Mood Disorders

Major Depressive Episode (building block) A. During the same 2-week period, five or more of the following symptoms including either 1 or 2 have been present (must be a change in functioning) Depressed mood most of the day, nearly everyday Diminished interest or pleasure in all, or almost all, activities Significant changes in appetite and/or weight Significant changes in sleep patterns Psychomotor retardation or agitation Fatigue or loss of energy Feelings of worthlessness or inappropriate guilt Diminished ability to concentrate or make decisions Recurrent thoughts or death or suicide

Major Depressive Episode (building block) B. The criteria do not meet criteria for a Mixed Episode C. The symptoms cause clinically significant distress or impairment in functioning D. Not due to a GMC or substance E. The symptoms are not better accounted for by Bereavement

Manic Episode (building block) Distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week During the mood disturbance, 3 or more of the following symptoms have persisted (4 or more if the mood is only irritable) Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual, or pressure to keep talking Racing thoughts (“flight of ideas”) Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities that have the potential for negative consequences

Manic Episode (building block) C. The symptoms do not meet criteria for a Mixed Episode D. The symptoms cause significant impairment in functioning or necessitate hospitalization to prevent harm to self or others E. Not due to a GMC or substance

Mixed Episode (building block) A. The criteria are met for both a Manic Episode and a Major Depressive Episode (except duration) nearly every day during at least a 1-week period B. The symptoms cause significant distress or impairment in functioning C. Not due to a GMC or substance

Hypomanic Episode (building block) Distinct period of persistently elevated, expansive, or irritable mood lasting at least 4 days During the mood disturbance, 3 (or more) of the following symptoms have been present (4 or more if mood is only irritable) Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual, or pressure to keep talking Racing thoughts (“flight of ideas”) Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities that have the potential for negative consequences

Hypomanic Episode (building block) C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic D. The mood disturbance and change in functioning are observable to others E. The episode is not severe enough to cause marked distress or impairment in functioning and does not require hospitalization F. Not due to a GMC or substance

Mood Episodes Mixed Episode Mania Hypomania Normal Mood Depression

Major Depressive Disorder One or more Major Depressive Episodes AND No history of mania or hypomania Specify: Single Episode Recurrent

Major Depressive Disorder Episode Major Depressive Episode Major Depressive Episode Major Depressive Episode MDD, single episode MDD, recurrent episodes

Major Depressive Disorder: Types Melancholic Catatonic Atypical Seasonal Pattern Post-partum onset

Facts about Major Depressive Disorder Prevalence: Gender: Culture:

Facts about Major Depressive Disorder Age of Onset: Course:

Likelihood of having another Major Depressive Episode if you’ve had… 3 episodes 90% 1 episode 50% 2 episodes 70% Major Depressive Episode Major Depressive Episode Major Depressive Episode Major Depressive Episode Major Depressive Episode Major Depressive Episode

Dysthymia A. Depressed mood most of the day, more days than not, for at least 2 years B. Presence, while depressed, of 2 (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, the person has never been without the symptoms for more than 2 months at a time

Dysthymia D. Not better accounted for by Major Depressive Disorder E. There has never been a Manic, Mixed, or Hypomanic episode F. Not better accounted for by another disorder G. Not due to a GMC or substance H. Symptoms cause clinically significant distress or impairment in functioning

Major Depression vs. Dysthymia Recurrent Major Depressive Episodes Dysthymia

Major Depression: Interepisode Recovery Recurrent, Full Interepisode Recovery Recurrent, Without Full Interepisode Recovery

Major Depression vs. Dysthymia Recurrent, Full Interepisode Recovery, with Dysthymia Recurrent, Without Full Interepisode Recovery, with Dysthymia

Facts about Dysthymia Prevalence: Gender: Age of Onset: Course:

Unipolar Depression – Possible Causes Stressful life events Learned Helplessness Depressogenic Schemas Neurotransmitters Genetic Factors

Unipolar Depression - Treatment Mild Depression Electroconvulsive Therapy Pharmacotherapy

Unipolar Depression - Treatment Cognitive Behavioral Therapy Identify and challenge depressogenic assumptions Identify more adaptive coping mechanisms Encourage client to actively engage in life and relationships Mindfulness At least as effective as antidepressants in reducing symptoms More effective than antidepressants in preventing relapse

Bipolar Disorder Two Main Distinctions Bipolar I Disorder: Technically, this should mean Mania/Mixed + Depression Actually, this means Mania/Mixed ± Depression Bipolar II Disorder: Hypomania + Depression (No mania ever)

Bipolar I Disorder OR OR Depressed and manic episodes One or more Major Depressive Episode Manic or Mixed Episode Manic or Mixed Episode OR

Bipolar II Disorder OR OR One or more hypomanic episode Depressed and hypomanic episodes OR Major Depressive Episode Hypomanic Episode Hypomanic Episode OR

Unipolar vs. Bipolar Disorder Elevated Mood Bipolar Depressed Mood Elevated Mood Unipolar Depressed Mood

Facts about Bipolar Disorders Prevalence: Gender:

Facts about Bipolar Disorders Age of Onset: Course: Culture:

Bipolar Disorders – Possible Causes Runs very strongly in families: 80-90% of variance! Relatives show both depression and bipolar disorder Family History of Depression Family History of Bipolar Disorder

Bipolar Disorders - Treatment Lithium Psychotherapy

Mood Disorders: Severity Mild Moderate Severe without Psychotic features Severe with Psychotic features

Mood Disorders – Cultural Factors Demographic Differences in the U.S. Unipolar Depressions Bipolar Disorders Symptom Differences China and Japan – somatic symptoms more common than psychological symptoms Aborigines – absence of guilt, attempted/completed suicide Tribe in New Guinea – only 1 case, mainly physical symptoms Prevalence Differences Taiwan: 1.5% United States and Lebanon: 17-19%

Suicide Risk Factors: Best predictor = Prior attempt Living alone, especially if divorced/separated Retired/unemployed Elderly Loss of a loved one Chronic illness Financial troubles Feelings of hopelessness Impulsivity Sexual identity difficulties

Suicide Suicide and Psychopathology Bipolar Disorder > Major Depression Melancholic Depression Substance abuse/dependence Insomnia Delusions

Suicide Who attempts? Who completes? Women: 3-4 times more likely to attempt suicide Men: 3-4 times more likely to complete suicide Ages 18-24: Peak age for attempting suicide Ages 65+: Peak age for completing suicide Method Intent

Suicide Common Warning Signs Symptoms of depression Talking about death, disappearing, “ending it all”, etc., even just in passing Writing letters, saying last goodbyes Getting rid of personal effects, making a will Arranging for the care of pets, plants, etc. Extravagant spending

Suicide Prevention Help the person regain ability to cope with immediate stressors Maintaining supportive contact with the person Help the person realize that their distress is impairing their judgment Help the person realize that the distress is not endless Broad based programs focused on high-risk groups Crisis hotlines Call 911/ER

Suicide…interesting question… Should suicide be prevented?