amenorrhealow body temperaturemetabolic & electrolyte imbalanceTEST 2 STUDY GUIDEChapter 6: Mood Disorders & Suicide1. BE FAMILIAR WITH THE DIAGNOSTIC CRITERIA, TREATMENT (e.g., 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 followingweight/appetite changesleep disturbancefatigue/energy losspoor concentrationpsychomotor agitation/retardationworthlessness/guiltthoughts of death/suicidepresent for at least 2 weeks4-9 months untreatedno manic/hypomanic episodes treatment:medical:SSRIs (Prozac)tricyclic antidepressants (Tofranil, Elavil)monoamine oxidase inhibitorsatypicals/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 Therapyaddresses errors in thinking1Behavioral ActivationInterpersonal Psychotherapyfocuses on problematic interpersonal relationshipscombined treatmentsrelapse prevention prevalence:lifetime- 16%females twice as likely as malesadolescents and adults have highest ratechildren and older adults have low ratesDysthymic 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 hoplessnessduring the 2+ years of disturbance, person has not been without the symptomsfor more than 2 months at a timeno major depressive episode has been present during this periodno manic episode has occurred, and criteria have not been met for cyclothymic disordersymptoms are not caused by the direct physiological effects of a substance or a medical conditionclinically significant distress or impairment of functioning treatment:see “treatment” under Major Depressive Disorder prevalence:lifetime- 3.5%females twice as likely as menalthough 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: full manic episode + Major Depressive Episode treatment:medical: “mood stabilizers”lithium (a common salt)side effects may be severeprimary drug of choice2why it works remains unclearanticonvulsants (Carbamazepine, Valproic Acid)psychosocial: (as an adjunct to meds)Interpersonal & Social Rhythm Therapystabilize social routines and sleep-wake habitseffectiveness not yet knownPsychoeducationFamily-focused therapy prevalence:lifetime- 1%women and men equal in prevalenceonset- ages 15-18Bipolar Disorder II diagnosis criteria:hypomanic episode + MDE treatment:same as treatment for BDI prevalence:same as BDIexcept, onset- ages 19-22Cyclothymic Disordermilder yet more chronic bipolar disorder diagnosis criteria:remain in one mood state for several years with very few periods of euthymic (normal) moodnumerous periods with hypomanic symptoms and depressive symptoms (that don’t meet criteria for a major depressive episode) treatment:same as BDI prevalence:same as BDIexcept, onset- ages 12-14Etiology of Mood Disordersbiological:genetic (depression, anxiety)neurotransmitter systems (serotonin, norepinephrine, dopamine imbalances)endocrine system (cortisol)sleep and circadian rhythmspsychological:stressful life eventslearned helplessnesscognitive vulnerabilities3social and cultural:marital relationsgenderpresence of social support2. Describe depressive episodes, manic episodes, and hypomanic episodes. How longdo depressive and manic episodes typically last? (Also know how long must manic, hypomanic, and depressive episodes last according to diagnostic criteria.) - Depressive Episodeso The most commonly diagnosed and most severe depressiono Can be severe to the point that even the slightest activity or movement takes overwhelming efforto Episode accompanied by general lost of interest in things and inability to experience any pleasure in lifeo The physical changes are most important because general feelings of sadnessor crying also occur equally in nondepressed individuals Ex: loss of energy and inability to engage in pleasurable activities- anhedoniao Overall, characterized by depressed mood or anhedonia plus 4 or more of thefollowing (present for at least 2 weeks) weight/appetite change sleep disturbance fatigue/energy loss poor concentration psychomotor agitation/retardation worthlessness/guilt thoughts of death/suicideo the duration of a Major Depressive Episode, if untreated, is 4-9 months- Manic Episodeso Elevated/irritable mood + at least 3 symptoms below for 1 week Inflated self-esteem/grandiosity Degreased need for sleep Excessive talkativeness Flight of ideas/racing thoughts Highly distractible Increase in goal-directed activity/psychomotor agitation- Excessive involvement in pleasurable activities with risk for bad outcomeso Impairment, hospitalization, or psychotic symptomso Individuals find extreme pleasure in every activity4 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 Episodeso Less severe version of maniao No marked impairmento Must last only 4 dayso Hypomanic disorders are not in themselves problematic, but its presence does contribute to the definition of several mood disorders3. What is the difference between single episode and recurrent major depressive disorder? - Major depressive disorder, single episodeo Characterized by the absence of manic or hypomanic episodes before or during the disordero An occurrence of just 1 isolated depressive