Lecture 8 Current Lecture Chapter 5: Mood DisordersI. Clinical Descriptions and Epidemiology of Mood DisordersII. Etiology of Mood DisordersIII. Treatment of Mood DisordersIV. SuicideMood Disorders Two broad types• Involves only depressive symptoms• Involves manic symptoms (bipolar disorders) Depressive disorders• Major depressive disorder• Dysthymia (renamed persistent depressive disorder in DSM-V)• Premenstrual dysphoric disorder (new DSM-V)• Disruptive mood dysregulation disorder (new DSM-V) Bipolar Disorders (same in DSM-IV-TR/DSM-5)• Bipolar I disorder• Bipolar II disorder• CyclothymiaDSM-5 Criteria for Major Depressive Disorder Sad mood OR loss of interest or pleasure (anhedonia)• Symptoms nearly every day, most of the day, for at least 2 weeks• Not due to normal bereavement (removed in DSM-5)  PLUS four of the following• Sleeping too much or too little• Psychomotor retardation or agitation• Poor appetite and weight loss, or increased appetite and weight gain• Loss of energy• Feelings of worthlessness or excessive guilt• Difficulty concentrating, thinking, or making decisions• Recurrent thoughts of death or suicideMajor Depressive Disorder (MDD) Episodic• Symptoms tend to dissipate (scatter) over time RecurrentPsych 380 1st Edition• Once depression occurs, future episodes likelyAverage number of episodes is 4  Subclinical depression• Sadness plus 3 other symptoms for 10 days• Significant impairments in functioning even though full diagnostic criteriaare not met*The more prior episodes the more likely to recur and shorter time symptom freePersistent (continuing firmly) Depressive Disorder Combines two disorders: Dysthymia and Major Depressive Disorder, chronic subtype• Depressed mood for at least 2 years; 1 year for children/adolescents• PLUS 2 other symptoms:Poor appetite or overeatingSleeping too much or too littlePoor self-esteemTrouble concentrating or making decisionsFeelings of hopelessnessPersistent Depressive Disorder• DSM-5 vs DSM-IVno requirement for absence of MDD during first 2 years of symptomsdoes not distinguish between chronic MDD and dysthymia• KEY INSIGHT: Chronicity of symptoms stronger predictor of negative outcomes than number of symptoms In a 10-year study, 95% of patients with dysthymic disorder developed MDD (Klein et al. 2006). DSM-5 Criteria for Premenstrual Dysphoric Disorder In most menstrual cycles during past year, at least five of the following present in the week before menses and improved within a few days of menses onset:• Affective liability• Irritability • Depressed mood, hopelessness, or self-deprecating thoughts• Anxiety • Diminished interest in usual activities• Difficulty concentrating • Lack of energy• Changes in appetite, overeating, or food craving• Sleeping too much or too little• Subjective sense of being overwhelmed or out of control• Physical symptoms such as breast tenderness or swelling, joint or muscle pain, or bloatingDSM-5 Criteria for Disruptive Mood Dysregulation Disorder Severe recurrent temper outbursts• out of proportion to the provocation.• inconsistent with developmental level.• occur at least three times per week.• Negative mood between temper outbursts most days Symptoms present for at least 12 months and not absent for more than 3 months ata time. Symtpoms present in at least two settings (at home, at school, or with peers) and are severe in at least one setting. Age 6 or older with onset before age 10EXCLUSIONS: DSM-5 Criteria for Disruptive Mood Dysregulation Disorder No period lasting more than 1 day with elevated mood and at least three other manic symptoms. Behaviors do not occur exclusively during the course of major depressive disorder. This diagnosis cannot coexist with oppositional defiant disorder, attention-deficit/hyperactivity disorder, intermittent explosive disorder, or bipolar disorder.Problems with Disruptive Mood Dysregulation Disorder DMDD rarely occurs alone, co-morbid with CD, ODD and ADHD DMDD has one of the poorest diagnostic reliabilitiesEpidemiology and Consequences Depression is common• Lifetime prevalence (Kessler et al., 2005)16.2% MDD2.5% Dysthymia• Twice as common in women as in men• Three times as common among people in poverty  Prevalence varies across cultures• MDD1.5% in Taiwan19% in Beirut, Lebanon People who move to the U.S. from Mexico have lower rates than people ofMexican descent who were born in the United States Epidemiology and Consequences Symptom variation across cultures• Latino culturesComplaints of nerves and headaches• Asian culturesComplaints of weakness, fatigue, and poor concentration• Closer to equator (longer day length) and higher fish consumption associated with lower rates of MDD Symptom variation across life span• ChildrenStomach and headaches• Older adultsDistractibility and forgetfulness Co-morbidity• 2/3 of those with MDD will also meet criteria for anxiety disorder at some point Bipolar Disorders Three forms:• Bipolar I, Bipolar II, and CyclothymiaMania defining feature of eachDifferentiated by severity and duration of mania• Usually involve episodes of depression alternating with maniaDepressive episode required for Bipolar II, but not Bipolar I Mania• State of intense elation or irritability• Hypomania (hypo = “under”; hyper = “above”)Symptoms of mania but less intenseDoes not involve significant impairment, mania doesDSM-5 Criteria for Manic and Hypomanic Episodes Distinctly elevated or irritable mood for most of the day nearly every day Abnormally increased activity and energy  At least three of the following are noticeably different (four if mood is irritable): • Increase in goal-directed activity or psychomotor agitation• Unusual talkativeness; rapid speech• Flight of ideas or subjective impression of racing thoughts• Decreased need for sleep• Increased self-esteem; belief that one has special talents, powers, or abilities• Distractibility; attention easily diverted• Excessive involvement in activities with undesirable consequences, such as reckless spending, sexual behavior, or drivingDSM-5 Criteria for Manic and Hypomanic Episodes For a manic episode:• Symptoms last for 1 week or require hospitalization• Symptoms cause significant distress or functional impairment For a hypomanic episode:• Symptoms last at least 4