Chapter 4 (Midterm 1 Content)

Question 1

What are mood disorders?

Answer 1

-as the name implies, mood disorders are a type of disorder characterized by disturbances of mood. They can take a variety of forms

Question 2

Types of Mood Disorders

Answer 2

• Mood Episodes
• Depressive Disorders
• Bipolar Disorder
• Other Mood Disorders
• Consider a continuum

Question 3

Major Depressive Disorder

Answer 3

• severe mood disorder characterized by the occurrence of major depressive episodes in the absence of a history of manic episodes
• Major depressive disorder is characterized by a range of features
  
  • depressed mood
  • lack of interest or pleasure in usual activities
  • lack of energy or motivation
  • changes in appetite or sleep patterns

Question 4

DSM-5 Criteria

Major Depressive Disorder

Answer 4

At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either:

1) depressed mood or
2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation made by others)
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

Question 5

-When are changes in mood considered abnormal?

Answer 5

• persistent or severs changes in mood or cycles of extreme depression may suggest the presence of a mood disorder
• In Canada:
  
  • depressive disorders are MOST common in adolescence and early adulthood (15-24 years of age)
• Through adolescence and adulthood (15-64 years of age) WOMEN have a higher prevalence of depressive disorders compared to men
• older adults (65 and older) have the lowest prevalence of depressive disorder, and no significant difference between men and women

Question 6

Major Depressive Disorder Specifiers

Answer 6

• with anxious distress
• with mixed features
• with melancholic features
• with atypical features
• with mood-congruent features
• with mood-incongruent features
• with catatonia with peripartum onset
  - used to be postpartum, now considered a special case as for the next below
• with seasonal pattern (recurrent episodes only)

Question 7

Risk Factors for depression:

Answer 7

• age
  
  • 20s and 30s
• SES status
• marital status
• women are nearly twice as likely as men to develop major depression
  
  • less pronounced difference in later years
  • greater array of life stressors?
• coping styles

Question 8

Seasonal Affective Disorder

• the feature of SAD include:
• correctly called MMD with seasonal pattern

Answer 8

• fatigue
• excessive sleep
• craving for carbs
• weight gain
• affects women more than men
• is most common among young adults
• possible occurs in children but not as commonly as young adults

Question 9

Postpartum Depression

-correctly termed: MDD with Peripartum Onset

Answer 9

-persistent and severe mood changes that occur after childbirth
In fact, about half begin in the late stages of pregnancy (hence to the switch to peripartum)
-Prevalence 10-15%

Question 10

Persistent Depressive Disorder (Dysthymia)

Answer 10

• previously called Dysthymic Disorder
• a milder form of depression, seems to follow a chronic course of development that often beings in childhood or adolescence

Question 11

Persistent Depressive Disorder (Dysthymia) DSM-5

Answer 11

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable, and duration must be at least 1 year.
B. Presence, while depressed, of two (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 (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.

Question 12

Premenstrual Dysphoric Disorder:

Answer 12

Premenstrual Dysphoric Disorder is characterized by mood changes that revolve around a woman’s menstrual cycle.
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses.
B. One (or more) of the following symptoms must be present:
1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.
1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite; overeating; or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.

Question 13

Bipolar disorder I:

Answer 13

features states of extreme elation (manic episodes); major depressive episodes are a common feature. Full manic to full depressive

Question 14

-Bipolar disorder II:

Answer 14

features states of abnormally elevated mood (hypomania) and major depressive episodes. Hypomanic range to extreme depression

Question 15

Manic episode:

Answer 15

-periods of unrealistically heightened euphoria, extreme restlessness and excessive activity characterized by disorganized behavior and impaired judgement

Question 16

Pressured Speech:

Answer 16

-outpouring of speech in which words seems surge urgently, as in a manic state

Question 17

Rapid Flight of Ideas

Answer 17

-a characteristic of manic behavior involving rapid speech and changes of topics

Question 18

MANIC EPISODE – DSM-5 Criteria

Answer 18

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

Question 19

BIPOLAR I DISORDER DSM-5 CRITERIA

Answer 19

A. Criteria have been met for at least one manic episode.
B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

-So really, Dx of a Manic Episode is usually tantamount to a Bipolar I Dx

Question 20

HYPOMANIC EPISODE – DSM-5 Criteria

Answer 20

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. NOT severe enough to require hospitalization or cause major disruption.

Question 21

BIPOLAR II DISORDER – DSM-5 Criteria

Answer 21

A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode (Criteria A-C under “Major Depressive Episode” above).
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 22

Cyclothymic Disorder

Answer 22

• mood disorder characterized by a chronic pattern of mild mood swings between depression and mania that are not of sufficient severity to be classified as bipolar disorder
• numerous periods of hypomanic symptoms for at least 2 years that fail to meet the criteria for hypomanic episodes
• Numerous periods of depressive symptoms that fail to meet the criteria for a major depressive episode. -The person has experienced the periods mentioned above for at least half the time, and the person has not been without symptoms for longer than two months.
• The symptoms experienced are not due to another mental health condition.
• The symptoms experienced are not caused by a medical condition or substance.
• The symptoms experienced impair the person’s ability to socialize, work, or function in other areas of his or her life.