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Chapter 5 (Mood Disorders)

Terms in this set (66)

Mood disorders
- Involve disabling disturbances of emotion - from the extreme sadness and disengagement of depression to the extreme elation and irritability of mania
- DSM-5 recognizes two broad types: (1) those that involve only depressive symptoms; and (2) those that involve manic symptoms (bipolar disorders)
DSM-5 diagnosis: Major depressive disorder
- Key change: differential diagnosis of bereavement-related symptoms described in more detail
- Major feature: 5 or more depressive symptoms, including sad mood or loss of pleasure, for 2 weeks
DSM-5 diagnosis: Persistent depressive disorder
- Also called "dysthymia"
- Key change: chronic major depressive disorder and dysthymia are merged into this new diagnosis
- Major feature: low mood and at least 2 other symptoms of depression at least half of the time for 2 years
DSM-5 diagnosis: Premenstrual dysphoric disorder
- Key change: moved from DSM-IV Appendix to the main body
- Major feature: depressive or physical symptoms in the week before menses
DSM-5 diagnosis: Disruptive mood disorder
- Key change: new category for the DSM-5
- Major feature: Severe recurrent temper outbursts and persistent negative mood for at least 1 year beginning before age 10
DSM-5 diagnosis: Bipolar I disorder
- Key change: abnormally increased activity or energy included as a required symptom of mania
- Major feature: at least 1 lifetime manic episode
DSM-5 diagnosis: Bipolar II disorder
- Key change: abnormally increased activity or energy included as a required symptom of hypomania
- Major feature: at least 1 lifetime hypomanic episode and 1 major depressive episode
DSM-5 diagnosis: Cyclothymia
- Key change: criteria are more specific
- Major feature: recurrent mood changes from high to low for at least 2 years, without hypomanic or depressive episodes
Cardinal symptoms of depression
- Profound sadness
- Inability to experience pleasure
Symptoms of depressive disorder
- Their heads may reverberate with self-recrimination
- May become focused on their flaws and deficits
- Paying attention can be so exhausting that they have difficult absorbing what they read and hear
- They often view things in a very negative light
- They tend to lose hope
- Initiative may disappear
Physical symptoms of depression
- Fatigue
- Low energy
- Physical aches and pains
- Find it hard to fall asleep and wake up frequently & others sleep throughout the day
- May find that food tastes bland, that their appetite is gone, or that they have an increased appetite
- Sexual interest disappears
- Some say their limbs feel heavy
Cognitive symptoms of depression
- Psychomotor retardation
- Psychomotor agitation
Psychomotor retardation
- Thoughts and movements may slow for some
Psychomotor
- Cannot sit still - they pace, fidget, and wring their hands
Social symptoms of depression
- Withdrawal is common
- Many prefer to be alone and be silent
- Some neglect their appearance
DSM-5 criteria for major depressive disorder
- Sad mood or loss of pleasure in usual activities
- At least 5 symptoms (must include either sad/depressed mood or loss of interest or pleasure):
1. Sleeping too much or too little
2. Psychomotor redardation or psychomotor agitation
3. Weight loss or change in appetite
4. Loss of energy
5. Feelings of worthlessness or excessive guilt
6. Difficulty concentrating, thinking, or making decisions
7. Recurrent thoughts of death or suicide
- Symptoms are present nearly every day, for at least 2 weeks
- Symptoms are distinct and more severe than a normative response to significant loss
Major depressive disorder
- Episodic disorder
- Even though episodes tend to dissipate over time, an untreated episode may stretch on for 5 months or longer
- For a small percentage of people, the depression becomes chronic, the person does not completely snap back to the prior level of functioning
- Some people improve enough that they no longer meet the criteria for diagnosis for MDD, but continue to experience subclinical episodes for years
- Major depressive episodes tend to recur, once a given episode clears, a person is likely to experience another episode
- Average number of episodes through the lifetime is about 4
Episodic disorder
- Symptoms tend to be present for a period of time, and then clear
Subclinical depression
- Has three symptoms of the major depressive disorder for 10 days
