Week 5 - Mood Disorders and Suicide Flashcards
______ depressive disorders, in which a person experiences only depressive episodes
Unipolar, or MDD
_______ disorders, in which a person experiences both depressive and manic episodes
bipolar
________ ________involve much more severe alterations in mood for much longer peri-ods of time. In such cases the disturbances of mood are intense and persistent enough to lead to serious problems in relationships and work performance.
mood disorders
_______ episode, in which a person is markedly depressed or loses interest in formerly pleasurable activities (or both) for at least 2 weeks, as well as other symptoms such as changes in sleep or appetite, or feelings of worthlessness.
depressive
episode, in which a person shows a markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of intense irritability or even violence—particularly when others refuse to go along with the manic person’s wishes and schemes. These extreme moods must persist for at least a week for this diagnosis to be made.
manic
_________ episode, in which a person experiences abnormally elevated, expansive, or irritable mood for at least 4 days. In addition, the person must have at least three other symptoms similar to those involved in mania but to a lesser degree (inflated self-esteem, decreased need for sleep, flights of ideas, pressured speech, etc.).
hypomanic
DSM-5 Criteria for. . . Manic Episode
DSM-5 Criteria for. . . Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- 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 unim-portant 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., pur-poseless 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 fool-ish business investments).
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to neces-sitate hospitalization to prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treat-ment) or to another medical condition. Note: A full manic episode that emerges during antidepres-sant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis.
Note: Criteria A–D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.
major depressive disorder (MDD; also known as “major depression” or “unipolar depression”), in which only major depressive episodes occur, is the most common, and its occurrence has apparently_______ in recent decades.
increased
lifetime prevalence rates of unipolar major depression at nearly __ percent (12-month preva-lence rates were nearly __ percent)
17
7
Worldwide, mood disorders are the second most prevalent type of disorder (following______ disorders), with a 12-month prevalence ranging from ___ to ___ percent across different countries
anxiety
1 to 10
Moreover, rates for major depression are always much higher for ______ than for ____ (usually about 2:1), similar to the sex differences for most anxiety disorders
women
men
gender disparity in MD starts in ______and continues until about age ____, when it seems to disappear. Yet among schoolchildren, boys are equally likely or slightly more likely to be diagnosed with depression.
adolescence
65
DSM-5 Criteria for. . . Major Depressive Disorder
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.
Note: Do not include symptoms that are clearly attributable to another medical condition.
- 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.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indi-cated by either subjective account or observation).
- 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.)
- Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropri-ate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisive-ness, nearly every day (either by subjective account or as observed by others).
- 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.
B. The symptoms cause clinically significant distress or impair-ment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.
Note: Criteria A–C constitute a major depressive episode. Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder. Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sad-ness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be under-standable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully consid-ered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizo-phreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.
few, if any depressions—including milder ones—occur in the absence of significant _____
anxiety
Depressive episodes typically last about ___ to ___ ____ if untreated
6 to 9 months
In approximately ___ to ___ percent of people with MDD, the symptoms do not remit for over ____ _____, in which case persistent depressive disorder is diagnosed
10 to 20
2 years
Relapse refers to the
return of symptoms within a fairly short period of time, a situation that probably reflects the fact that the underlying episode of depression has not yet run its course (Boland & Keller, 2002; Frank et al., 1991).
For example, relapse may commonly occur when pharmacotherapy is terminated prematurely—after symptoms have remitted but before the underlying episode is really over
(MDD) Recurrence, which refers to the onset of a new episode of
depression, occurs in approximately ___ to ___ percent of peo-ple who experience a depressive episode
40 to 50
True or False:
(MDD) The probability of recurrence increases with the number of prior episodes and also when the person has comorbid disorders.
