Week 3 - Mood disorders

Question 1

Mood

Answer 1

A pervasive and sustained emotional response

Question 2

Euthymia

Answer 2

normal mood

Question 3

Dysphoria/dysthymia

Answer 3

Experience of unpleasant (usually low) mood

Question 4

Depression

Answer 4

pervasive and sustained low mood & related behaviours & symptoms

Question 5

Mania

Answer 5

Elevated mood, inflated self-esteem & associated

Question 6

Hypomania

Answer 6

Increased energy but less severe features than mania

Question 7

Euphoria

Answer 7

Intense feeling of wellbeing, excitement, over-confidence & over optimism

Question 8

Different domains of mood disorders

Answer 8

• emotional
• cognitive
• somatic
• behavioural/affective

Question 9

Emotional domain

Answer 9

dysphoria/euphoria (and associated mood extremes)

Question 10

Cognitive domain

Answer 10

Abilities - disturbed concentration
Appraisals - grandiosity & inflated self-esteem OR depressive/negative triad: hopeless view of self, environment, future

Question 11

Somatic domain

Answer 11

Fatigue/energy level, pain threshold, appetite, sleep

Question 12

behavioural/affective domain

Answer 12

psychomotor slowing versus agitation; limited behaviour vs ceaseless activity

Question 13

Distinguishing depression and normal sadness

Answer 13

• pervasive and persistent
• occurs without precipitating event
• impacts ability to function day to day
• accompanied by additional cognitive, somatic, behavioural signs and symptoms
• nature or quality may be different than normal sadness

Question 14

Previous thinking of mood disorders

Answer 14

mood disorders = depressive + bipolar disorders - formerly known as manic-depressive disorder

Question 15

Current conceptualisation - DSM-5/DSM-5-TR

Answer 15

depressive disorders and bipolar and related disorders are separate

Question 16

Common features of depressive disorders

Answer 16

• presence of sad, empty or irritable mood, accompanied by somatic and cognitive changes (DSM-V)
• duration, timing, severity and presumed aetiology is what differs

Question 17

Major Depressive Episode/Disorder - DSM-V

Answer 17

• 1 major episode in the absence of a manic episode
• episode = >5 of 9 symptoms over 2 weeks inclusive of depressed mood or loss of interest of pleasure
  PLUS
• Cause significant distress or impairment
• Not attributable to other disorders/substances

Question 18

MDE/MDD & Bereavement

Answer 18

DSM-IV - excluded bereavement
DSM-V - separate but can co-occur and be more severe
DSM-V-TR - added prolonged grief disorder but as a trauma and stressor-related disorder

Question 19

Persistent Depressive Disorder (Dysthymia)

Answer 19

• more chronic, mild presentation
• over a period of >2 years, exhibiting depressed mood most of the day, more days than not
• > 2 symptoms of 6

Question 20

Why would you not diagnose PDD

Answer 20

• If symptoms are absent for more than 2 months at a time
• If at any time during first 2 years meets criteria for MDE/MDD
• presence of manic episode

Question 21

Cultural considerations for MDD

Answer 21

differences in prevalence, risk factors, and greater somatic symptoms in some cultures
Chinese culture: boredom, discomfort, feelings of inner pressure, pain, dizziness, fatigue
Western culture: crying, feeling sad or down, fatigue/decreased energy, change in appetite and sleep, loss of pleasure

Question 22

Disruptive mood dysregulation disorder

Answer 22

• children 6-18 y/o
• chronic, severe, persistent irritability and frequent episodes of extremely out-of-control behaviours

Question 23

Premenstrual Dysphoric Disorder (PMDD)

Answer 23

• was in DSM IV but wasn’t strong enough to warrant clinical use
• severe form of PMS, characterised by mood lability, irritability, dysphoria, anxiety, difficulty concentrating, changes in appetite and sleep, pain

Question 24

Bipolar I

Answer 24

at least one manic episode

Question 24

Bipolar II

Answer 24

• Hypomania: episodes of increased energy, not severe enough to qualify manic episodes
• severity and duration

Question 25

Cyclothymia

Answer 25

• chronic, but less severe form of bipolar
• symptoms of mania and depression rather than episodes

Question 26

Manic episode

Answer 26

• At least a week of abnormally & persistently elevated, expansive, or irritable mood and persistently increased goal-directed activity/energy: present for most of the day nearly every day
• > 3 of 7 symptoms (>4 if mood is irritable)
• Sufficiently severe to cause marked impairment in functioning, OR necessitate hospitalisation, OR with psychotic features

Question 27

Hypomanic Episode

Answer 27

• same symptoms as manic episode
• lasts at least 4 consecutive days
• change in function but not severe enough to cause ‘marked impairment’ in function or trigger hospitalisation

Question 28

Cyclothymic disorder

Answer 28

• chronic, fluctuating mood disturbance
• numerous periods of hypomanic & depressive symptoms
• never symptoms free for more than 2 months
• onset usually in adolescence or early adulthood

Question 29

General critique of DSM

Answer 29

reification - list of features defines the entity

Question 30

Course and outcome of depressive disorders

Answer 30

• mean age of onset: 32 years
• typically 5 to 6 episodes over lifetime

Question 31

Risk of recurrence of depressive disorders

Answer 31

1 episode - 50%
2 episodes - 70%
3 episodes - 90%
- 50% recover within 6 months of beginning of an episode
- comorbidities: anxiety, substance abuse

Question 32

Course and outcome for Bipolar disorder

Answer 32

• onset if younger (18-22 y/o)
• manic or depressive episode may come first usually lasting 2-3 months but difficult to predict. >90% of individuals who have manic episode will have further mood episodes
• usually more lifetime episodes than depressive disorders
• mixed long-term prognosis

Question 33

Prevalence of Affective disorders over 12 months

Answer 33

6.2% overall
depressive episode: 4.1%
dysthymia: 1.3%
bipolar I/II: 1.8%

Question 34

Impact of Depressive disorders

Answer 34

• 1 million adults experience depression each year
• 1 in 6 will be depressed in their lifetime (women more at risk)
  -12.6 billion/yr
• 6 million working days of lost productivity
• 80% of suicides preceded by mood disorder
• depression accounts for 10% of all disability