Abnormal Psychology Dr. David M. McCord Mood Disorders

DSM-IV Classification Categories Disorders Usually First Evident in Infancy, Childhood, or Adolescence Delirium, Dementia, and Amnestic and Other Cognitive Disorders Substance-Related Disorders Schizophrenia and Other Psychotic Disorders Mood Disorders Anxiety Disorders Somatoform Disorders Dissociative Disorders Sexual and Gender Identity Disorders Sleep Disorders Eating Disorders Factitious Disorders Adjustment Disorders Impulse Control Disorders Personality Disorders

Mood Disorders Major Depressive Disorder (1 or more Major Depressive Episodes) Dysthymic Disorder (2 years of depressed mood, no MDE) Bipolar I Disorder (1 or more Manic or Mixed Episodes) Bipolar II Disorder (1 or more MDE’s with Hypomanic Episode) Cyclothymic Disorder (2 years of numerous periods of hypomanic symptoms)

Four types of Mood Episodes: Major Depressive Episode Manic Episode Mixed Episode Hypomanic Episode

Major Depressive Episode (at least 5 of these, including at least 1 of the 1st 2) Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observation made by others. 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 weigh gain (more than 5% body weight in 1 month) 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 (which may be delusional) nearly every day (not merely self-reproach about being sick). Diminished ability to think or concentrate, or indecisiveness, nearly every day. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan.

Manic Episode A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or less if hospitalization is necessary). During the period of mood disturbance, 3 or more of the following have persisted to a significant degree: –Inflated self-esteem or grandiosity –Decreased need for sleep –More talkative than usual or pressure to keep talking –Flight of ideas, or subjective experience that thoughts are racing –Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli) –Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation –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 investments)

Mixed Episode The criteria are met for both a Manic Episode and a Major Depressive Episode (except for duration) nearly every day for at least a 1-week period The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features The symptoms are not due to the direct physiological effects of a substance (drug of abuse, medication, other treatment) or a general medical condition

Hypomanic Episode A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood. During the period of mood disturbance, at least 3 of the following have been present to a significant degree: –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 pleasurable activities that have a high potential for painful consequences The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic The disturbance in mood and the change in functioning are observable by others The episode is NOT severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features

Mood Disorders Major Depressive Disorder (1 or more Major Depressive Episodes) Dysthymic Disorder (2 years of depressed mood, no MDE) Bipolar I Disorder (1 or more Manic or Mixed Episodes) Bipolar II Disorder (1 or more MDE’s with Hypomanic Episode) Cyclothymic Disorder (2 years of numerous periods of hypomanic symptoms)

Major Depressive Disorder Presence of single Major Depressive Episode There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode MDE not better accounted for by schizophrenia or related psychotic disorder Specifiers Single Episode or Recurrent Severity: –Mild –Moderate –Severe without Psychotic Features –Severe with Psychotic Features –In Partial Remission –In Full Remission Chronic With Catatonic Features With Melancholic Features With Atypical Features With Postpartum Onset With or Without Interepisode Recovery With Seasonal Pattern

Examples: –Major Depressive Disorder, Recurrent, Moderate, With Atypical Features, With Seasonal Pattern, With Full Interepisode Recovery

Dysthymic Disorder Depressed mood for most of day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Presence while depressed of at least two: –Poor appetite or overeating –Insomnia or hypersomnia –Low energy or fatigue –Low self-esteem –Poor concentration or difficulty making decisions –Feelings of hopelessness Symptoms have not disappeared for more than 2 months No MDE, no Manic Episode, no Mixed Episode, no Hypomanic Episode, no Cyclothymic Disorder Specifiers: Early Onset versus Late Onset With Atypical Features

Bipolar I Disorder (Single Manic Episode) (Most Recent Episode Hypomanic) (Most Recent Episode Manic) (Most Recent Episode Mixed) (Most Recent Episode Depressed) –Currently or most recently in _________ Episode –There has been at least one ________ Episode Specifiers: Severity/Psychotic/Remission Specifiers Chronic With Catatonic Features With Melancholic Features With Postpartum Onset With or Without Interepisode Recovery With Seasonal Pattern With Rapid Cycling

Bipolar II Disorder Presence of or history of one or more MDE’s Presence of at least one Hypomanic Episode Never has been a Manic Episode or a Mixed Episode Specifiers: Hypomanic Depressed (and most other specifiers)

Cyclothymic Disorder For at least 2 years, numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for MDE. No MDE, Manic Episode, or Mixed Episode present during the 2 year period Other Mood Disorders: Mood Disorder Due to a General Medical Condition Substance-Induced Mood Disorder

Things to Study: Comer’s categorization of mood symptoms: emotional, cognitive, motivational, behavioral Definitions of specifiers Neurotransmitters involved –How tricyclics work –How 2 nd -generation drugs work Freudian perspectives on depression Behavioral perspectives on depression Cognitive perspectives on depression Cognitive Therapy Learned helplessness theory Relative effectiveness of different therapies Artifact, quality-of-life, and self-blame theories