Transcript Mood Disorders Depression and Bipolar

Mood Disorders
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)
1.
2.
3.
4.
5.
6.
7.
8.
9.
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
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
Manic Episode (building block)
A.
B.
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)
1.
2.
3.
4.
5.
6.
7.
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
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
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
Hypomanic Episode
(building block)
A.
B.
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)
1.
2.
3.
4.
5.
6.
7.
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
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
Mood Episodes
Mixed Episode
Mania
Hypomania
Normal Mood
Depression
Major Depressive Disorder
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One or more Major Depressive Episodes
AND
No history of mania or hypomania
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Specify:
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Single Episode
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Recurrent
Major Depressive Disorder
Major
Depressive
Episode
Major
Depressive
Episode
MDD, single episode
Major
Depressive
Episode
Major
Depressive
Episode
MDD, recurrent episodes
Major Depressive Disorder: Types
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Melancholic
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Catatonic
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Atypical
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Seasonal Pattern
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Post-partum onset
Facts about Major Depressive Disorder
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Prevalence:
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Gender:
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Culture:
Facts about Major Depressive Disorder
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Age of Onset:
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Course:
Likelihood of having another Major
Depressive Episode if you’ve had…
1 episode
50%
Major
Depressive
Episode
Major
Depressive
Episode
3 episodes
90%
2 episodes
70%
Major
Depressive
Episode
Major
Depressive
Episode
Major
Depressive
Episode
Major
Depressive
Episode
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
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
Major Depression vs. Dysthymia
Recurrent
Major
Depressive
Episodes
Dysthymia
Major Depression:
Interepisode Recovery
Recurrent, Full
Interepisode
Recovery
Recurrent,
Without Full
Interepisode
Recovery
Major Depression vs. Dysthymia
Recurrent, Full
Interepisode
Recovery, with
Dysthymia
Recurrent,
Without Full
Interepisode
Recovery, with
Dysthymia
Facts about Dysthymia
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Prevalence:
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Gender:
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Age of Onset:
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Course:
Unipolar Depression – Possible Causes
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Stressful life events
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Learned Helplessness
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Depressogenic Schemas
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Neurotransmitters
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Genetic Factors
Unipolar Depression - Treatment
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Mild Depression
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Electroconvulsive Therapy
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Pharmacotherapy
Unipolar Depression - Treatment
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Cognitive Behavioral Therapy
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Identify and challenge depressogenic assumptions
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Identify more adaptive coping mechanisms
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Encourage client to actively engage in life and relationships
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Mindfulness
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At least as effective as antidepressants in reducing symptoms
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More effective than antidepressants in preventing relapse
Bipolar Disorder
Two Main Distinctions
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Bipolar I Disorder:
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Technically, this should mean Mania/Mixed + Depression
Actually, this means Mania/Mixed ± Depression
Bipolar II Disorder:
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Hypomania + Depression (No mania ever)
Bipolar I Disorder
One or more
manic episode
Manic
or Mixed
Episode
OR
OR
Depressed and
manic episodes
Major
Depressive
Episode
Manic
or Mixed
Episode
Bipolar II Disorder
One or more
hypomanic episode
OR
OR
Hypomanic
Episode
Depressed and
hypomanic episodes
Major
Depressive
Episode
Hypomanic
Episode
Unipolar vs. Bipolar Disorder
Elevated
Mood
Bipolar
Depressed
Mood
Elevated
Mood
Unipolar
Depressed
Mood
Facts about Bipolar Disorders
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Prevalence:
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Gender:
Facts about Bipolar Disorders
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Age of Onset:
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Course:
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Culture:
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
Bipolar Disorders - Treatment
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Lithium
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Psychotherapy
Mood Disorders: Severity
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Mild
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Moderate
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Severe without Psychotic features
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Severe with Psychotic features
Mood Disorders – Cultural Factors
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Demographic Differences in the U.S.
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Symptom Differences
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Unipolar Depressions
Bipolar Disorders
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
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Taiwan: 1.5%
United States and Lebanon: 17-19%
Suicide
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Risk Factors:
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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
Suicide

Suicide and Psychopathology

Bipolar Disorder > Major Depression
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Melancholic Depression
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Substance abuse/dependence
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Insomnia
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Delusions
Suicide

Who attempts? Who completes?
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Women: 3-4 times more likely to attempt suicide
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Men: 3-4 times more likely to complete suicide
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Ages 18-24: Peak age for attempting suicide
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Ages 65+: Peak age for completing suicide
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Method
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Intent
Suicide
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Common Warning Signs
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Symptoms of depression
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Talking about death, disappearing, “ending it all”, etc., even
just in passing
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Writing letters, saying last goodbyes
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Getting rid of personal effects, making a will
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Arranging for the care of pets, plants, etc.
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Extravagant spending
Suicide
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Prevention
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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
Suicide…interesting question…
Should suicide be prevented?