1. Mood Disorders

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Mood Episodes
Mixed Episode
Mania
Hypomania
Normal Mood
Depression

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

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

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

13. Facts about Major Depressive Disorder
Prevalence:
Gender:
Culture:

14. Facts about Major Depressive Disorder
Age of Onset:
Course:

15. 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

16. 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

17. 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

18. Major Depression vs. Dysthymia
Recurrent
Major
Depressive
Episodes
Dysthymia

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

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

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

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

23. Unipolar Depression - Treatment
Mild Depression
Electroconvulsive Therapy
Pharmacotherapy

24. 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

25. 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)

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

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

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

29. Facts about Bipolar Disorders
Prevalence:
Gender:

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

31. 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

32. Bipolar Disorders - Treatment
Lithium
Psychotherapy

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

34. 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%

35. 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

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

37. 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

38. 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

39. 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

40. Suicide…interesting question…
Should suicide be prevented?