Week 8 Lecture 8 - Depressive disorders, bipolar and related disorders - Jo Fielding (DN) Flashcards Preview

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What does Jo say is a take home message about mood disorders (right at beginning of lecture)?


It is the pattern of episodes; whether they recur, whether they alternate that determines which mood disorder a person has?


What are the two main 'mood disorder' categories in DSM-5?

  1. Depressive disorders
  2. Bipolar and related disorders



What are disorders that only involve depressive symptoms commonly referred to as?

How are these disorders differentiated?

  • Unipolar
  • Differentiatied by the severity & duration




What are the subset of the mood disorders that involve manic symptoms referred to as?


How are these differentiated?

  • Bipolar
  • Differentiated by intensity, duration & types of symptoms




What emotions are involved in mood disorders?

Involve disabling disturbances in emotion

  • extreme sadness & disengagement of depression
  • extreme elation & irritability of mania


Temporal patterning important in determining diagnoses & treatment

  • dealing with treating current symptoms
  • preventing future episodes


What are the defining features of Depressive Disorders?

  • profound sadness
  • inability to experience pleasure


What are the 4 Depressive Disorders covered in the lecture?

  • Major Depressive Disorder
  • Dysthymia (Persistent Depressive Disorder)
  • Premenstrual Dysphoric Disorder
  • Disruptive Mood Dysregulation Disorder


What differentiates the 4 Depressive Disorders?

differentiated by intensity & duration of symptoms


What disorders come under each of  the two main 'mood disorder' categories in DSM-5?

Depressive disorders

  • Major depressive disorder
  • Persistent (chronic) depressive disorder (dysthymia)
  • Premenstrual dysphoric disorder
  • Disruptive mood dysregulation disorder
  • Substance/medication induced
  • Disorder due to another medical condition
  • Specified/unspecified disorder

Bipolar and related disorders

  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder
  • Substance/medication induced
  • Disorder due to another medical condition
  • Specified/unspecified disorder


What are some additional features of

Depressive disorders?

Cardinal symptoms profound sadness &/or ability to experience pleasure

  • Self-recrimination
  • Difficulty paying attention
  • Physical symptoms very common:
    • fatigue, low energy, aches & pains o sleeping problems
    • sexual interest disappears
    • psychomotor retardation
    • psychomotor agitation
  • Initiative may disappear
  • Social withdrawal
  • Neglect appearance


What are some really important components in the diagnosis of Major Depressive Disorder?

  • Must not have had a manic episode
  • needs to be almost all of the time for at least 2 weeks


5:00 - 7:00 approx


What is DSM-5 criteria for Major Depressive Disorder?

At least 5 symptoms,

including (1) depressed mood and/or (2) loss of pleasure

  • Significant weight loss or change in appetite
  • Sleeping too much or too little
  • Psychomotor retardation or agitation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive/inappropriate guilt
  • Difficulty concentrating
  • Recurrent thoughts of death or suicide (or attempt/plan)
  • Symptoms are present for at least 2 weeks and represent a change from previous functioning



What are some other features of Major Depressive Disorder?

MDD is an episodic disorder

  • Can last for months at a time
  • may become chronic
  • Subclinical depression possible for years
  • Major episodes tend to recur (2/3 of people)
  • Average number of episodes ~4
  • Risk increases each time
  • Controversial criteria re: number of symptoms
  • But impairment appears higher with greater number of symptoms



What is the time course for Major Depressive Disorder?

  • an episodic disorder
    • (symptoms come & go)
  • although can drag on for months
  • tends to recur


5:00-7:00 approx


What is psychomotor retardation?

  • physical symptom of depressive disorders
  • when thoughts & movements slow down



What is psychomotor agitation?

  • physical symptom of depressive disorders
  • restlessness, figeting



DSM-5 criteria for Dysthymia - Persistent depressive disorder?

Depressed mood for most of the day, for more days than not, for at least 2 years (1 year for children/adolescents)

At least 2 of the following during that time:

  • Poor appetite or overeating
  • Sleeping too much or too little
  • Poor self esteem
  • Trouble concentrating or making decisions
  • Feelings of hopelessness

The symptoms do not clear for more than 2 months at a time




Which depressive disorder is most likely to require hospitalisation?



because of its chronicity


What are the defining features of Dysthymia (Persistent depressive disorder)

  • persistent depressed mood
  • no relief more than 2 years


How does Dysthymia differ from Major Depressive Disorder?

Dysthymia (persistent depressive disorder)

  • 2 symptoms
  • 2 years (1yr for child)
  • chronic

Major Depression

  • 5 Symptoms
  • 2 week period
  • episodic


Which two Depressive Disorders are new to DSM-5?

Premenstrual Dysphoric Disorder

Dysruptive Mood Dysregulation Disorder



Premenstrual Dysphoric disorder: DSM-5 criteria?

In most menstrual cycles, 5+ symptoms present in final week before menses, improving within few days of menses onset:

Including ≥1:

  • Affective lability
  • Marked irritability, anger, arguments
  • Depressed mood, hopelessness, self-deprecating thoughts
  • Anxiety diminished interest in usual activities, difficulty concentrating

Including ≥ 1:

  • Decreased interest in usual activities
  • Difficulty concentrating
  • Lack of energy
  • Change in appetite, overeating, or food craving
  • Sleeping too much or too little
  • Subjective sense of being overwhelmed or out of control
  • physical symptoms


What are the defining features of Premenstrual Dysphoric Disorder?

  • affect up & down (moody)
  • impacted concentration, energy, sleep, appetite, physical pain
  • must cause significant distress/impairment


Disruptive mood dysregulation disorder: DSM-5 criteria?

Severe recurrent temper outbursts in response to common stressors, out of proportion in intensity or duration to the provocation

  • Temper outbursts are inconsistent with developmental level
  • Temper outbursts tend to occur at least 3 times per week
  • Persistent negative mood between temper outbursts most days, & the negative mood is observable to others
  • Symptoms present for at least 12 months, do not clear for more than 3 months at a time
  • Temper outbursts or negative mood present in at least 2 settings
  • Age 6 +
  • Onset before age 10
  • In past year, no distinct period lasting >1 day where elevated mood & at least 3 other manic symptoms present


What are the defining features of Disruptive Mood Dysregulation Disorder?

  • Chronic, severe & persistent irritability
  • negative mood
  • in at least 2 settings, 12 months
  • no mania



  • extreme recurrent temper outbursts
  • inconsistent with developmental level


  • present most of the time
  • must be differentiated from other disorders





What distinguishes Disruptive Mood Dysregulation Disorder from other disorders?

such as Bipolar, ADHD (may be comorbid), Oppositional Defiance Disorder (children), Intermittent Explosive Disorder.

its the level of chronicity that distinguishes this disorder from others with similar symptoms




Which is rarer Major Depressive Disorder or Dysthymia?





What other disorders often coexist with Major Depressive Disorder & Dysthymia?

  • Anxiety Disorder
    • 60% Depressives also have anxiety


  • Substance-related disorders
  • Sexual dysfunction
  • Personality disorders
  • Cardiovascular disease


What may the varied prevalence rates of Depressive Disorders across cultures be due to?

What may varied symptoms across cultures be due to?

  • may vary due to different environmental stressors e.g., Beirut 19%, Taiwan 1.5%



  • may reflect differences in acceptable expression
    • e.g., Latino - nerves, headaches
    • e.g., Asian - fatigue & weakness

Cultural differences - bound to be more complex relationship


17:45 approx


How do symptoms of Depressive Disorders behave across the lifespan?

Symptoms change over lifespan

  • children → somatic complaints
  • older adults → distractibility & memory loss