Psych 380 1st Edition Lecture 8 Current Lecture Chapter 5 Mood Disorders I Clinical Descriptions and Epidemiology of Mood Disorders II Etiology of Mood Disorders III Treatment of Mood Disorders IV Suicide Mood 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 Cyclothymia DSM 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 suicide Major Depressive Disorder MDD Episodic Symptoms tend to dissipate scatter over time Recurrent Once depression occurs future episodes likely Average number of episodes is 4 Subclinical depression Sadness plus 3 other symptoms for 10 days Significant impairments in functioning even though full diagnostic criteria are not met The more prior episodes the more likely to recur and shorter time symptom free Persistent 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 overeating Sleeping too much or too little Poor self esteem Trouble concentrating or making decisions Feelings of hopelessness Persistent Depressive Disorder DSM 5 vs DSM IV no requirement for absence of MDD during first 2 years of symptoms does 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 bloating DSM 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 at a 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 10 EXCLUSIONS 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 attentiondeficit 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 reliabilities Epidemiology and Consequences Depression is common Lifetime prevalence Kessler et al 2005 16 2 MDD 2 5 Dysthymia Twice as common in women as in men Three times as common among people in poverty Prevalence varies across cultures MDD 1 5 in Taiwan 19 in Beirut Lebanon People who move to the U S from Mexico have lower rates than people of Mexican descent who were born in the United States Epidemiology and Consequences Symptom variation across cultures Latino cultures Complaints of nerves and headaches Asian cultures Complaints 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 Children Stomach and headaches Older adults Distractibility 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 Cyclothymia Mania defining feature of each Differentiated by severity and duration of mania Usually involve episodes of depression alternating with mania Depressive 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 intense Does not involve significant impairment mania does DSM 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 driving DSM 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 days Changes in functioning observable to others but impairment is not marked No psychotic symptom Bipolar Disorders Cyclothymic disorder Cyclothymia Milder chronic form of bipolar disorder Lasts at least 2 years in adults 1 year in children adolescents Numerous periods with hypomanic and depressive symptoms Does not meet criteria for mania or major depressive episode Symptoms