TEST 2 STUDY GUIDE Chapter 6 Mood Disorders Suicide BE FAMILIAR WITH THE DIAGNOSTIC CRITERIA TREATMENT e g 1 pharmacological psychological and other biological methods ETIOLOGY AND PREVALENCE e g which disorder is the most common FOR THE FOLLOWING DISORDERS Major Depressive Disorder Bipolar I Disorder Dysthymic Disorder Bipolar II Disorder Cyclothymia 1 Be familiar with the diagnostic criteria treatment etiology and prevalence for the following disorders Major Depressive Disorder Bipolar I Disorder Dysthymic Disorder Bipolar II Disorder Cyclothymia Major Depressive Disorder diagnostic criteria Major Depressive Episode depressed mood or anhedonia inability to feel pleasure plus 4 or more of the following weight appetite change sleep disturbance fatigue energy loss poor concentration psychomotor agitation retardation worthlessness guilt thoughts of death suicide present for at least 2 weeks 4 9 months untreated no manic hypomanic episodes treatment medical SSRIs Prozac tricyclic antidepressants Tofranil Elavil monoamine oxidase inhibitors atypicals mixed reuptake inhibitors Effexor Serzone biological Electroconvulsive Therapy side effects short term memory loss confusion Transcranial Magnetic Stimulation less severe side effects psychosocial Cognitive Behavioral Therapy addresses errors in thinking 1 Behavioral Activation Interpersonal Psychotherapy focuses on problematic interpersonal relationships combined treatments relapse prevention prevalence lifetime 16 females twice as likely as males adolescents and adults have highest rate children and older adults have low rates Dysthymic Disorder diagnostic criteria depressed mood for most of the day on most days for at least 2 years or at least 1 year in children and adolescents presence while depressed of at least two of the following poor appetite or overeating insomnia or hypersomnia low energy fatigue low self esteem poor concentration or difficulty making decisions feelings of hoplessness during the 2 years of disturbance person has not been without the symptoms for more than 2 months at a time no major depressive episode has been present during this period no manic episode has occurred and criteria have not been met for cyclothymic disorder symptoms are not caused by the direct physiological effects of a substance or a medical condition clinically significant distress or impairment of functioning treatment prevalence see treatment under Major Depressive Disorder lifetime 3 5 females twice as likely as men although similar to MDD symptoms of DD are milder but remain relatively unchanged over long periods of time differs in severity chronicity number of symptoms fewer but last longer Bipolar Disorder I diagnosis criteria treatment full manic episode Major Depressive Episode medical mood stabilizers lithium a common salt side effects may be severe primary drug of choice 2 why it works remains unclear anticonvulsants Carbamazepine Valproic Acid psychosocial as an adjunct to meds Interpersonal Social Rhythm Therapy stabilize social routines and sleep wake habits effectiveness not yet known Psychoeducation Family focused therapy prevalence lifetime 1 women and men equal in prevalence onset ages 15 18 Bipolar Disorder II diagnosis criteria hypomanic episode MDE treatment prevalence same as treatment for BDI same as BDI except onset ages 19 22 Cyclothymic Disorder diagnosis criteria milder yet more chronic bipolar disorder remain in one mood state for several years with very few periods of euthymic normal mood numerous periods with hypomanic symptoms and depressive symptoms that don t meet criteria for a major depressive episode treatment same as BDI prevalence same as BDI except onset ages 12 14 Etiology of Mood Disorders biological psychological stressful life events learned helplessness cognitive vulnerabilities genetic depression anxiety neurotransmitter systems serotonin norepinephrine dopamine imbalances endocrine system cortisol sleep and circadian rhythms 3 social and cultural marital relations gender presence of social support 2 Describe depressive episodes manic episodes and hypomanic episodes How long do depressive and manic episodes typically last Also know how long must manic hypomanic and depressive episodes last according to diagnostic criteria Depressive Episodes o The most commonly diagnosed and most severe depression o Can be severe to the point that even the slightest activity or movement takes o Episode accompanied by general lost of interest in things and inability to overwhelming effort experience any pleasure in life o The physical changes are most important because general feelings of sadness or crying also occur equally in nondepressed individuals Ex loss of energy and inability to engage in pleasurable activities anhedonia o Overall characterized by depressed mood or anhedonia plus 4 or more of the following present for at least 2 weeks weight appetite change sleep disturbance fatigue energy loss poor concentration psychomotor agitation retardation worthlessness guilt thoughts of death suicide Inflated self esteem grandiosity Degreased need for sleep Excessive talkativeness Flight of ideas racing thoughts Highly distractible o the duration of a Major Depressive Episode if untreated is 4 9 months Manic Episodes o Elevated irritable mood at least 3 symptoms below for 1 week Increase in goal directed activity psychomotor agitation Excessive involvement in pleasurable activities with risk for bad outcomes o Impairment hospitalization or psychotic symptoms o Individuals find extreme pleasure in every activity 4 Sometimes the feeling is compared to a continuous orgasm o Speech is typically rapid and may become incoherent because the individual is attempting to express so many exciting ideas at once flight of ideas o Hypomanic Episodes o Less severe version of mania o No marked impairment o Must last only 4 days o Hypomanic disorders are not in themselves problematic but its presence does contribute to the definition of several mood disorders 3 What is the difference between single episode and recurrent major depressive disorder Major depressive disorder single episode o Characterized by the absence of manic or hypomanic episodes before or during the disorder o An occurrence of just 1 isolated depressive episode in a lifetime is now known to be relatively rare because recurrences are common Major Depressive disorder recurrent o Defined by the occurrence of 2 or major depressive episodes separated by at least 2 months