W3: Depressive & Bipolar Disorders Flashcards
What are the mood disorders in the DSM
Unipolar depressive disorders and bipolar disorders
What are the depressive disorders in the DSM
Major depressive disorder
Persistent depressive disorder (dysthymia)
Disruptive mood dysregulation disorder
Premenstrual dysphoric disorder
What is major depressive disorder (MDD)? 
Clinically significant sadness with associated cognitive and somatic changes
It’s an episodic disorder with periods of normal mood in between periods of the depressed mood
What is the DSM criteria for major depressive disorder
Need to have five or more of the following within the same two week period
Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day (anhedonia)
Significant weight loss or gain or increase/decrease in appetite
insomnia or hypersomnia nearly every day
Psycho motor 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, concentrate, or indecisiveness nearly every day
Recurrent thoughts of death, suicidal ideation, suicide attempt or plan

Causes clinically significant distress, not attributable to substances or other medical conditions or mental disorder
There has never been a manic or hypomanic episode!!!!!!

What is the prevalence of MDD
14.4%
What is the mean onset of MDD
The main age of onset is 30.5 but this age seems to be decreasing this could be because people are becoming more aware and are willing to seek help earlier
Are there any gender differences in MDD
There are higher rights in women but is this a genuine reflection of prevalence or are women socialised to get help
Explain relapse in MDD
The risk of relapse is high but it is lowered went successfully completing CBT compared with medication
What is suicide ideation
Thoughts about ending your life this is common in depression
What is suicide attempt
An attempt was made to end your life but it is not completed
Women attempt suicide more than men
What is suicide
Successful death from a suicide attempt
Completed suicides are more likely in men
What is nonsuicidal self injury
The aim is to cause harm for not to die there may be a range of reasons for this but the main one seen is a release of pain
Differential diagnosis between bipolar and major depressive disorder
When you have someone with a major depressive episode it is important to always assess for a history of mania and or hypo mania - if the patient has had a manic or hypomanic episode it will exclude them from a diagnosis of MDD
What does the DSM say about persistent depressive disorder (dysthymia)?
Depressed mood for most of the day, for more days the not, as indicated by subjective account or observation by others, for at least two years
Two or more of the following: Poor appetite or over eating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness
During the two year period the individual has not been without symptoms for more than two months at a time
There has never been a manic or hypomanic episode
The disturbance is not better explained by schizoaffective disorder, schizophrenia, delusional disorder, other psychotic disorder
Not due to substances or medical conditions and cause clinically significant distress or impairment
What is Persistent depressive disorder (dysthymia)?
A mild but long-term form of depression.
Dysthymia is defined as a low mood occurring for at least two years, along with at least two other symptoms of depression.
Individuals with MDD and PDD often experience comorbidity disorders such as
Anxiety disorders
Substance use disorders
Personality disorders (borderline & dependent)
Explain the specifier of MDD and PDD of anxious distress
2 of the following;
Feeling keyed up or tense
Feeling unusually restless
Difficulty concentrating because of worry
Fear that something awful might happen
Feeling that the individual might lose control of himself or herself
Explain the specifier of MDD and PDD of mixed features
3 manic/hypomanic symptoms:
Elevated, expansive mood
Inflated self-esteem or grandiosity
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Increase in energy or goal directed energy
Increased or excessive involvement in activities that have a high potential for painful consequences
Decreased need for sleep 
Explain the specifier of MDD and PDD of melancholic features
1 of the following when episode is most severe
- loss of pleasure in all, or almost all, activities
- loss of reactivity to usually pleasurable stimuli
3+:
– Depressed mood characterised by profound despondency, despair, and or empty mood
– Depression that is regularly worse in the morning
– Early-morning awakening
– Marked psychomotor agitation or retardation
- Significant anorexia or weight gain
– Excessive or inappropriate guilt
Explain the specifier of MDD and PDD of atypical features
Mood reactivity (mood brightens in response to actual or potential positive events)
2 or more:
Significant weight gain or increasing appetite
Hypersomnia
Leaden paralysis (heavy feelings in arms and legs)
A long-standing pattern of interpersonal rejection sensitivity that results in significant social occupational impairment
Criteria is not met with melancholic features or with catatonia
Explain the specifier of MDD and PDD of psychotic features
Delusions and hallucinations are present
With mood congruent psychotic features, content is consistent with depressive themes
- inadequacy
- guilt
- disease
- death
- deserved punishment
With mood incongruent psychotic features, content is not consistent with depressive themes
Explain the specifier of MDD (only) of Catalonia?
Catatonic features
dominated by 3 or more:
- stupor (no psychomotor activity, not actively relating to the environment)
- catalepsy (passive induction of a posture held against gravity)
- waxy flexibility (slight, even resistance to positioning by the examiner)
- mutism (no, or little verbal message)
- negativism (opposition or no response to instructions or external stimuli)
- posturing (spontaneous and active maintenance of a posture against gravity)
- mannerism (odd, circumstantial caricature of normal actions)
- stereotypy (repetitive, abnormally frequent, non-goal directed movements)
- agitation (not influenced by external stimuli)
- grimacing (pulling unusual faces)
- echolalia (mimicking others speech)
- echopraxia (mimicking others movement)
