Detecting the Mood Disorder Today we’re going to apply what we know about various mood disorders, as well as how we differentiate between mental disorders....thinking about what criteria are necessary to meet the threshold of a mood disorder, and what additional information might impact your decision to make a mood disorder diagnosis. Learning objective: Critically evaluate a clinical case study to differentiate between mood disorders Present case study What info is relevant? What info is missing that could be relevant? Eliminate mood disorders that don’t fit Consensus – does this adequately address everything we know? Do you feel like you need any more information? Additional info scenario – does this change your opinion? https://www.div12.org/case_study/gary-bipolar-disorder/

Major Depressive Disorder Example of graph using Major Depressive Disorder

Blank example to leave up for class while working in small groups

Case Study 1 Gary is a 19-year-old who withdrew from local college recently after an incident involving Campus Police (“I took the responsibility to pull multiple fire alarms in my dorm to ensure that they worked, given the life or death nature of fires”). He changed his major from engineering to philosophy and increasingly reduced his sleep, spending long hours engaging his friends in conversations about the nature of reality. He had been convinced about the importance of his ideas, stating frequently that he was more learned and advanced than all his professors. He told others that he was on the verge of revolutionizing his new field, and he grew increasingly irritable and intolerant of any who disagreed with him. He also started drinking and engaging in sexual behaviors in a way that was unlike his previous history.  At the present time, he has returned home and is living with his parents. Been placed on a mood stabilizer (after a period of time on an antipsychotic), and his psychiatrist is requesting adjunctive psychotherapy for his bipolar disorder.  Patient’s parents are somewhat shocked by the diagnosis, but they acknowledge that Gary had early problems with anxiety during pre-adolescence, followed by some periods of withdrawal and depression before moving to college Remember depressive symptoms lasting for weeks at a time Do his friends think his recent behavior is outside of his normal behavior? In what areas of life might a person be experiencing impairment or distress? (e.g., academic, occupational, social or interpersonal) Scenario: International student from Philippines – no family in U.S., friends at school but not outside of school, grandfather in Philippines died recently, couldn’t go home because of school work Any scenario that might change your interpretation of events?

Case Study 2 Sara is 45-year-old woman presents with a one-month history of poor sleep and irritable mood. She mentions several stressful events going on in her life right now. She is currently dealing with a recent divorce and ongoing custody battle with her former husband over their 2 teenage children. She has also just had a bad performance review at work due to her inability to meet deadlines and is fearful of losing her job. She explains that her work problems have arisen because she has been unable to keep her concentration focused on work. She expresses feelings of worthlessness and wonders sometimes what is the point of living. She has to force herself to stay engaged in her children's activities and other interests that she used to enjoy; she feels she is "just going through the motions". Her exam is notable for poor eye contact and frequent tears. Prior history: She had a similar episode after the birth of her second child, but pulled out of it after several months. No current plans to kill herself Has been feeling down for less than a year (no dysthymia) Family history: There is a family history of suicide; her mother killed herself when the patient was 10 years old. Medical screening came back normal Vignette generated from https://online.epocrates.com/diseases/5522/Depression-in-adults/Common-Vignette

Three types of Bipolar Disorders Bipolar I Disorder: At least 1 or more Manic Episodes (may include one or more Depressive Episodes) Bipolar II Disorder: At least 1 Hypomanic Episode and at least 1 Depressive Episode Cyclothymic Disorder: Chronic cycling between mild hypomanic and depressive symptoms for at least a year that do not meet criteria for a Hypomanic or Depressive Episode

Diagnostic Criteria: Manic Episode 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 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 Increase in goal-directed activity or psychomotor agitation Excessive involvement in activities that have a high potential for painful consequences The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. The episode is not attributable to the physiological effects of a substance or to another medical condition.

Diagnostic Criteria: Hypomanic Episode 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 4 consecutive days and present most of the day, nearly every day 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 Increase in goal-directed activity or psychomotor agitation Excessive involvement in activities that have a high potential for painful consequences The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. The episode is not attributable to the physiological effects of a substance or to another medical condition.

Diagnostic Criteria: Major Depressive Disorder (MDD) DSM-V 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 either (1) depressed mood or (2) loss of interest or pleasure.   Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others Anhedonia: Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day. Insomnia or hypersomnia nearly every day. Psychomotor agitation or retardation nearly every day Fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive or inappropriate guilt nearly every day Diminished ability to think or concentrate, or indecisiveness, nearly every day Recurrent thoughts of death, and/or recurrent suicidal ideation

Diagnostic Criteria: Major Depressive Disorder (MDD) DSM-V The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The episode is not attributable to the physiological effects of a substance or to another medical condition. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. There has never been a manic episode or a hypomanic episode.