Mood Disorders Chapter 6

Major Depressive Episode Most of the day nearly every day for at least 2 weeks One of- Depressed mood or anhedonia Other symptoms- Weight loss/weight gain (significant change in weight) or significant increase/decrease in appetite (change in appetite) Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feeling worthless or excessive guilt Problems concentrating or making decisions SI Distress/impairment Not due to substance other condition

Depressive Episode Cognitive symptoms Disturbed physical functioning Everything effort Loss of interest Inability to experience pleasure Low positive affect, not just high negative affect 4-9 months untreated

Mania A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week Significant degree of at least 2- inflated self-esteem, decreased need for sleep, excessive talkativeness, racing thoughts, distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in high-risk behaviors Impairment or requires hospitalization or psychotic features Not substance or other condition

Major Depressive Disorder One MDE and absence of manic or hypomanic episode before or during 2 or more with separation of at least 2 months- recurrent Cycling in and out of episodes

Persistent depressive disorder Differs in course May have fewer symptoms Unchanged over long periods Depressed mood that continues at least 2 years where patient is not symptom free for more than 2 months at a time (Dysthymia and chronic major depression)

Double Depression Both MDE and persistent depression with fewer symptoms Bad sign for treatment and course

Early onset Not a good sign Genetic, long course, poor response to treatment, lots of comorbidity

Beck’s Cognitive Triad Negative cognitions about Self World Future Father of cognitive therapy Cognitive errors

Worry Chain of thoughts and images Negatively affect-laden Uncontrollable Mental problem solving on an issue that is uncertain- Possibility of more than one negative outcome

Worry Living in the future Feels like problem solving but actually can’t do anything Almost superstitious- if don’t worry, something bad might happen, like the worrying keeps the probability that it will happen down Waste of time- likelihood what we worry about actually happens Once its past, didn’t happen, spent all that time worrying Avoiding something- what is feared to happen, what if it does happen, worst thing in the world?

Rumination Behaviors and thoughts that passively focus one’s attention on one’s depressive symptoms and the implications of these symptoms Distraction may be good here- just dwelling on negative feelings and symptoms doesn’t do any good here Blocks coping? Part of a cycle? Rumination then worry etc

Disruptive Mood Dysregulation Disorder Severe temper outbursts occurring 3 or more times per week for at least a year Out of proportion in intensity or duration to the situation Inconsistent with developmental level Mood between temper outbursts is persistently irritable or angry most of the day, nearly every day and observed in at least 2 of 3 settings, severe in one of these settings DX btwn 6-18 NO mania or hypomania Not result of anything else

Bipolar I versus II Bipolar II- hypomanic states instead of mania Bipolar I- full manic episode Hypomania- Does not cause marked impairment in functioning 4 days instead of full week

Cyclothymic Disorder 2 years- numerous periods with hypomanic symptoms, numerous periods with depressive symptoms that do not meet criteria for MDE Person not without symptoms for more than 2 months at a time No MDE, manic, or hypomanic episode present during first 2 years Not from another issue Impairment in functioning Like pervasive depressive disorder “moody”

Depressive attributional style Internal- negative life events are due to personal failure Stable- even after negative event passes, additional bad things will always be my fault Global- extend across a variety of issues Stressful early life events- more likely to develop negative attribution style, lead to later depression Also associated with anxiety

Medication Depression- SSRIs- block reuptake of serotonin MAOi’s- inhibit MAO which is an enzyme (don’t break down norep and serotonin, more in the synapse): effective for more atypical depression Tricyclics Block reuptake Worse side effects Relieve symptoms in 50% but eliminate in only about 25 to 30% Bipolar- lithium (50% respond), also anticonvulsants, calcium channel blockers 70% relapse on lithium in 5 years

ECT Treats really resistant depression Safer and reasonable effective 50% of those not responding to meds will benefit 60% or higher relapse rates Memory loss and confusion Transcranial magnetic stimulation Less side effects