- Twin studies found taht this type of depression predicts the occurrence of future episodes of MDD and even the diagnosis of MDD in a co-twin (when one twin has this type of depression, both twins were likely to have future episodes of major depression)
MDD prevalence
- One of the most common psychiatric disorders
- Twice as common among women than men
- Socioeconomic status matters: this condition is 3 times more common among people who are impoverished
- People who have moved to the US from Mexico have lower rates of this disorder and other psychiatric disorders than do people of Mexican descent that were born in the US
- Median onset is in the late teens to early 20s
Depression in children
- Often results in somatic complaints, such as headaches or stomachaches
Depression in older adults
- Often characterized by distractability and complaints of memory loss
Seasonal affective disorder
- Winter depression
- Person experiences depression during 2 consecutive winters and that the symptoms clear during the summer
- These rates are higher in people who live further from the equator
DSM-5 criteria for premenstrual dysphoric disorder
- A. In most menstrual cycles during the past year, at least 5 of the following symptoms from sections B and C were present in the final week before menses, improved within a few days of menses onset, and became minimal in the week after menses
- B. At least 1 of the following symptoms: 1. Affective lability; 2. Irritability; 3. Depressed mood, hopelessness, or self-deprecating thoughts; 4. Anxiety
- C. At least 1 of the following symptoms: 1. Diminished interest in usual activities; 2. Difficulty concentrating; 3. Lack of energy; 4. Changes in appetite, overeating, or food craving; 5. Sleeping too much or too little; 6. Subjective sense of being overwhelmed or out of control; 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating, or weight gain
- Symptoms lead to significant distress or functional impairment
- Symptoms are not an exacerbation of another mood or anxiety disorder or personality disorder
- Symptoms are confirmed with prospective daily ratings over two cycles
- Symptoms are present when oral contraceptives are not being taken
DSM-5 of persistent depressive disorder (dysthymia)
- Depressed mood for most of the day more than half of the time for 2 years (or 1 year for children, and adolescents)
- At least 2 of the following during that time:
1. Poor appetite or overeating
2. Sleeping too much or too little
3. Poor self-esteem
4. Low energy
5. Trouble concentrating or making decisions
6. Feelings of hopelessness
- The symptoms do not clear for more than 2 months at a time
Persistent depressive disorder
- These people are chronically depressed
- They feel blue or derive little pleasure from usual activities and pastimes
- The chronicity of symptoms has been shown to be a stronger predictor of poor outcome than the number of symptoms experienced
- The DSM-5 does not separate chronic MDD from PDD
DSM-5 criteria for disruptive mood dysregulation disorder
- Severe recurrent temper outbursts, including verbal or behavioral expressions of temper that are out of proportion in intensity or duration to the provocation
- Temper outbursts are inconsistent with developmental level
- The temper outbursts tend to occur at least 3 times per week
- Negative mood between temper outbursts is observable to others on most days
- These symptoms have been present for at least 12 months, and do not clear for more than 3 months at a time
- Temper outbursts and negative mood are present in at least 2 settings (at home, at schools, or with peers) and are severe in at least one setting
- Age 6 or older (or equivalent developmental level)
- Onset before age 10
- There has never been a distinct period lasting more than 1 day during which elevated mood and at least 2 other manic symptoms were present
- The behaviors do not occur exclusively during the course of major depressive disorder and are not better accounted for by another mental disorder
- The diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorders
Bipolar disorders
- Three forms: bipolar I disorder, bipolar II disorder, cyclothymic disorder
- Manic symptoms are the defining feature of all three
- They are differentiated by how severe and long-lasting the manic symptoms are
- Labeled "bipolar" because most people who experience mania will also experience depression during their lifetime
- An episode of depression is not required for a diagnosis for bipolar I, but it is required for a diagnosis of bipolar II
Mania
- A state of intense elation or irritability accompanied by other symptoms shown in the diagnostic area
