Transcript Atypical Melancholic Mixed Feature Specifiers in Mood Disorders

 Gross Deviations in Mood
 Depression: “The Low”
– The “Common Cold” of Mental Illness
– Major Depressive Episode is Most
Common
 Mania: “The High”
– Abnormally Exaggerated Elation, Joy,
or Euphoria
Mania
Depression
Unipolar Mood Disorder
– Either Depression or Mania
Bipolar Mood Disorder
– Alternates Between Depression and
Mania
Important to Determine the Course
– Temporal Patterning of the Episodes
Depressive Disorders
– Major Depression
– PDD, formerly Dysthymic Disorder
– “Double Depression” - - dysthymia
punctuated by period of major
depression
 Bipolar I and Bipolar II Disorders
– Cyclothymic Disorder
 Clinical Description
Extremely Depressed Mood
– Lasting at Least 2 Weeks
Cognitive Symptoms
Anhedonia
Vegetative Symptoms
Single or Recurrent Episode
– No Manic or Hypomanic Episodes
 Clinical Description
Similar to Major Depression BUT
With a Different Course
– Symptoms are Milder
– Symptoms can Last 20-30+ Years
Persistently Depressed Mood for
2+ Years
– Cannot be Symptom Free > 2 Months
 Facts and Statistics
Mean Age of Onset Early 20s
Onset Prior to Age 20
– Greater Chronicity
– Poor Prognosis
Major Depressive Episodes are
Common
 Clinical Description
Suffer From Both
– Major Depression Episodes
– PDD - Dysthymic Disorder
Dysthymia Usually Begins First
Associated With Severe Pathology
A Problematic Future Course
 Clinical Description
Dysthymia
Dysthymia
Major
Depression
 Major Features
Experience Both
– Manic Episodes
– Major Depressive Episodes
Roller Coaster of Mood
What are Manic Episodes?
 Mania and Hypomania
 Elevated Mood
 Grandiosity
 Increased Activity
 Varied Impairment
 Clinical Description
Mania
Major
Depression
 Clinical Description
Major Depressive Episodes
Alternate With
Hypomanic Episodes
 Clinical Description
Milder Depressive Episodes
Alternate With
Hypomanic Episodes
 Clinical Description
Hypomania
Dysthmia
 General Facts and Statistics
Bipolar I
– Onset Around 18 Years
Bipolar II
– Onset Around 22 Years
16% Commit Suicide
Cyclothymia
– Typically Chronic
 Descriptions of Recent
Episode and Pattern Varies
1. Atypical
– Pertains to Depressive Episodes and
Dysthymia, not Manic Episodes
– Typically Overeat and Oversleep
 Recent Episode and Pattern
Atypical (overeat, oversleep, wght gain –
keep interested, can experience pleasure)
2. Melancholic
– Pertains to Major Depressive Episode
Only
– More Severe Symptoms
– Strong Biological Component
 Recent Episode and Pattern
Atypical
Melancholic
3. Mixed Features
– With some mania symptoms
 Recent Episode and Pattern
Atypical
Melancholic
4. Catatonic Mixed
– Can be part of Major Depression and
Mania
– Very Serious Condition
– Catalepsy (“Muscle Rigidity”)
 Recent Episode and Pattern
Atypical
Catatonic
Melancholic
Mixed
5. Psychotic
– Hallucinations and Delusions
– Very Rare but Serious Condition
– Poor Treatment Response
 Recent Episode and Pattern
Atypical
Melancholic
Catatonic
Mixed
6. PeripartumPsychotic
– Major Depression and Mania
– Prior to…Four Weeks Following
Birth…and up to a year: high %
– Mood Episodes of a Psychotic Nature
Relatively Rare
 Recent Episode and Pattern
Atypical
Melancholic
Catatonic
Mixed
Peripartum Psychotic
Anxious Distress
 Course and Pattern
Rapid-Cycling
Seasonal Pattern
– Bipolar and Recurrent Major
Depression
– Episodes During Certain Seasons
Other Depressive Disorders new to DSM-5
• Premenstrual Dysphoric Disorder (PMDD)
– 2- 5% of women meet criteria
• Disruptive Mood Dysregulation Disorder
– Children: increased diagnosis for bipolar, up
40% between 1995 and 2005
• Bipolar (NOS)
About 16% Lifetime Global Prevalence MDD
Past Year:
Bipolar-.8%
Maj Depression-6%
Females > Males
– Major Depression and Dysthymia
Females = Males
– Bipolar Disorders
 Biological Dimensions
Family Studies
Twin Studies
– As Severity Increases, so Does the
Genetic Connection
No Single Genetic Link
 Neurotransmitters
 The Serotonin Connection
 Endocrine Function
 Elevated Cortisol
 Dexamethasone Suppression Test:
cortisol suppressed in nondepressed people, not in severely
depressed….but….
 Sleep and Circadian Rhythms
 Sleep Disturbances are Common
More intense and earlier start to
REM Sleep among the Depressed
 Diminished Deep Sleep
 Disruption of Circadian Rhythms
 Stressful Life Events; Loss
 Learned Helplessness
 Attributional Style
 Internal
 Stable
 Global
 Negative Cognitive Biases
 Beck’s Cognitive Triad
 Negative Schema About
Self,
World,
& Future
 In the United States:
 About 30,000 Kill Themselves Annually
 More Die from Suicide Each Year Than Homicide
(about 20,000)
 More Common Among Whites, Native Americans
 Increasing in Adolescents (3rd leading cause of
death) & Elderly (globally, the elderly have highest
suicide rate, esp. males)
 Males > Females in Killing Themselves
 Females > Males in Attempts
 Approximately 500,000 people each year require ER
treatment as a result of attempted suicide
 Suicidal behavior typically occurs in the presence of
mental illness or substance use disorders
 Firearms account for 59% of all suicide deaths
 Website of Extreme and Urgent Interest
 suicidology.org
 Medications
 Tricyclic Antidepressants
Imipramine (Tofranil)
Amitriptyline (Elavil)
 Block Neurotransmitter Reuptake
 Side Effects
 Medications
 MAO Inhibitors
 Block Enzyme MonoAmine Oxidase
 The Result?
More Neurotransmitter is Available
 Side Effects and Complications
 Medications
 SSRIs
 Block Reuptake of Serotonin- Prozac
 SSNRIs
 Medications - Bipolar
 Lithium, Depakote, Lamictal…Effective
for Manic Episodes
 Lithium Must be Carefully Regulated
 Other Medical Treatments
 Electroconvulsive Therapy (ECT)
TMS
 Psychological Interventions
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 Combined Treatments?