True
(MDD) Unfortunately, people who experience multiple depressive episodes often are not symptom-free in between episodes, but instead have some depressive symp-toms ___ to ___ ____of the time
half to two-thirds
(MDD) People with some residual symptoms, or with significant ______ _______, following an initial depressive episode, are more likely to have recurrences than those whose symptoms remit completely.
psychosocial impairment
Rates of depression in children and adolescence
1-3%
15-20%
Specifiers of Major Depressive Episodes (5)
With Melancholic Features:
Three of the following: early morning awakening, depression worse in the morning, marked psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively different depressed mood
With Psychotic Features:
Delusions or hallucinations (usually mood congru-ent); feelings of guilt and worthlessness common
With Atypical Features:
Mood reactivity—brightens to positive events; two of the four following symptoms: weight gain or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead), being acutely sensitive to interpersonal rejection
With Catatonic Features:
A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity
With Seasonal Pattern:
At least two or more episodes in past 2 years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring). No other nonseasonal episodes in the same 2-year period
specifier
Ordinarily, any ________ or _______ present are mood congruent—that is, they seem in some sense appropriate to serious depression because the content is negative in tone, such as themes of personal inadequacy, guilt, deserved punishment, death, or disease.
delusions or hallucinations
______ _____ _____ (formerly called dysthymic disorder or dysthymia) is a disorder characterized by persistently depressed mood most of the day, for more days than not, for at least 2 years (1 year for children and adolescents
Persistent depressive disorder
Criteria for. . . Persistent Depressive Disorder
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 epi-sode, 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.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited num-ber of individuals will have depressive symptoms that have per-sisted longer than 2 years but will not meet criteria for persistent depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode of ill-ness, they should be given a diagnosis of major depressive dis-order. Otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted
Persistent depressive disorder is quite common, with a
lifetime prevalence estimated at between __.__ and ___ percent
2.5 and 6
What is double depression?
MDD + persistent depressive disorder
The average duration of persistent depressive disorder is __ to __ years, but it can last for 20 years or more
4 to 5
One 10-year prospective study of 97 individuals with early-onset dysthymia found that 74 percent recovered within 10 years but that, among those who recovered, ___ percent relapsed, with most relapses occurring within approximately 3 years of follow-up
71
Bowlby’s (1980) classic observations revealed that there are usually four phases of normal response to the loss of a spouse or close family member:
(1) numbing and disbelief,
(2) yearning and searching for the dead person,
(3) disorganization and despair that sets in when the person accepts the loss as permanent, and
(4) some reorganization as the person gradually begins to rebuild his or her life.
premenstrual dysphoric disorder has been added to the depressive disorders category in DSM-5.
The four symptoms of which one must occur include
(1) marked affective lability such as mood swings;
(2) marked irritability or anger or increased interpersonal conflicts;
(3) marked depressed mood, or
feelings of hopelessness or self-deprecating thoughts; or
(4) marked anxiety, tension, or feelings of being “keyed up” or “on edge.” Seven other symptoms are listed and a total of five symp-toms must be experienced. These other symptoms include
(1) decreased interest in usual activities;
(2) subjective sense of diffi-culties in concentration;
(3) lethargy, easy fatigability, or lack of energy;
(4) marked changes in appetite or overeating;
(5) hyper-somnia or insomnia;
(6) a sense of being overwhelmed or out of control; and
(7) physical symptoms such as breast tenderness or swelling, a sense of bloating, weight gain, and so on
Monozygotic co-twins of a twin with MDD are about ____as likely to develop the disor-der as are dizygotic co-twins, with about 31 to 42 percent of the variance in liability due to genetic influences
twice
Family studies have shown that the prevalence of mood disorders is approximately ____ to _____ times higher among blood relatives of persons with clinically diagnosed unipolar depression than it is in the population at large
two to three
Notably, however, even more vari-ance in the liability to most forms of MDD is due to non-shared environmental influences (i.e., experiences that family members do not share) than to genetic factors.
There is more limited evidence that high levels of
introversion (or low positive affectivity) may also serve as vulnerability factors for depression, either alone or when combined with neuroticism
