Week 3 - Mood disorders Flashcards
Mood
A pervasive and sustained emotional response
Euthymia
normal mood
Dysphoria/dysthymia
Experience of unpleasant (usually low) mood
Depression
pervasive and sustained low mood & related behaviours & symptoms
Mania
Elevated mood, inflated self-esteem & associated
Hypomania
Increased energy but less severe features than mania
Euphoria
Intense feeling of wellbeing, excitement, over-confidence & over optimism
Different domains of mood disorders
- emotional
- cognitive
- somatic
- behavioural/affective
Emotional domain
dysphoria/euphoria (and associated mood extremes)
Cognitive domain
Abilities - disturbed concentration
Appraisals - grandiosity & inflated self-esteem OR depressive/negative triad: hopeless view of self, environment, future
Somatic domain
Fatigue/energy level, pain threshold, appetite, sleep
behavioural/affective domain
psychomotor slowing versus agitation; limited behaviour vs ceaseless activity
Distinguishing depression and normal sadness
- 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
Previous thinking of mood disorders
mood disorders = depressive + bipolar disorders - formerly known as manic-depressive disorder
Current conceptualisation - DSM-5/DSM-5-TR
depressive disorders and bipolar and related disorders are separate
Common features of depressive disorders
- presence of sad, empty or irritable mood, accompanied by somatic and cognitive changes (DSM-V)
- duration, timing, severity and presumed aetiology is what differs
Major Depressive Episode/Disorder - DSM-V
- 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
MDE/MDD & Bereavement
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
Persistent Depressive Disorder (Dysthymia)
- 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
Why would you not diagnose PDD
- 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
Cultural considerations for MDD
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
Disruptive mood dysregulation disorder
- children 6-18 y/o
- chronic, severe, persistent irritability and frequent episodes of extremely out-of-control behaviours
Premenstrual Dysphoric Disorder (PMDD)
- 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
Bipolar I
at least one manic episode
Bipolar II
- Hypomania: episodes of increased energy, not severe enough to qualify manic episodes
- severity and duration
Cyclothymia
- chronic, but less severe form of bipolar
- symptoms of mania and depression rather than episodes
Manic episode
- 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
Hypomanic Episode
- 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
Cyclothymic disorder
- 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
General critique of DSM
reification - list of features defines the entity
Course and outcome of depressive disorders
- mean age of onset: 32 years
- typically 5 to 6 episodes over lifetime
Risk of recurrence of depressive disorders
1 episode - 50%
2 episodes - 70%
3 episodes - 90%
- 50% recover within 6 months of beginning of an episode
- comorbidities: anxiety, substance abuse
Course and outcome for Bipolar disorder
- 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
Prevalence of Affective disorders over 12 months
6.2% overall
depressive episode: 4.1%
dysthymia: 1.3%
bipolar I/II: 1.8%
Impact of Depressive disorders
- 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
