1. Mood Disorders Depressive Disorders Depressive Disorders –Major Depressive Disorder –Dysthymic Disorder

2. Major Depressive Disorder A. At least one of the following three abnormal moods which significantly interfered with the person's life (for at least 2 weeks, nearly every day) : 1.Abnormal depressed mood or dysphoric mood most of the day. depressed mooddepressed mood 2.Abnormal loss of all interest and pleasure most of the day. loss of all interest and pleasureloss of all interest and pleasure 3.If 18 or younger, abnormal irritable mood most of the day. irritable moodirritable mood

3. Major Depressive Disorder B. At least five of the following symptoms have been present during the same 2 week depressed period. 1.Abnormal depressed mood (or irritable mood if a child or adolescent). depressed moodirritable mooddepressed moodirritable mood 2.Abnormal loss of all interest and pleasure [as defined in criterion A2]. loss of all interest and pleasureloss of all interest and pleasure 3.Appetite or weight disturbance, either: Appetite or weight disturbanceAppetite or weight disturbance 1.Abnormal weight loss (when not dieting) or decrease in appetite. 2.Abnormal weight gain or increase in appetite. 4.Sleep disturbance, either abnormal insomnia or abnormal hypersomnia. Sleep disturbanceSleep disturbance

4. Major Depressive Disorder B. (cont’d) 5.Activity disturbance, either abnormal agitation or abnormal slowing (observable by others). 6.Abnormal fatigue or loss of energy. fatigue 7.Abnormal self-reproach or inappropriate guilt. self-reproach 8.Abnormal poor concentration or indecisiveness. poor concentrationpoor concentration 9.Abnormal morbid thoughts of death (not just fear of dying) or suicide morbid thoughts of deathmorbid thoughts of death

5. Major Depressive Disorder C. The symptoms are not due to a mood- incongruent psychosis. mood- incongruent psychosismood- incongruent psychosis D. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Manic EpisodeManic Episode E. The symptoms are not due to physical illness, alcohol, medication, or street drugs. physical illness, alcohol, medication, or street drugsphysical illness, alcohol, medication, or street drugs F. The symptoms are not due to normal bereavement. normal bereavementnormal bereavement

6. Assessment Self-report instruments screening Self-report instruments screening »Beck Depression Inventory »MMPI -2 Clinical Interview Clinical Interview Suicide Risk Suicide Risk

7. Incidence Males and females are equally affected by Major Depressive Disorder prior to puberty Males and females are equally affected by Major Depressive Disorder prior to puberty After puberty, this disorder is twice as common in females as in males After puberty, this disorder is twice as common in females as in males Greatest incidence ages 25-44 Greatest incidence ages 25-44 Up to 15% of patients with severe Major Depressive Disorder die by suicide Up to 15% of patients with severe Major Depressive Disorder die by suicide

8. Treatment Plans Psychotherapies Psychotherapies Biological therapies Biological therapies Family therapies Family therapies Suicide intervention Suicide intervention

9. Treatment Plans: Psychotherapies Cognitive Cognitive Rational Emotive Behaviour Therapy Rational Emotive Behaviour Therapy Behaviour Therapy Behaviour Therapy Interpersonal Psychotherapy Interpersonal Psychotherapy Family Therapies Family Therapies

10. Treatment Plans: Suicide Intervention plans Active vs passive ideation Active vs passive ideation No-suicide contracts No-suicide contracts Modify maladaptive cognitions Modify maladaptive cognitions

11. Treatment Plans: Biological Therapies Psychotropic medications: Psychotropic medications: –SSRI’s (selective serotonin reuptake inhibitors) Prozac, Zoloft Prozac, Zoloft –Tricyclic Antidepressants –MAOI’s: (monomine oxidase inhibitors) Electro-Convulsive Therapy Electro-Convulsive Therapy

12. Bipolar Disorders A. Abnormally expansive, elevated or irritable mood B. At least three additional symptoms ( 4 if irritable) during 1 week period: Inflated self-esteem Inflated self-esteem Decreased need for sleep Decreased need for sleep Talkativeness (loud, nonstop, rapid) Talkativeness (loud, nonstop, rapid) Racing ideas Racing ideas High distractibility High distractibility Increased goal-directed activity or physical agitation Increased goal-directed activity or physical agitation Excessive involvement in sexual or other risk-related pleasurable activities Excessive involvement in sexual or other risk-related pleasurable activities Manic Phase

13. Bipolar Disorders A. Parallel manic episodes B. At least three additional symptoms ( 4 if irritable) during a four day period: Inflated self-esteem Inflated self-esteem Decreased need for sleep Decreased need for sleep Talkativeness (loud, nonstop, rapid) Talkativeness (loud, nonstop, rapid) Racing ideas Racing ideas High distractibility High distractibility Increased goal-directed activity or physical agitation Increased goal-directed activity or physical agitation Excessive involvement in sexual or other risk-related pleasurable activities Excessive involvement in sexual or other risk-related pleasurable activities Hypomanic Episodes

14. Bipolar Disorders A. Both manic and depressive episodes nearly every day for at least a one-week period. B. Rapid cycling bipolar Bipolar I – a past or present manic episode despite past history of depressive episodes Bipolar I – a past or present manic episode despite past history of depressive episodes Bipolar II – in absence of past manic episode or mixed episodes, a person experiencing hypomania and a past major depressive episode Bipolar II – in absence of past manic episode or mixed episodes, a person experiencing hypomania and a past major depressive episode Mixed Episodes

15. Cyclothymia A. Sustained period of vacillation between spirited & dispirited moods »Hypomania but not all the way to manic episodes »And numerous periods of sub-clinical depression