Chapter 6 Psy 303 Abnormal Psych PART MOOD DISORDERS

Mood disorders Disturbances in emotion that cause discomfort or hinder functioning Rank among the top 10 causes of worldwide disability a leading cause of absenteeism and diminished productivity in workplace prevalence for all mood disorders is 15 percent for males, 24 percent for females

Mood disorders: General Stats Likelihood of recurrence is 50 percent after one episode 70 percent after two 90 percent after three Women twice as likely as men to become depressed except for Bipolar 1

Major Depressive Episode 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 note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. (1) depressed mood most of the day. Note: In children and adolescents, can be irritable mood. (2) markedly diminished interest or pleasure in all, or almost all, activities (3) significant weight loss when not dieting or weight gain, decrease or increase in appetite nearly every day. (4) insomnia or hypersomnia nearly every day (5) psychomotor agitation or retardation nearly every day (6) fatigue or loss of energy nearly every day (7) feelings of worthlessness or excessive or inappropriate guilt (8) diminished ability to think or concentrate, or indecisiveness (9) recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide B. The symptoms do not meet criteria for a Mixed Episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Major Depressive Episode cont’d B. The symptoms do not meet criteria for a Mixed Episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. Mixed episode changed to specifier: ‘mixed episode specifier’

Manic Episode:*** For a week, or less of manic symptoms (less only if symptoms are severe manic symptoms enough for hospitalization) Affective symptoms: ELEVATED OR IRRITABLE MOOD (expansive mood, boundless energy, and enthusiasm) Cognitive symptoms: Speech, attention, judgment Behavioral symptoms: Mania: more disruptive grandiosity, incoherent speech; hallucinations and delusions possible Physiological symptoms: High arousal and decreased need for sleep, weight loss Elevated mood, Expansiveness, Irritability, Hyperactivity DMS5 ADDITION – EMPHASIS ON CHANGES IN ACTIVITY AND ENERGY

DSM IV Criteria for Manic Episode A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree. 1. inflated self-esteem or grandiosity 2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3. more talkative than usual or pressure to keep talking 4. flight of ideas or subjective experience that thoughts are racing 5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investment

Manic Episode NOTE: The person may become involved in more activities than usual – starting new projects etc also shopping sprees, money on luxury items, reckless sexual behavior or driving etc….

Hypomanic Episodes – a minimum duration of four days Less severe mania that does not cause impairment in social or occupational functioning Overactive in behavior but no delusions like mania IF THE DURATION CRITERIA IS NOT MET or too FEW SYMPTOMS– Other specified bipolar and related disorders

Classification of Mood Disorders: Depressive Disorders Major depressive disorder (Single episode or recurrent) Dysthymic disorder *** Depressive disorder not otherwise specified *** DSM-5: Chronic major depressive disorder and dysthymia falls now under PERSISTENT DEPRESSIVE DISORDER

Dsm-5 additions Chronic major depressive disorder and dysthymia falls now under PERSISTENT DEPRESSIVE DISORDER Premenstrual Dysphoric Disorder Disruptive Mood Regulation Disorder For children up to 18 years of age Persistent irritability and frequent episodes of exterme behavioral dyscontrol

Classification of Mood Disorders: Bipolar Disorder Mood shifts between two emotional “poles” Cyclothymic disorder (fluctuations between hypomanic and depressive symptoms)

Bipolar Disorder Bipolar I (full blown mania alternates with episodes of major depression) Bipolar II (hypomania mood elevation that is abnormal yet not severe enough to impair functioning or require hospitalization, at least one episode of hypomania and one episode of major depression Bipolar II is more common than Bipolar I; however, because of the high levels of productivity and creativity associated with the hypomania, one may view the episodes in a more positive light.

Cyclothymic Disorder A condition characterized by fluctuations that alternate between hypomania and depression Episodes not as severe as with mania or major depression Persist for at least two years Puberty, premenstrual period, pregnancy, post partum period, and menopause are all considered risk factors for mood disorders. Fact or fiction? Yes, rates of depression do vary by age, but these reproductive events are all indentified as risk factors.

Classification of Mood Disorders: Other Due to general medical condition Substance induced

Course of Mood Disorders Longitudinal course specifier Past history of mood disturbance History of recovery from depression and/or mania Rapid cycling specifier -- Applies to Bipolar 1 and 2 Four or more mood disturbances within a year Extreme cycling: multiple shifts within a single day Seasonal pattern specifiers: Seasonal affective disorder Fluctuations in melatonin (hormone secreted by the pineal gland) Circadian rhythms

Comparison between depressive and bipolar disorders Bipolar more genetically based Bipolar much less common Bipolar disorders equally affect males and females. Onset of both bipolar and unipolar early twenties (bipolar a little earlier), but onset is acute in bipolar disorders Bipolar displays psychomotor retardation and more suicide attempts Completed suicides: four times higher than for MDD, recurrent (Brown et al., 2006) Bipolar responds to Lithium

Approximately 80% of new mothers will develop the “baby blues.” Sex, Race, and Ethnicity Women are twice as likely to suffer from major depression (10%) than men (5%) Common in lower SES Impact of unemployment and lack of education and financial resources Impact of reproductive events Postpartum Depression (PPD) Higher rates of depression in Whites at 17.9% Approximately 80% of new mothers will develop the “baby blues.”

Prevalence of Mood Disorders Children and adolescents Symptom presentations different from adults’ Gender ratio different from adults’ Consequences rather dramatic In the Elderly (65 and higher) Medical illnesses or dementia complicate the diagnosis Sex ratio balanced

Prevalence of Mood Disorders Overlap between anxiety and depression Most depressed are also anxious. Not all anxious individuals are depressed. Mixed anxiety and depression symptoms

Mixed Anxiety and Depressive Symptoms Anticipating the worst, worry, poor concentration, irritability, hypervigilance, unsatisfying sleep or insomnia, crying, guilt, fatigues, poor memory, worthlessness, hopelessness