Mood Disorders I Unipolar Depression & Bipolar Disorder Symptoms Classification EpidemiologyTo understand mood disorders, we must understand the differences between: Emotion - Subjective states of feelingE.g., sadness, anger, disgust Affect - Observable behavior that goes with emotionE.g., facial expression Mood - Pervasive and sustained emotional responseE.g., depression and elation What distinguishes normal sadness from clinical depression? Pervasiveness  Absence of situational cues Additional signs and symptoms Subjective quality - doesn’t feel like ‘normal sadness’ Some mood variation is normal… Mood disorders  Involve discrete periods of time dominated by depressed and/or manic mood, which is reflected in a person’s behavior Cause clinically significant distress, impairment, and/or possibility of harm to person Unipolar Disorders Major Depressive Disorder Dysthymia Bipolar Disorders Bipolar I Bipolar II CyclothymiaMajor Depressive Disorder (MDD)  Symptoms: ≥1 major depressive episodes (MDEs) Episode must last at least 2 weeks No manic or unequivocal hypomanic episodesMajor Depressive Episode 5 of 9 symptoms, experienced most of the day, nearly every day, for at least TWO WEEKS!! Emotional Symptoms  Depressed mood*, loss of interest/pleasure in activities,* feelings of worthlessness/guilt  Physical Symptoms  Weight loss/gain, sleep difficulties, psychomotor retardation/agitation, loss of energy Cognitive Symptoms  Problems with concentration and decision-making, recurrent thoughts of death Depression with Melancholic Features early morning wakening, weight loss, not reactive to fun things Depression with Atypical Features Will brighten to fun things; over-eat and over-sleep; not rare Depression with Catatonic Features Depression with Postpartum Onset  Depression with Seasonal Pattern AKA “Seasonal Affective Disorder”**Also, severe depression can have psychotic features Dysthymic Disorder Depressed mood for at least 2 years, more days than not but:▪ No MDE during first 2 years▪ Never without these symptoms for longer than 2 monthsEpidemiology for Unipolar Disorders Lifetime prevalence 17% for MDD 3% for Dysthymic Disorder Women 2x more likely to develop MDD than men Lifetime prevalence: 26% of women vs. 12% of men …But in kids, prevalence is similar among boys and girls  Common comorbidities: Anxiety Disorders are most common (40%) Also substance abuse (18%) Some theories: Differences in cortisol, melatonin, and serotonin Life-stress Body dissatisfaction Distraction vs. Rumination Differences in prevalence due to other factors? Race/ ethnicity Education▪ Lower = more risk Income ▪ Poverty = risk Marital Status Types of Manic Episodes Manic Episode ▪ Elevated, expansive, or irritable mood- one week or longer Mixed Episode  Hypomanic Episode  Symptoms of Mania Emotional▪ Inflated self-esteem or grandiosity Physical▪ Decreased need for sleep Behavioral▪ More talkative and pressured speech ▪ Increased goal-directed behavior▪ Excessive involvement in high-risk pleasurable activities Cognitive▪ Racing thoughts or “flight of ideas”▪ High distractibilityBipolar I DisorderSymptoms: ≥1 manic episodes Elevated, expansive or irritable mood Plus: 3 out of 7 symptoms ≥ 1 week period (unless hospitalized) can have ≥1 MDEs too, but not required for diagnosisExclusion:  Not during SchizophreniaBipolar II DisorderSymptoms > 1 hypomanic episodes 3 out of 7 symptoms 4 day period > 1 major depressive episodesExclusion Criteria: No manic episodes Not during SchizophreniaCyclothymiaSymptoms: Multiple hypomanic episodes + mild depressive symptoms 2 year periodExclusions: No manic episodes (during 1st two years) No major depressive episodesCycling Bipolar patients often shift between mood states, which is called cycling. Patients average about one cycle every two years (median is 18 months).  Rapid cycling occurs if there are 4 or more cycles in a year. Depressive episodes are more common (usually 3:1)Episode specifiers:  Psychotic features Postpartum onsetCourse specifiers:  Rapid cycling Seasonal patternEpidemiology for Bipolar Disorders Lifetime prevalence = <1% No gender differences Common comorbidities: Substance abuse Anxiety disorders Eating