Affective Disorders Flashcards
affective (mood) disorders
-complex behavioral syndromes which are multifaceted and last a minimum period of time and which cause social or occupational dysfunction or significant distress and are not induced by drugs or by a general medical condition
timing vs. severity of disease
- the earlier the onset, the more severe the disorder
- onset after 40 may suggest medical condition
diathesis-stress hypothesis
- people have a genetic, biologic and experiential predisposition and vulnerability for illnesses (diatheses) but possessing vulnerability for an illness is insufficient to trigger the development of the illness
- vulnerabilities must interact with life stresses to prompt the onset of the illness
- the greater the person’s inherent propensity for developing an illness, the less stress is necessary for the illness to manifest
euphoric, euthymic, dysthymic
euphoric = up or high euthymic = in the middle dysthymic = down or sad
Major depressive episode
- 5 or more symptoms present during same 2-week period; at least one is either 1. depressed mood or 2. loss of interest or pleasure
- weight loss when not dieting
- insomnia, hypersomnia
- fatigue
- feeling worthless or guilt
- diurnal variation in mood; more depressed early in the day
- in children irritability counts, not just depressed mood
- early morning awakening (worst mood of the day)
- recurrent thoughts of death
manic episode
- can be a career ending event
- mania is much harder for people to understand or to tolerate than depressed mood episode
- most will have more than one manic episode
- persistently elevated, expansive, or irritable mood lasting at least 1 week
- 3 or more of the following symptoms are present to a significant degree: inflated self-esteem, decreased sleep, more talkative than usual, pressure of talking, flight of ideas, distractibility, increase in goal directed activity, excessive involvement in activities that have high potential for painful consequences
hypomanic episode
- note that it is hypomanic (less than manic) there is no “hypermanic” state
- need not be as severe or last as long (4 days rather than 7)
- hypomania: euphoric, but not as high as if they were manic. Duration of disturbance isn’t as long and the individual doesn’t need to be hospitalized. Less severe
major depressive disorder
- must last at least two weeks
- can happen only once but is often recurrent (specifier single or recurrent)
- can be mild, moderate, or severe and with or without psychotic features
- psychotic features can be mood congruent or incongruent (there may be hallucinations as well as delusions)
- look for medical conditions that could affect the condition (anemia, hypothyroid)
Bipolar
- Bipolar I and Bipolar II
- type of major affective disorder
- major genetic influence
- course of illness affected by life events
- Bipolar I = pt has to have had at least one manic episode (cant be induced by drugs or resulted form a medical condition unless its persistent
- Bipolar II = the occurrence of one or more major depressive episodes and at least one hypomanic episode
- if pt had a hypomanic episode but no manic episodes, they have bipolar II
- if pt had hypomanic and manic episodes, they have Bipolar I
Persistent depressive (dysthymic) disorder
- presence, while depressed, of two or more of the following: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness
- milder disorder, occurs over protracted time period
- mild, low mood, may not recognize that they are depressed, just think life sucks
- cant have had a major depressive episode for the 2 years it takes to meet the criteria for PDD
Cyclothymic disorder
- milder, rapid cycling bipolar disorder lasting for at least 2 years (one year in children and adolescents)
- pt usually switch rapidly over a few days or a week from being mildly depressed to being hypomanic (but never meeting hypomanic criteria) and then back again
- during those two years, has not been without sxs for more than 2 months at a time
- sxs cannot be better attributed to a different illness or induced by drugs or other factors
unspecified depressive disorder with anxious distress
- presence of at least two of the following symptoms during the majority of days and a major depressive episode or persistent depressive disorder:
1. feeling keyed up or tense
2. feeling unusually restless
3. difficulty concentrating because of worry
4. fear that something awful may happen
5. feeling that the individual might lose control of himself or herself
unspecified depressive disorder with melancholic features
one of the following is present during most severe period of current episode:
- lack of pleasure in all, or almost all, activities
- lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)
three or more of the following:
- depressed mood characterized by profound despondency, despair, or empty mood
- depression that is regularly worse in the morning
- early-morning awakening (i.e., at least 2 hrs before usual awakening)
- marked psychomotor agitation or retardation
- significant anorexia or weight loss
- excessive or inappropriate guilt
unspecified depressive disorders with atypical features
- features predominate during the majority of days of the current or most recent major depressive episode or persistent depressive disorer
- mood brightens in response to positive events
- two or more of the following:
1. significant weight gain or increase in appetite
2. hypersomnia
3. leaden paralysis (hard to move)
4. longstanding pattern of sensitivity to interpersonal rejection
unspecified depressive disorders with psychotic features
- specifier applies to recurrent major depressive disorder
- mood congruent psychotic features (content of delusions and hallucinations is consistent with typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment)
- mood-incongruent psychotic features (content of delusions or hallucinations does not involve typical depressive themes, or content is a mixture of mood-incongruent and mood-congruent themes)
- catatonia excessive motor activity - catatonic excitement or poverty of movement/posturing
unspecified depressive disorders with catatonia
-applies to an episode of depression if catatonic features are present during most of the episode
unspecified depressive disorders with peripartum onset
-onset of mood symptoms occurs during pregnancy or in the 4 weeks following pregnancy
unspecified depressive disorders with seasonal pattern
-regular temporal relationship between onset of an episode and a particular time of year
major depressive disorder prevalence
3% in men and 5-9% in women
- differential expression of dysphoria explanation: women get depressed, men develop alcoholism
- rates higher in women during childbearing years (estrogen related)
MDD twins rates
- monozygotic = 40%
- dizygotic = 11%
risk of MDD for people with relatives with Mdd
2-3x higher
indicators of more severe MDD disease
- earlier onset
- never being married
- more impaired social and occupation function
- poorer quality of life
- greater medical and psychiatric comorbidity
- more negative view of life and the self
- more lifetime depressive episodes and suicide attempts
Ages when people are more at risk
- caucasians over 65
- recently rates of suicide in middle age are increasing
- average age = 40
symptoms of MDD
- severe cases may have psychotic features
- may occur gradually or over a short time
- hibernation
- decreased social behavior
- decreased exploratory behavior
- increased need for sleep
- increase or decrease in eating
duration of MDD sxs without treatment
many people get better in 6-12 months (25-75%)
