Lecture VII: Mood Disorders cont.Last LectureOutlineLecturePSY 2301 1st Edition Lecture 6Lecture VII: Mood Disorders cont.Last LectureClassification & Diagnosis and Mood Disorders OutlineI. RiskII. Risk of NOT giving ECTIII.Dysthymia (Persistent Depressive Disorder)IV. Bipolar DisorderV. CyclothymiaVI. Lifetime PrevalenceVII. Postpartum DepressionLectureI. RiskA. Quite safe if done properlyB. Death is extremely rare – usually due to anesthesia not ECT, per se.C. Cardiac arrest is another riskD. Further seizures are a riskE. Irreversible brain damage is a risk (e.g., complaints of memory loss)II. Risk of NOT giving ECTA. SuicideB. Self-harmC. HomicideD. MalnutritionE. Drug abuseF. Drug dependenceIII.Dysthymia (Persistent Depressive Disorder)A. Depressed mood most of the day, for majority of the days verse not, for at least 2 years (in children: 1 year)B. Never w/o these symptoms for more than 2 months during the 2+ yearsC. Need 2 or more of the following:1. Poor appetite or overeating2. Insomnia3. Hypersomnia4. Low energy or fatigue5. Low self-esteem6. Poor concentration or difficulty w/decision-making7. Feelings of hopelessnessD. No MDD during the first 2 years of symptoms, and no manic episodes everE. Symptoms = impairments are not due to drugs/medicalIV. Bipolar DisorderA. Also termed Manic-DepressionB. The clinical course is characterized by cycles of manic and depressive episodes (e.g., every three weeks), with, at times, periods of normal functioning interspersed between mania and depression1. Bipolar Ia. One or more manic episodes (but doesn’t preclude having a mixed or major depressive episode)2. Bipolar IIa. One or more major depressive episodes, at least one hypomanic episode, and no manic episodesC. A distinct period of abnormally and persistent elevated, expansive, and/or irritable moodD. 3+ of the following:1. Inflated self-esteem/grandiosity2. Decreased need for sleep3. Pressured speech/much more talkative4. Flight of ideas/racing thoughts5. Distractibility6. Increase in goal-directed activity or psychomotor agitation7. Excessive involvement in pleasurable activities that have high potential for painful consequencesE. Manic episode1. Often accompanied by delusions2. Lasts 1 week or moreF. Hypomanic episode1. Delusions often not present2. Lasts 4 days or moreG. Symptoms cause significant distress or impairment in social, occupational, or other functioningH. Symptoms are not the direct physiological effects of a substance or medical condition1. Completed suicide in 10-15% of individuals with dipolar d/oV. Cyclothymia1. Numerous periods with hypomanic symptoms and numerous periods with depressed mood, for at least 2 years2. Never without these symptoms for more than 2 months during 2-year period3. No prior major depressive episode, manic episode, or mixed episode during first 2 years4. Symptoms = impairments and not due to drugs/medicalVI. Lifetime Prevalence1. MDD (unipolar = only go in the depressive direction)a. 10% to 25% for women, 5% to 12% for men2. Dysthymiaa. 6%3. BPD (bipolar = go in manic and depressive direction)a. Approximately 1%4. Cyclothymiaa. Approximately 1%5. Women are 2x as likely to be diagnosed with MDD as men, but equal prevalence for othersa. Why? VII. Postpartum DepressionA. DSM-V1. Still does not recognize PPD as a separate diagnosis; rather, [patients must meet the criteria for MDD and the criteria for the peri-partum onset specifier (i.e., onset in pregnancy or within 4 weeks of delivery)B. Definition1. Although different definitions exist PPD can be defined asa. A non-psychotic depressive episode that either occurs after delivery or begins prior to delivery and continues into the postpartum periodb. Often defined in terms of standardized diagnostic criteria for depression (O’Hara & Swain, 1996)C. Prevalence and Duration of PPD1. PPD occurs in approximately 13% of the population according to a recent meta-analysis (O’Hare & Swain, 1996)2. Symptoms must persist for at least one week3. Symptoms can last for months after delivery and recur at later times in the woman’s lifeD. Risk Factors for PPD1. Increase in estrogen & progesterone during pregnancy and decrease after deliver2. Lower income, SES3. Poor marital relationship4. Lack of social support5. History of depression or dysthymia (O’Hare & Stuart, 1999)E. Blues and Psychosis in the PP1. Each occur in the postpartum period with varying prevalence2. Postpartum blues is most common (30 to 75%) and is defined as a relatively benign, short-lived, time-limited depressive reaction within the first several days postpartum (Nonacs & Cohen, 1998)3. Postpartum psychosis is least common (.1 to .2%) and is defined as a sudden onset, rapidly evolving disorder marked by depressive and psychotic symptoms (Nonacs & Cohen, 1998)F. In the Media1. Andrea Yatesa. Probably postpartum psychosisb. Treated with Haldol (anti-psychotic) and taken off meds shortly before incidentc. Not a typical PPD reactiond. Had previous episodes of PPD after prior deliveries (at higher risk so should be monitored