Week 8 Chapter 5 Mood Disorders (Caff) Flashcards
a brief overview of Chapter 5 Mood Disorders
Mood Disorders involve disabling disturbances in emotion, from extreme sadness & disengagement of depression to extreme elation & irritability found in mania.
How many broad types of mood disorder are there and what are they?
There are 2 broad types of Mood Disorder:
- Depressive Disorder
- BiPolar Disorder
What are the main types of depressive disorders?
Depressive Disorders include:
- Major Depression
- Dysthymia
- Mixed anxiety/depressive disorder
- Premenstrual dysphoric disorder
- Disruptive mood dysregulation disorder
What symptoms might someone with depression experience?
They may:
- become focused on their flaws & deficits
- view things in a negative light & lose hope
- Fatigue, low energy & physical aches & pains may develop
- it may be hard to fall asleep & may wake up frequently
- Food may taste bland: may lose weight or increase in weight
- Sexual appetite may disappear
- Psychomotor retardation or agitation may develop
- Social withdrawal is common
- neglecting their appearance
- thoughts about suicide are common
What’s the proposed DSM-5 Criteria for Major Depressive Disorder?
- Sad mood or loss of pleasure in usual activities
- At least 5 symptoms (including the above)
- sleeping too much or too little
- Psychomotor retardation or agitation
- Weight loss or change in appetite
- loss of energy
- feelings of worthlessness or excessive guilt
- Difficulty concentrating, thinking, making decisions
- recurrent thoughts of death or suicide
Symptoms are present nearly every day, most of the day, for at least 2 weeks
Why is Major Depressive Disorder called an episodic disorder?
Because symptoms tend to be present for a period of time and then clear
- even though episodes tend to dissipate over time, an untreated episode can last 5 months or more
- for a small No. of people the depression becomes chronic
Major Depressive Disorder tends to recur. What often happens?
Once a given episode clears, a person is likely to experience another episode.
- This happens for about two-thirds of people
- With every new episode a person experiences, their risk for another episode increases by 16%
The DSM-5 will combine Chronic MDD with dysthymia, placing the emphasis on the chronicity of the symptoms. What is the proposed DSM-5 Criteria for Chronic Depressive Disorder (Dysthymia)?
Depressed mood for most of the day more than half of the time for 2 years (1 year for children/ adolescents)
At least 2 of the following:
*poor appetite or overeating
*sleeping too much or too little
*Poor self-esteem
*Low energy
*Trouble concentrating or making decisions
*Feelings of hopelessness
The symptoms do not clear for more than 2 months at a time
What are the prevalence rates for MDD and Dysthymia?
*MDD is one of the most prevalent psychiatric disorders
*16.2% meet criteria for MDD in their lifetime
*2.5% for dysthymia, which is rarer
*MDD is twice as common in women than men
**MDD is 3 x more common in people with low SES
*MDD is low in Taiwan (1.5%) and highest in Beirut (19%)
*Median onset is now late teens to early 20’s
NB: The resiliency of people who are able to migrate could be a protective factor
What issues are often comorbid with MDD?
- About 60% of people with MDD will also meet criteria for Anxiety disorder
- Depression is linked to Cardiovascular disease
Why is it inappropriate to consider Dysthymia a milder form of depression than MDD?
The chronicity of Dysthymia takes it’s toll
*People with dysthymia are more likely to require hospitalisation, to attempt suicide, and to be impaired in their functioning than people with MDD
What is the proposed DSM-5 Criteria for Premenstrual Dysphoric DIsorder?
Symptoms begin after ovulation & end shortly after menstruation begins. On average, the symptoms last 6 days
Emotional symptoms are generally present, and in PMDD, mood symptoms are dominant.
Substantial disruption to personal relationships is typical for women with PMDD.Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include:
*Feelings of sadness or despair, or even thoughts of suicide
*Feelings of tension or anxiety
*Panic attacks
*Mood swings or frequent crying
*Lasting irritability or anger that affects other people
*Lack of interest in daily activities and relationships
*Trouble thinking or focusing
*Tiredness or low energy
*Food cravings or binge eating
*Trouble sleeping
*Feeling out of control
Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
The symptoms occur during the week before menstruation, and go away once it starts. A diagnosis of PMDD requires the presence of at least five of these symptoms
What is the proposed DSM-5 Criteria for Disruptive Mood Dysregulation DIsorder (DMDD)?
DMDD symptoms go beyond describing temperamental children to those with a severe
impairment that requires clinical attention. Far beyond temper tantrums, DMDD is
characterized by severe and recurrent temper outbursts that are grossly out of
proportion in intensity or duration to the situation. These occur, on average, 3 or
more times each week for 1 year or more.
*Children with DMDD display a persistently irritable or angry mood, most of the day and nearly every day, that is observable by parents, teachers, or peers.
A diagnosis requires the above symptoms to be present in at least two settings (at
home, at school, or with peers) for 12 or more months, and symptoms must be severe
in at least one of these settings. During this period, the child must not have gone three
or more consecutive months without symptoms.
The onset of symptoms must be before age 10, and a DMDD diagnosis should not be made for the first time before age 6 or after age 18.
What are the main types of BiPolar disorder?
BiPolar Disorders include:
*BiPolar I Disorder
defined by mania
*BiPolar II Disorder
defined by hypomania & episodes of depression
*Cyclothymia
Define Mania & specify how it is differnt from Hypomania
Mania is a state of intense elation or irritability. *During a manic episode, people will act & think in ways that are highly unusual to their typical selves
- they may engage in disastrous behaviours: imprudent sexual activities, overspending, reckless drinking
- During mania people may become sociable to the point of intrusiveness
Whereas, hypomania, is less extreme - and involves a change in functioning that does not cause serious problems. The person with hypomania may feel more social, flirtatious, energised, & produced
What is the DSM-5 Diagnostic criteria for Manic & Hypomanic Episodes?
*Distinctly elevated or irritable mood for most of the day nearly every day.
*Abnormally increased activity and energy
*At least 3 of the following are noticeably changed from baseline (4 if mood is irritable):
-increase in goal directed activity or psychomotor agitation
-unusual talkativeness, rapid speech
-flight of ideas or subjective impression that thoughts are racing
-Decreased need for sleep
-increased self-esteem, belief one has special talents, powers, or abilities
-Distractibility; attention is easily diverted
Excessive involvement in activities that are likely to have undesirable consequences: spending, driving, sexual behaviour
for manic episode:
- symptoms last 1 week or require hospitalisation
- symptoms cause significant distress or functional impairment
for hypomanic:
- symptoms last at least 4 days
- clear changes in functioning are observable to others but impairment is not marked
- No psychotic symptoms are present
