EXAM 2 - Mood Disorders Flashcards
(49 cards)
Unipolar Depression
Major Depressive Disorder
Persistent Depressive Disorder
Disruptive Mood Dysregulation Disorder
Premenstrual Dysphoric Disorder
Same“poles” of mood (NO depression to mania)
Bipolar Disorders (mania or hypomania is present typically alternating with periods of depression)
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Different “poles” of mood (depression to mania)
Incidence of Depression
16 % suffered from Major Depressive Disorder at some point in their lives
3 % suffered from Dysthymic Disorder
Incidence of Bipolar Disorder
Lifetime Incidence Rate for Bipolar I and II combined according to the National Comorbidity Survey Replication is close to 4%.
Most Common Age of Onset - Major Depressive Episodes
Onset is typically 25 to 44 years old
Some MDD begin in childhood, but more often in adolescence
Rates in the elderly are high
Most Common Age of Onset - Bipolar Disorder
Typical onset is in early 20’s (18 to 22)
However, some cases start in childhood or adolescence and others after age 50
Gender Differences - Major Depression
Women are 2 to 3 times as likely as men to develop depression
Gender Differences - Bipolar Disorder
Equally common in men and women
First episode in men tends to manic
First episode in women tends to be depressive
DSM-5 Criteria: Major Depressive Episode
A. Five (or more) 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.
Note: Do not include symptoms that are clearly due to a general medical condition or mood-incongruent delusions or hallucinations.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful). Note: in children and adolescents can be irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either 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. Note: in children, consider failure to make expected weight gains
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 a specific plan for committing suicide
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC
Persistent Depressive Disorder
Depressed mood most of the day on more than 50% of days
No more than two months symptom free
Symptoms can persist unchanged over long periods (≥ 20 years)
May include periods of more severe major depressive symptoms
Major depressive symptoms may be intermittent or last for the majority or entirety of the time period
Types of Persistent Depressive Disorder
Mild depressive symptoms without any major depressive episodes (“with pure dysthymic syndrome”)
Mild depressive symptoms with additional major depressive episodes occurring intermittently (previously called “double depression”)
Major depressive episode lasting 2+ years (“with persistent major depressive episode”)
DSM-5 Criteria: Persistent Depressive Disorder
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 person has never been without the symptoms in criteria A and B for more than 2 months at a time.
D. Criteria for major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Current severity: Mild, moderate, severe; With anxious distress; With mixed features; With melancholic features; With atypical features; With mood-congruent psychotic features; With mood-incongruent psychotic features; With peripartum onset; Early onset: If onset is before age 21 years;
Late onset: If onset is at age 21 years or older; Specify (for most recent 2 years of dysthymic disorder):
With pure dysthymic syndrome: if full criteria for a major depressive episode have not been met in at least the preceding 2 years.
With persistent major depressive episode: if full criteria for a major depressive episode have been met throughout the preceding 2-year period.
With intermittent major depressive episodes, with current episode: if full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode.
With intermittent major depressive episodes, without current episode: if full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years.
In full remission, in partial remission
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
DSM-5 Criteria for Depressive Disorders: Persistent Depressive Disorder (2 years)
Persistent Depressive Disorder with pure dysthymic syndrome
Persistent Depressive Disorder:Double Depression
Persistent Depressive Disorder with persistent major depressive episode
Both criteria have been met for at least the past 2 years
Persistent Depressive Disorder with intermittent major depressive episodes with current episode
Persistent Depression AND major depressive episode, however, there was at least 8 weeks without a major depressive episode during the past 2 years
Persistent Depressive Disorder with intermittent major depressive episodes without current major depressive episode
Persistent Depression AND 1 or more major depressive episodes in at least the past 2 years
Diagnostic Specifiers for Depressive Disorders - Major depressive episodes which also include some psychotic features
Hallucinations: Sensory experience in the absence of sensory input
Delusions: Strongly held inaccurate and bizarre beliefs
Diagnostic Specifiers for Depressive Disorders - Anxious distress specifier
Depression is accompanied by several significant symptoms of anxiety
Predicts poorer outcome
agnostic Specifiers for Depressive Disorders - Peripartum onset specifier:
Depression occurring around the time of giving birth
Diagnostic Specifiers for Depressive Disorders - Seasonal pattern specifier:
Depression occurring primarily in certain seasons (usually winter)
Sometimes called seasonal affective disorder.
May be related to seasonal changes in melatonin
May be treated effectively with light therapy
Premenstrual Dysphoric Disorder
Significant depressive symptoms occurring prior to menses during the majority of cycles, leading to distress or impairment
DSM 5 DISORDER CRITERIA SUMMARY Premenstrual Dysphoric Disorder
Features of premenstrual dysphoric disorder include the following:
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 postmenses
One (or more) of the following symptoms must be present:
(1) Marked affective lability (e.g., mood swings),
(2) marked irritability or anger,
(3) marked depressed mood, or
(4) marked anxiety and tension
One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms above:
(1) Decreased interest in usual activities;
(2) difficulty in concentration;
(3) lethargy, fatigability, lack of energy;
(4) marked change in appetite, overeating, or specific food cravings; (5) hypersomnia or insomnia;
(5) a sense of being overwhelmed or out of control; or
(7) physical symptoms such as breast tenderness or weight gain.
Clinically significant distress or interference with work, school, usual social activities, or relationships Symptoms are not attributable to the effects of a substance (e.g., drug abuse) or another medical condition
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washing DC.
Disruptive Mood Dysregulation Disorder
Severe temper outbursts occurring frequently, against a backdrop of angry or irritable mood
Diagnosed only in children 6-18; Criterion A-E have to be met before 10 years old
Criteria for manic/hypomanic episode are not met
Designed in part to combat over diagnosis of bipolar disorder in youth who essentially have a temperamental-type mood disorder (however, recent research doesn’t support that this diagnosis has fulfilled this goal)
Unfortunately, recent research indicates that this disorder is likely not a valid mood disorder.
Research indicates that children diagnosed with this disorder meet the primary criteria for Oppositional Defiant Disorder
DSM 5 DISORDER CRITERIA SUMMARY Disruptive Mood Dysregulation Disorder
Features of disruptive mood dysregulation disorder include the following.
Severe temper outbursts occurring three or more times per week for at least one year, manifested verbally and/or behav-iorally that are out of proportion in intensity or duration to the situation and are inconsistent with developmental level
The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, is observable by others in at least two of three settings (i.e., at home, at school, with peers), and is severe in at least one of these settings
The diagnosis should not be made for the first time before age 6 years or after age 18 years
There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met
The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition
