Explore lecture notes on mood disorders. Gain insights into the complexities of depression, bipolar disorder, and related conditions. Examine diagnostic criteria, symptoms, and contributing factors. Discover evidence-based treatments for managing mood disorders.
8.1 General Characteristics of Mood Disorders
- Mood disorders: disorders in which there are disabling disturbances in emotion.
Involve disabling disturbances in emotion, from sadness of depression to elation and
irritability of mania.
- Mood disorders are often associated with other psychological problems, such as panic attacks,
substance abuse, sexual dysfunction, and personality disorders.
The presence of other disorders can increase severity and result in poorer prognosis
Depression: Signs and Symptoms
- Depression: an emotional state marked by great sadness and feelings of worthlessness and guilt.
A disorder marked by great sadness and apprehension, feelings of worthlessness and
guilt, withdrawal from others, loss of sleep, appetite, sexual desire, loss of interest and
pleasure in usual activities, and either lethargy or agitation.
Called “major depression” in the DSM-IV and “unipolar depression” by others.
Can be an associated symptom of other disorders.
- Additional symptoms may include:
Withdrawal from others
Loss of interest and pleasure in usual activities
Loss of sexual desire.
Paying attention is exhausting for them
Sleep and appetite may be affected some people with depression sleep more than
usual, others less.
Appetite may increase or decrease intense weight gain or weight loss.
- Most people experience occasional sadness, but perhaps not to a degree or with a frequency that
creates a diagnosis for depression.
- Symptoms and signs of depression vary somewhat across the lifespan.
Depression in children often results in somatic complaints headaches, stomach-aches.
Older adults can be characterized by distractibility and complaints of memory loss.
- Symptoms of depression exhibit some cross-cultural variation results from differences in
cultural standards of acceptable behaviour.
E.g., depression is less prevalent in China than in North America cultural standards
make it less appropriate for Chinese people to display emotional symptoms
Commonly believed that people from non-Western cultures emphasize somatic
symptoms vs. people from Western cultures emphasize emotional symptoms,
Only 15% of depressed primary care patients in Canada are what psychologizers (people
who emphasize the psychological aspects of depression).
- Most depression (recurrent) tends to dissipate with time untreated episodes may continue for
months and become chronic
Mania: Signs and Symptoms
- Mania: an emotional state or mood of intense but unfounded elation accompanied by irritability,
hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans.
Some who experience episodic periods of depression may at times become manic.
, There are some clinical reports of individuals who experience mania and not depression,
(condition is quite rare)
- People in manic episodes are recognized by their loud and incessant stream of remarks,
sometimes full of puns, jokes, rhyming, and interjections about objects and happenings that have
attracted the speaker's attention.
May last from several days to several months
Speech is difficult to interrupt shows manic person's flight of ideas.
Small bits of talk are coherent but individual shifts rapidly from topic to topic.
Need for activity may cause them to be annoyingly sociable & intrusive, constantly, and
purposelessly busy, and oblivious to the pitfalls of their endeavours.
Mania usually comes on suddenly over a period of a day or two.
Formal Diagnostic Listings of Mood Disorders
- Two major mood disorders are listed in DSM-5: major depressive disorder (unipolar depression)
and bipolar disorder.
Other depressive disorders added to the DSM-5 include disruptive mood dysregulation
disorder and premenstrual dysphoric disorder.
- Another change in DSM-5 is that the manual now has separate chapters for depressive disorders
and bipolar and related disorders.
Mentioned in the DSM-5 that pages on bipolar and related disorders are located between
the chapter on schizophrenia spectrum disorders and depressive disorders chapter
Highlights bipolar disorder “as a bridge between the two diagnostic classes in terms of
symptomatology, family history, and genetics”
Diagnosis of Depression
- Major depressive disorder (MDD): an extreme form of depression that satisfies the number of
symptoms required for the category of depression to apply.
- The formal DSM-5 diagnosis of a major depressive disorder (MDD) requires the presence of five
of the following symptoms for at least two weeks. Either depressed mood or loss of interest and
pleasure must be one of the five symptoms:
Sad, depressed mood, most of the day, nearly every day
Loss of interest and pleasure in all, or almost all, activities
Difficulties sleeping (insomnia) not falling asleep initially, not returning to sleep after
awakening in the night, early morning awakenings; or, in some individuals, a desire to
sleep a great deal of the time
Shift in activity level, becoming either lethargic (psychomotor retardation) or agitated.
o Known as psychomotor agitation or retardation
Poor appetite and weight loss, or increased appetite and weight gain
Loss of energy, great fatigue nearly every day
Negative self-concept, self-reproach and self-blame, feelings of worthlessness, and guilt
Complaints or evidence of difficulty concentrating, e.g., slowed thinking, indecisiveness
Recurrent thoughts of death or suicide
- While the presence or absence of MDD still involves a categorical decision, DSM-5 incorporates
dimensional ratings of severity, frequency, and duration of symptoms
MDD is about 2x more common in women than in men
, Research on rumination & depression by Treynor focused on the brooding component as
the key point that accounts for the link between female gender and depression.
o Brooding: a moody contemplation of depressive symptoms
o “What am I doing to deserve this?”
o More common in females than males
There is a notion that females are more likely than males to engage in ruminative coping
(tendency to focus cognitively on the causes of depression and their associated feelings
rather than engaging in distraction) while males are more likely to engage in distractions
- DSM-5 also includes a diagnostic category of persistent depressive disorder (combining chronic
depression and the condition formerly known as dysthymia)
Persistent depressive disorder: a chronic form of depression lasting at least two years.
Predictors of a chronic depressive disorder included comorbid diagnoses, a younger age
of onset, and a history of more frequent episodes of depression.
- MDD is currently the second-leading cause of disability worldwide and is expected to rank first
in disease burden in high-income countries by the year 2030.
Diagnosis of Bipolar Disorder
- Bipolar I disorder: a disorder in which people experience episodes of both mania and depression
or mania alone.
- Bipolar II disorder: a disorder in which people experience episodes of major depression followed
by a type of manic phase that is less severe than in bipolar I disorder
Bipolar I involves periods of severe mood episodes from mania to depression.
Bipolar II milder form of mood elevation, involving milder episodes of hypomania
that alternate with periods of severe depression
- DSM-5 defines bipolar I disorder as involving episodes of mania or mixed episodes that include
symptoms of both mania and depression.
Most people with bipolar I disorder also experience episodes of depression.
A formal diagnosis of a manic episode requires:
o The presence of elevated or irritable mood
o Abnormally and persistently increased goal-directed activity or energy
o + 3 additional symptoms (four if the mood is irritable). T
The inclusion of increased activity criterion is new to DSM-5 some clinicians do not
regard euphoria as a core symptom and report irritable mood and depressive features are
more common
- Symptoms of BD must be sufficiently severe to impair social and occupational functioning:
Increase in goal-directed activity
More talkative than usual or pressure to keep talking
Flight of ideas or subjective impression that thoughts are racing
Less than the usual amount of sleep needed
Inflated self-esteem: belief one has special talents, powers, and abilities
Distractibility (attention easily diverted)
Excessive involvement in pleasurable activities likely to have undesirable consequences
(spending)
- Bipolar disorder occurs less often than MDD lifetime prevalence rate for both bipolar I and II
is about 4.4% of the population (NCS-R)
- Average age of onset is in the 20s
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