- Is usually comes on suddenly over a period of a day or two
Manic episodes characteristics
- People will act and think in ways that are highly unusual compared to their typical selves
- They may become louder and make an incessant stream of remarks, sometimes full of puns, jokes, rhymes, and interjections about nearby stimuli that have attracted their attention
- They may be difficult to interrupt
- May shift rapidly from topic to topic, reflecting an underlying flight of ideas
- During this, people may become sociable to the point of intrusiveness
- They become excessively self-confident
- They can be oblivious to the potentially disastrous consequences of their behavior, which can include imprudent sexual activities, overspending, and reckless driving
- They may stop sleeping but stay incredibly energetic
- Attempts by others to curb such excesses can quickly bring anger and even rage
Hypomania
- "Under" "mania"
- Less extreme than mania
- Does not involve significant impairment
- Involves a change in functioning that does not cause serious problems
- The person may feel more social, flirtatious, energized, and productive
Bipolar I disorder
- Formerly known as manic-depressive disorder
- Includes a single episode of mania during the course of a person's life
- Someone diagnosed with this disorder may or may not be experiencing current symptoms of mania
- Even someone who experienced only 1 week of manic symptoms years ago is still diagnosed with this disorder
- These episodes tend to recur, even more than with MDD
- More than 50% of these people experience 4 or more episodes
- Among the most severe form of mental illnesses
- Much less common than MDD
DSM-5 criteria for manic episodes
- Bipolar I disorder
- Distinctly elevated or irritable mood
- Abnormally increased activity or energy
- At least three of the following are noticeably changed from baseline (four if mood is irritable): 1. Increase in goal-directed activity or psychomotor agitation; 2. Unusual talkativeness, rapid speech; 3. Flight of ideas or subjective impression that thoughts are racing; 4. Decreased need for sleep; 5. Increased self-esteem; belief that one has special talents, powers, or abilities; 6. Distractibility; attention easily averted; 7. Excessive involvement in activities that are likely to have painful consequences, such as reckless spending, sexual indiscretions, or unwise business investments; 8. Symptoms are present most of the day, nearly every day
- For for this type of episode:
0 Symptoms last for 1 week, require hospitalization, or include psychosis
0 Symptoms cause significant distress or functional impairment
Bipolar II disorder
- To be diagnosed, a person must have experienced at least one major depressive episode and at least one episode of hypomania
DSM-5 criteria for hypomanic episodes
- Bipolar II disorder
- Distinctly elevated or irritable mood
- Abnormally increased activity or energy
- At least three of the following are noticeably changed from baseline (four if mood is irritable): 1. Increase in goal-directed activity or psychomotor agitation; 2. Unusual talkativeness, rapid speech; 3. Flight of ideas or subjective impression that thoughts are racing; 4. Decreased need for sleep; 5. Increased self-esteem; belief that one has special talents, powers, or abilities; 6. Distractibility; attention easily averted; 7. Excessive involvement in activities that are likely to have painful consequences, such as reckless spending, sexual indiscretions, or unwise business investments; 8. Symptoms are present most of the day, nearly every day
- For this type of episode:
0 Symptoms last at least 4 days
0 Clear changes in functioning that are observable to others, but impairment is not marked
0 No psychotic symptoms are present
Cyclothymic disorder
- A chronic mood disorder
- DSM-5 requires that symptoms be present for at least 2 years among adults
- The person has frequent but mild symptoms of depression, alternating with mild symptoms of mania
- Although the episodes do not reach the severity of full-blown hypomania or depressive episodes, people with the disorder and those close to them typically notice ups and downs
Cyclothymic disorder "lows"
- A person may be sad
- Feel inadequate
- Withdraw from people
- Sleep for 10 hours a night
Cyclothymic disorder "highs"
- A person may be boisterous
- Overly self-confident
- Socially unihibited and gregarious
- Need little sleep
DSM-5 criteria for cyclothymic disorder
- For at least 2 years for adults (or 1 year in children or adolescents):
1. Numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episodes
2. Numerous periods with depressive symptoms that do not meet criteria for a major depressive episode
- The symptoms do not clear for more than 2 months at a time
- Criteria for a major depressive manic, or hypomanic episode have never been met
- Symptoms cause significant distress or functional impairment
Melancholic
- Used only for episodes of depression
Seasonal pattern subtype
- Episodes happen regularly at a particular time of the year
- Applicable to MDD
- Applicable to bipolar disorder
Rapid cycling subtype
- At least 4 mood episodes per year
- Not applicable to MDD
- Applicable to bipolar disorder
Mood-congruent psychotic features subtype
- Delusions or hallucinations with themes that are consistent with the mood state (e.g., guilt, disease, or death themes accompanying depression)
- Applicable to MDD
- Applicable to bipolar disorder
Mood-incongruent psychotic features subtype
- Delusions or hallucinations with themes that do not match the valence of the depressive or manic episode
- Applicable to MDD
- Applicable to bipolar disorder
Mixed features subtype
- At least 3 manic symptoms are present during a depressive episode, or at least 3 depressive symptoms are present during a manic episode
- Applicable to MDD
- Applicable to bipolar disorder
Catatonia subtype
- Extreme physical immobility or excessive peculiar physical movement
- Applicable to MDD
- Applicable to bipolar disorder
Melancholic feature subtype
- Lack of pleasure in any activity, inability to gain relief from positive events, and at least 3 other symptoms of depression, such as a distinct quality of mood, depressive symptoms that are worse in the morning, waking at least 2 hours too early, loss of appetite/weight, psychomotor retardation or agitation, or guilt
- Applicable to MDD
- Applicable to bipolar disorder, only for depressive episodes
Atypical features subtype
- Symptoms that are unusual for depressive or manic episodes are present
- Applicable to MDD
- Applicable to bipolar disorder
Peripartum onset subtype
- Onset during pregnancy or within 4 weeks postpartum
- Applicable to MDD
- Applicable to bipolar disorder
With anxious distress subtype
- At least 2 symptoms of anxiety are present
- Applicable to MDD
- Applicable to bipolar disorder
Suicide risk severity subtype
- Suicidal ideation, plans, or other risk indicators are present
- Applicable to MDD
- Applicable to bipolar disorder
Genetic contribution
- Neurobiological hypothesis
- Major depression: moderate
- Bipolar disorder: high
Serotonin and dopamine receptor dysfunction
- Neurobiological hypothesis
- Major depression: present
- Bipolar disorder: present
Cortisol dysregulation
- Neurobiological hypothesis
- Major depression: present
- Bipolar disorder: present
Changes in activation of emotion-relevant regions in the brain
- Neurobiological hypothesis
- Major depression: present
- Bipolar disorder: present
Increased activity in the striatum
- Neurobiological hypothesis
- Major depression: not present
- Bipolar disorder: present during mania
(not related to depression)
Changes in cell membranes and receptors
- Neurobiological hypothesis
- Major depression: not present
- Bipolar disorder: present
MDD genetic factors
- 37% heritability (37% of the variance in depression is explained by genes)
-
Bipolar genetic factors
- One of the most heritable of disorders
- Genetic models do not explain the timing of manic symptoms
3 neurotransmitters studied in mood disorders
- Norepinephrine
- Dopamine
- Serotonin
Effective antidepressants
- Promote an immediate increase in levels of serotonin, dopamine, and/or norepinephrine
- Take 7 to 14 days to relieve depression
Neurotransmitter effects
- Absolute levels of neurotransmitters (either too much or too little) do not explain the cause of mood disorders
Reward system in the brain
- Dopamine plays a major role in sensitivity of this area of the brain
- Believed to guide pleasure, motivation, and energy in the context of opportunities to obtain rewards
Dopamine & depression
- Functioning of this neurotransmitter might be lowered in depression
- Some research suggests that diminished function of this system could help explain deficits in pleasure, motivation, and energy in MDD
Dopamine & bipolar disorder
- Several drugs that increase this neurotransmitter levels have been found to trigger manic symptoms --> one possibility is because these receptors might be overly sensitive in people with bipolar disorder
Serotonin & depression
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