Chapter 5 Mood Disorders Mood disorders involve disabling disturbances in emotion from the extreme sadness and disengagement of depression to the extreme elation and irritability mania Symptoms an observable physiological or psychological manifestation of a disease Two broad types Involves only depressive symptoms Involves manic symptoms bipolar disorders Depressive Disorders Major depressive disorder Bereavement related symptoms are no longer excluded Major Features Five or more depressive symptoms including sad mood or loss of pleasure for 2 weeks Dysthymia is now Persistent Depressive Disorder PDD Chronic major depressive disorder is included in dysthymia Major Features Low mood and at least two other symptoms of depression at least half of the time for 2 years DSM 5 Adds two new depressive disorders Premenstrual dysphoric disorder Major Features Depressive or physical symptoms in the week before menses Disruptive mood dysregulation disorder Is intended to capture children with frequent temper tantrums and irritability in part to prevent overdiagnosis of bipolar disorder in youth Major Features Severe recurrent temper outburst and persistent negative mood for at least 1 year before age 10 Major Depression Sad mood OR loss of interest or pleasure anhedonia Symptoms are present nearly everyday most of the day for at least 2 weeks Plus 4 of the following symptoms 1 Sleeping too much or too little 2 Psychomotor retardation or agitation 3 Poor appetite and weight loss or increased appetite and weight gain 4 Loss of energy 5 Feelings of worthlessness or excessive guilt 6 Difficulty concentrating thinking or making decisions 7 Recurrent thoughts of death or suicide Persistent Depressive Disorder Dysthymia Chronic depressive disorder Depressed mood or at least 2 years 1 year for children adolescents Plus 2 of the following symptoms 1 Poor appetite or overeating 2 Sleeping too much or too little 3 Poor self esteem 4 Trouble concentrating or making decisions 5 Feelings of hopelessness Premenstrual Dysphoric Disorder In most menstrual cycles during the past year at least 5 of the following symptoms were present in the final week before menses and improves within a few days of menses onset 1 Affective lability 2 Irritability 3 Depressed mood hopelessness or self deprecating thoughts 4 Anxiety 5 Diminished interest in usual activities 6 Difficulty concentrating 7 Lack of energy 8 Changes in appetite overeating or food craving 9 Sleeping too much or too little 10 Subjective sense of being overwhelmed or out of 11 Physical symptoms such as breast tenderness or swelling joint muscle pain or bloating control Mood Dysregulation Disorder Child Adolescent Diagnosis was developed because of the over diagnosis of childhood bipolar disorder 1 Severe recurrent temper outburst in response to common stressors including verbal or behavioral expressions of temper that are out of proportion in intensity or duration to the provocation 2 Temper outburst are inconsistent with development level 3 The temper outbursts tend to occur at least 3 times per week Persistent negative mood between temper outbursts most days and the negative mood is observable to others 4 These symptoms have been present for at least 12 months and do not clear for more than 3 months at a time 5 Temper outburst or negative mood are present in at least two settings at home at school or with peers and are severe in at least one settin 6 Age 6 or higher or equivalent developmental level 7 Onset before age 10 and a diagnosis should not be made for the first time before the age of 6 and after age 18 Bipolar Disorders Mania state of intense elation or irritability Hypomania hypo under hyper above symptoms of many but less intense Does not involve significant impairment mania does Bipolar I Abnormally increased activity and energy included as a required symptom of mania Major Features at least one lifetime manic episode Bipolar II Disorder Abnormally increased activity and energy included as a required symptom of hypomania Major Features At least one lifetime hypomanic episode and one major depressive episode Cyclothymia No key changes Major Features Recurrent mood changes from high to low for at least 2 years without manic or depressive episodes Cycle up and down between hypo mania and mild depression Mania is a defining feature of each differentiated by severity and duration of mania 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 3 of the following are noticeably changed from baseline 4 if mood is irritable 1 Increase in goal directed activity or psychomotor 2 Unusual talkativeness rapid speech 3 Flight of ideas or subjective impression that thoughts are racing 4 Decreased need for sleep 5 Increased self esteem belief that one has special talents powers or abilities 6 Distractibility attention easily diverted 7 Excessive involvement in activities that are likely to have undesirable consequences such as reckless spending sexual behavior or driving 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 Clear changes in functioning that are observable to others but impairment is not marked Ex Some people actually get more stuff done No psychotic symptoms are present Describe Aaron Beck s Cognitive Theory regarding Depression Negative Triad negative views of the self the world and the future The world part of the depressive triad refers to the person s own corner of the world the situations he or she faces For example people might think I cannot possibly cope with all these demands and responsibilities as opposed to worrying about about problems in the broader world outside of their life Martin Seligman Attribution Theory Attributions are the explanations a person forms about why a stressor has occurred Stable permanent versus unstable temporary causes Global relevant to many life domains versus specific limited to one area causes Susan Nolen Hoeksema Rumination Rumination is the natural instinct to dwell on the sources of problems rather than their possible solutions A specific way of thinking tendency to repetitively dwell on sad thoughts Most detrimental is to brood over causes of events Lynn Abramson Hopelessness Theory Hopelessness is the most important trigger of depression It is defined as
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