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Mood Disorders Overview

• Chapter 6

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An Overview of Mood Disorders

• Extremes in Normal Mood
• Nature of depression
• Nature of mania and hypomania
• Types of DSM-IV Depressive Disorders
• Major depressive disorder
• Dysthymic disorder
• Double depression
• Types of DSM-IV Bipolar Disorders
• Bipolar I disorder
• Bipolar II disorder
• Cyclothymic disorder

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Nature of Depressive Episodes

• Major Depressive Episode
• Extremely depressed mood state lasting at least 2
  weeks
• Cognitive symptoms
• Feelings of worthlessness, inappropriate guilt,
  diminished concentration or thinking, and
  preoccupation with death
• Vegetative or somatic symptoms
• Change in weight or appetite, change in sleep,
  psychomotor changes, and fatigue
• Anhedonia Loss of pleasure/interest in usual
  activities

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Nature of Manic Episodes

• Distinctly elevated or irritable mood lasting at
  least one week
• Three or more of the following
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Talkativeness, pressured speech
• Flight of ideas or racing thoughts
• Distractibility
• Increased goal-directed activity or agitation
• Excessive involvement in pleasurable activities
  that are likely to have painful consequences

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Nature of Hypomanic and Mixed Episodes

• Hypomanic episodes
• Same criteria as manic episodes, but duration
  only 4 days, and does not require clinical
  impairment of functioning
• Mixed episodes
• Meet criteria for both depressive and manic
  episode (except duration)

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Major Depressive Disorder Overview

• Requires presence of major depressive episode
• No history of manic, hypomanic, or mixed episode
• Single episode Highly unusual
• Recurrent episodes More common
• Statistics
• Point prevalence peaks in middle adulthood (7.5)
• Lifetime prevalence 10-25 for women, 5-12 for
  men

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Dysthymia An Overview

• Overview and Defining Features
• Defined by persistently depressed mood that
  continues for at least 2 years
• Symptoms of depression are milder than major
  depression
• Symptoms can persist unchanged over long periods
  (e.g., 20 years or more)
• Facts and Statistics
• Late onset Typically in the early 20s
• Early onset Before age 20, greater chronicity,
  poorer prognosis
• Lifetime prevalence 6, point prevalence 3

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Double Depression An Overview

• Overview and Defining Features
• Person experiences major depressive episodes and
  dysthymic disorder
• Dysthymic disorder often develops first
• Facts and Statistics
• Associated with severe psychopathology
• Associated with a problematic future course

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Bipolar I Disorder An Overview

• Overview and Defining Features
• Alternations between full manic episodes and
  depressive episodes
• Facts and Statistics
• Average age on onset is 18 years, but can begin
  in childhood, rarely after age 40
• Tends to be chronic
• Suicide is a common consequence (9-60, average
  estimate 19)
• Lifetime prevalence 0.4 1.6

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Bipolar II Disorder An Overview

• Overview and Defining Features
• Alternations between major depressive episodes
  and hypomanic episodes
• Facts and Statistics
• Average age of onset is 22 years, but can begin
  in childhood
• Only 10 to 13 of cases progress to full bipolar
  I disorder
• Tends to be chronic

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Cyclothymic Disorder An Overview

• Overview and Defining Features
• More chronic version of bipolar disorder
• Manic and major depressive episodes are less
  severe
• Manic or depressive mood states persist for long
  periods
• Pattern must last for at least 2 years (1 year
  for children and adolescents)
• Facts and Statistics
• Average age of onset is about 12 or 14 years
• Cyclothymia tends to be chronic and lifelong
• Most are female
• High risk for developing bipolar I or II disorder

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Additional Defining Criteria for Mood Disorders

• Symptom Specifiers
• Melancholic (40-60)
• Depression worse in the morning, insomnia with
  early waking, anorexia and significant weight
  loss, anhedonia
• Atypical (15)
• Depression worse at night, oversleeping,
  overeating and significant weight gain
• Chronic Major depression only, lasting 2 years
• Catatonic Very serious condition, absence of
  movement
• Psychotic Mood congruent/incongruent
  hallucinations/delusions
• Postpartum Severe manic or depressive episodes
  post childbirth

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Additional Defining Criteria for Mood Disorders
(cont.)

• Course Specifiers
• Longitudinal course Past history and recovery
  from depression and/or mania
• Rapid cycling pattern Applies to bipolar I and
  II disorder only
• Seasonal pattern Whether episodes are more
  likely during a certain season