity (e.g. multiple overlapping new projects with little knowledge, uncritical self-confidence, can be delusional)
- Decreased need for sleep
- Excessive talking or pressured speech (rapid, loud, hard to interrupt, talk without regard, forceful, theatrical)
- Racing thoughts or flight of ideas (evident in speech – continuous flow and abrupt shifts)
- Extreme distractibility (inability to censor)
- MANIC EPISODE: Part 3
- Increase in goal-directed activity (e.g. highly productive (?) at work or school, increased social or sexual activity) or psychomotor agitation (e.g. purposeless activity)
- Excessive involvement in activities that have a high potential for painful consequences (e.g. buying sprees, sexual promiscuity, worthless investments)
C. Severe enough to cause marked impairment, or necessitate hospitalization to prevent harm to self or others, or there are psychotic features
D. Not attributable to physiological effects of a substance or other medical condition
IN CHILDREN (SOME NOTES): Part 1
A. Happiness, silliness and ‘goofiness’ are normal in many social contexts:
• If these symptoms are recurrent, inappropriate to the context, and beyond what is expected for the developmental level of the child, they may meet mood requirement of persistently elevated mood.
• Must be distinctly increased from the child’s baseline and accompanied by increased activity or energy levels that
to those who know the child well are clearly unusual for that child.
IN CHILDREN (SOME NOTES): Part 2
B:
• Inflated self-esteem or grandiosity (overestimation of abilities may be normal but when these are present
despite clear evidence to contrary, or child attempts dangerous feats, and this differs from baseline, may be
grandiose).
• Increase in goal-directed activity (can be difficult to ascertain but when takes on many tasks simultaneously, devises elaborate and unrealistic plans for projects, has developmentally inappropriate sexual preoccupations) -
should be a change
- HYPOMANIC EPISODE: Part 1
A. A distinct period of persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days, present most of the day, nearly every day
B. During the period, 3 or more of the following symptoms (4 if mood is irritable) have persisted, represent a noticeable change from usual behaviour and have been present to a significant degree (see list of mania symptoms)
- HYPOMANIC EPISODE: Part 2
C. The episode is associated with unequivocal change in functioning uncharacteristic of the individual when not symptomatic
D. Disturbance in mood and change in functioning are observable by others
E. Episode is not severe enough to cause marked impairment in functioning; no psychotic features; no hospitalization
F. Not attributable to physiological effects of a substance or other medical condition
RECAP: CRITERIA FOR DEFINING ABNORMALITY
A psychological disorder – a psychological dysfunction
within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected.
- Dysfunction
- Significant impairment
- Emotional distress
- Help-seeking
- Atypical
- Not culturally expected
DEPRESSIVE DISORDERS: Part 1
Differ in terms of duration, timing, perceived aetiology
1. Major depressive disorder
• single episode or recurrent
2. Persistent depressive DO (dysthymia)
Vary according to frequency, severity, course.
Specifiers: psychotic, anxious distress, melancholic, catatonic, mixed, seasonal, peripartum
DEPRESSIVE DISORDERS: Part 2
Other:
3. Premenstrual Dysphoric Disorder,
4. Disruptive Mood Dysregulation Disorder
Also:
• Substance/Medication Depressive Disorder
• Depressive Disorder due to Another Medical Condition
• Other Specified Depressive Disorder
• (Prolonged Grief Disorder – but classified under Trauma and Stressor-related Disorders, new in DSM5-TR)
DSM-5-TR: MAJOR DEPRESSIVE DISORDER: Part 1
D. At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic or hypomanic episode.
