1 Mood Disorders a Two broad types Abnormal Psych Test 2 Chapter 5 Involves only depressive symptoms Involves manic symptoms bipolar disorders and usually also involved depressive symptoms i ii iii What factors contribute to onset of mood disorders 1 Neurobiological factors 2 Psychosocial factors b Depression is common i Lifetime prevalence 16 2 MDD 2 5 Dysthymia twice as common in women than men three times as common among people in poverty People who move to the U S from Mexico have lower rates than people of Mexican descent who were born in the United States 1 2 3 4 5 c Depressive Disorders i Major Depressive Disorder Key changes differential diagnosis of bereavement related symptoms described in more details 1 2 Major features five or more depressive symptoms including sad mood or loss of pleasure for 2 weeks 3 Symptoms 5 or more sx at least 1 is sad mood or loss of pleasure a sad mood or loss of interest or pleasure anhedonia i ii symptoms are present nearly every day most of the day for at least 2 weeks loss in pleasure of activities usually enjoyed b PLUS the following symptoms i Sleeping too much or too little ii Psychomotor retardation or agitation iii Poor appetite and weight loss or increased appetite and weight gain iv v Feelings of worthlessness or excessive guilt vi Difficulty concentrating thinking or making decision vii Recurrent thoughts of death or suicide Loos of energy 4 Episodic 5 Recurrent a Symptoms tend to dissipate over time a Once depression occurs future episodes are likely b Average number of episode is 4 ii Persistent Depressive Disorder PDD used to be called dysthymia Key changes chronic major depressive disorder and dysthymia are merged into this new diagnosis 1 2 Major features low moo and at least two other symptoms of depression at least half of the time for 2 weeks 3 Symptoms a Depressed mood for at least 2 years 1 year for children adolescents b PLUS 2 other symptoms i Poor appetite or overeating ii Sleeping too much or too little iii Poor self esteem iv Trouble concentrating or making decisions v Feelings of hopelessness iii Premenstrual Dysphoric Disorder In a 10 yr study 95 of patients with dysthymic disorder developed MDD 4 5 Combines two disorders formerly named dysthymia and major depressive disorder DSM 5 does not distinguish between chronic MDD and dysthymia a Chronicity of symptoms stronger predictors of negative outcomes than number of symptoms Key changes moved from the DSM IV appendix to the main body 1 2 Major features depressive or physical symptoms in the week before menses 3 Symptoms In most menstrual cycles during the past year at least five of the following symptoms were present in the final week before menses and improved within a few days of menses onset a Affective lability b c Depressed mood hopelessness or self deprecating thoughts Irritability Difficulty concentrating Lack of energy d Anxiety e Diminished interest in usual activities f g h Changes in appetite overeating or food craving i j k 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 iv Disruptive Mood Dysregulation Disorder DMDD Key changes new category for DSM 5 1 2 Major features severe recurrent temper outburst and persistent negative mood for at least 1 year beginning before age 10 3 Children Adolescents 4 DMDD is intended to capture children with frequent temper tantrums and irritability in part to prevent the over diagnosis of bipolar disorder in youth Symptoms 5 a Severe recurrent temper outbursts in response to common stressors including verbal or behavioral expressions of temper that are out of proportion in intensity or duration to the provocation Temper outbursts are inconsistent with developmental level The temper outbursts tend to occur at least three times per week b c d Persistent negative mood between temper outbursts most days and the negative mood is observable e f to others These symptoms have been present for at least 12 months and do not clear for more than 3 months at a time Temper outbursts or negative mood are present in at least two settings at home at school or with peers and are severe in at least in one setting g Age 6 or higher or equivalent developmental level h Onset before age 10 i The onset of symptoms must be before age 10 and a diagnosis should not be made for the first time before age 6 or after age 18 d Bipolar Disorders i Mania 1 2 What kind of sleeping problems are associated with mania State of intense elation or irritability a You don t sleep but you re still full of energy ii Hypomania 1 Hypo under 2 3 Does not involve significant impairment mania does Symptoms of mania but less intense iii DSM 5 manic and hypomanic episodes 1 Distinctly elevated or irritable mood for most of the day nearly every day 2 Abnormally increased activity and energy 3 At least three of the following are noticeably changed from baseline four if mood is irritable Increase in goal directed activity or psychomotor agitation Flight of ideas or subjective impression that thoughts are racing a b Unusual talkativeness rapid speech c d Decreased need for sleep e f g Increased self esteem belief that one has special talents powers or abilities Distractibility attention easily diverted Excessive involvement in activities that are likely to have undesirable consequences such as reckless spending sexual behavior or driving 4 For manic episodes a b c Symptoms last for 1 week or require hospitalization Symptoms cause significant distress or functional impairment May have psychosis 5 For hypomanic episodes Symptoms last at least 4 days a b Clear changes in functioning that are observable to others but impairment is not marked c No psychotic symptoms are present iv Bipolar I Disorder severe mania 1 Key changes abnormally increased activity or energy included as a required symptom of mania 2 Major features at least one lifetime manic episode 3 Has the most extreme mania 4 Usually involve episodes of depression alternating with mania a Depressive episode required for Bipolar II but not Bipolar I b but almost everyone who has had a manic episode will have a depressive episode 5 At least one episode of severe mania v Bipolar II Disorder hypo mania severe depression Key changes abnormally increased activity or energy included as a required symptom of hypomania 1 2 Major features at least one lifetime hypomanic episode and one major
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