Chapter 11 Mood Disorders and Suicide 1 Diagnosis of Mood Disorders a Mood Episodes i Mood disorders area defined by various combinations of mood episodes that function somewhat like diagnostic building blocks 1 Include major depressive episode manic episode and hypomanic episode a Do constitute diagnoses themselves but their presence or absence is essential in most mood disorder diagnosis ii Major Depressive episode symptoms 1 Episode involves a 2 week period of nearly constant depressive a Sadness loss of interest or pleasure adhedonia change in weight changes in sleep loss of energy agitated or slow movement difficulty concentrating guilt and or thoughts of death b Melancholia particular deep level of depression characterized by absence of interest or pleasure in all things changes in sleep changes in weight and or excessive guilt 2 Major depressive episode is distinguished by its length degree of disturbance and the impairment it causes life because occasionally people experience depression a nearly constant for 2 weeks b c at least 5 symptoms are present symptoms must represent a change from previous functioning 3 Most common depressive episode symptoms a Appetite usually decreases but in some cases increases i Weight may change in accordance to this b Sleep disturbed in the form of insomnia or waking early and not being able to go back to bed i Some increase the amount they sleep c People feel fatigued tired and find common tasks exhausting d Concentration is difficult e Thinking seems slow f Tasks that are intellectually challenging are not completed or attempted g May be preoccupied with personal failure and blame themselves for any non positive event they encounter h Sense of guilt and worthlessness can combine with feelings of hopelessness and helplessness and extend to thoughts of death and suicide 4 People may experience psychotic symptoms due to major depressive episode a Guilt can be of delusional proportions i Feeling responsible for global problems b Psychotic symptoms are not included in the identification of the episode i Ex Person might think sleep might cause others to die so they don t sleep resulting loss of sleep is not included because its caused by delusion c Requires differentiation from schizoaffective disorder in which psychotic symptoms are also present in the absence of mood disorders 5 Distinction must be made between a major depressive episode and the normal depressive symptoms associated with bereavement a Normal grief reaction following death of a loved one generally does not include a strong sense of worthlessness suicidal ideation psychosis or extreme impairment b DSM IV did not diagnose Major Depressive Episode if there was c DSM V discontinued bereavement exclusion because it can serve bereavement as a trigger for MDE i Clinicians have to distinguish between normal grief from ii Depression has adhedonia people dealing with grief can grief related depression have positive emotions iii Manic Episode 1 Key feature distinct period 1 week unless the person has already required hospitalization of expansive elevated or irritable mood a Nearly the opposite of MDE b Experienced as enjoyable and euphoric i Observers think its excessive c Expansive mood i Person seems overly enthusiastic and intrusive in social interactions d Irritability is common 2 Manic episode euphoria i Frequently there are swings between irritability and a Evidence inflated self esteem b Little need for sleep c Pressured speech d Flight of ideas e Distractibility f Multi task several activities at once and seek out pleasurable activities that provide immediate gratification without regard for consequences g Usually sociable and frequently sexually indiscriminate h Angry outbursts and hostility may be part of the nearly constant flow of verbal output i Some of which is incoherent i Demeanor is dramatic and judgment is poor j Sometimes become aggressive assaultive and increase their use of alcohol and drugs k Begin rapidly and may follow exposure to stressors iv Hypomanic Episode 1 Similar to but Less severe than a manic episode a at least 3 symptoms of elevated expansive or irritable mood are required lasting at least 4 days b c no psychotic symptoms d e impairment is minimal hospitalization is not required tend to begin abruptly and may last for weeks to months i frequently preceded or followed by a major depressive episode and some people can have a manic episode 2 Mixed features specifier has been added by the DSM V for both manic and hypomanic episodes Indicated that depressive features are also present a b Depressive episodes can also have manic or hypomanic specifiers 3 Presence of any manic episode results in the Diagnosis of Bipolar 1 4 Major Depressive episode can occur in Major depressive disorder 5 Dysthymic and cyclothymic disorder involve less severe depressive Bipolar 1 and Bipolar 2 states 6 A hypomanic episode characterized Bipolar 2 disorder and to a lesser extent cyclothymic disorder 7 Mood Disorders include a variety of qualifiers a Qualifiers can include a rating of severity i High severity an indication is included as to whether psychotic symptoms are present or not b Echolia exhopraxia or disturbances in motor activity are dominant among the symptoms of bipolar 1 disorder or MDD the qualifier of with catatonic features is added c Melancholic features qualifier describes deep depression which tends to be worse in the morning and is characterized by loss of pleasure in nearly all things significant anorexia or weight loss psychomotor changes and early morning wakening i Can be seen as an indication for more active intervention including electroconvulsive therapy d Postpartum onset is added if it occurs within 4 weeks after birth e Seasonal pattern qualifier is added if it occurs at certain points in f Anxious distress qualifier is added for mood conditions with the year anxiety symptoms 2 Depressive Disorders a Major Depressive Disorder MDD i Young people have higher rates of depression than those later in life ii Diagnosis requires 1 Presence of a MDE for at least 2 weeks without a history of any manic or hypomanic episodes 2 May consist of a single depressive episode which remits and never 3 Second episode occurs although the episodes may be separated by a Depression becomes more likely to recur with each additional reoccurs several years episode iii Can be associated with general medical conditions diabetes cancer heart conditions 1 2 3 can be preceded or