Chapter 8 - Mood Disorders Flashcards
Most common cause of depression
Interpersonal relationships
List types of Unipolar depression
1) Major depression
2) Dysthymic disorder - less severe but more chronic
Cost of depression in Canada
$14.4 billion or 1% of GNP
- due to treatment and lost productivity
Diagnostic criteria for Major Depressive Episode
1) 5 or more symptoms lasting 2+ weeks. Most of the day nearly every day.
a) mood symptoms (1 must)
- depressed mood
- anhedonia
b) Physcial symptoms
- weight loss (common) or gain
- insomnia (common) or hypersomnia
- psychomotor agitation or retardation
- fatigue, loss of energy
c) Cognitive symptoms
- worthlessness or guilt
- indecisiveness
- death or suicidal ideation
2) clinically significant distress or impairment in functioning
3) Depression as a syndrome ***
Define anhedonia
Loss of interest or pleasure in activities
Features of major depressive disorder
1) presence of episode
2) no manic or hypomanic episodes
3) Subtype: single episode or recurrent
4) Specifiers
Name specifiers of major depressive disorder
1) Mild, moderate, severe w/out psychotic features, severe w/ psychotic features (delusions)
2) Atypical - oversleep, overeat, weight gain, anxiety
3) w Catatonic features
4) w Melancholic features (severe, biologically-based. Anhedonia, insomnia, psychomotor agitation, sig weight loss)
5) w Postpartum onset
6) w seasonal pattern. bipolar mania in summer
Bio reason for MDD w postpartum onset
- w/in 4 weeks
- progesterone levels drop post birth
- progesterone had an antianxiety effect on brain prev
Stats on depression?
- 1.5million Canada, 400k in Ontario any year
- 6% women, 3% men given time
- Lifetime: 12% women, 6% men
- increased dramatically in last century
Why does prof think depression increased so dramatically?
- loss of social connections
Course
- 1st episodes adolescence or early child
- precipitated by severe stressor
- episodes 6mos - 1yr (resolve w no intervention)
- after one, will have 5 or 6
Variable course of depression
- full versus partial remission between episodes
Rate of recurrence of depression
1 episode: 50% risk of second
2 episodes: 70% risk of third
3+ : 90% risk of more
Associated features of depression
- risk suicide (15% of multiple episodes commit suicide)
- Comorbidity:
- anxiety disorders 50% - eg panic, OCD
- eating, substance abuse, BPD, sexual dysfunctions
Criteria Features of Dysthymic disorder
- less severe, but more chronic/long lasting
1) depressed mood most of the day, more days than not for 2+ years
2) 2 of: appetite, sleep, energy, low self-esteem, concentration, hopless
3) tends to be chronic, life-long
What’s Double Depression
- Dysthymia + major depressive episodes
What’s hypomania
less severe form of mania
Bipolar subtypes
- Bipolar I disorder - mania + typically major depression episodes
- Bipolar II disorder - hypomania AND major depression episodes
- Cyclothymia - hypomania & dysthymia
Features of a manic episode
1) elevated, expanisive/talkative, irritable mood, 1+ week
2) 3 or more:
- inflated self-esteem, grandiosity
- less sleep needed
- pressure of speech/words tumbling
- racing thoughts
- distractability
- psychomotor agitation
- high risk pleasurable activities
3) Functional impairment
Features of Bipolar I disorder
- just one episode to qualify
- almost never have just mania, often depression episode too
- men = women
- Lifetime: 1%
- onset avg: 20yrs, but can begin in childhood
- recurrent, chronic
- risk of suicide, unemployment, marital, financial
- rapid cycling: less than 10-20% of cases (chgs occur at least 4 times per year)
Features of Bipolar II disorder
- not full mania, only hypomania
- must include depressive episodes
- no history of manic episodes
- men = women
- less common than BP1 .5% lifetime
Features of cyclothymic disorder
- continuous periods of hypomanic and depression, but not meet criteria of major depression
- lasts 2+ years
- clinically significant distress, imairment
- chronic, lifelong
- women = men
- risk for developing BP1 or 2 disorder
- lifetime: <1%
New name for dysthymia
Persistent depressive disorder
DSM - 5 diagnoses
Bipolar & Related disorders
- BP1
- BP2
- Cyclothymic
Depressive Disorders
- MDD
- Persistent depressive disorder (dysthymia)
- Disruptive mood dysregulation disorder
- premenstrual dysphoric disorder
