FSU CLP 4143 - Chapter 5 – Mood Disorders

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Abnormal Exam 2 Chapter 5 Mood Disorders Two broad types o Involving only depressive symptoms o Involves manic symptoms bipolar Major Depressive Disorder MDD o Sad mood OR loss of interest or pleasure anhedonia o Symptoms are present nearly every day most of the day for at least two weeks o Not due to normal bereavement o Four of the following symptoms o Sleeping too much too little o Psychomotor retardation or agitation o Poor appetite and weight loss or increased appetite and weight gain o Loss of energy o Feelings of worthlessness or excessive guilt o Difficulty concentrating thinking or making decisions o Recurrent thoughts of death or suicide o Episodic symptoms tend to be present for a period of time then clear and dissipate over o Chronically depressed more than half of the time for at least 2 years they feel blue or time o Once depression occurs future episodes are likely o Average number of episodes is 4 Dysthymia Chronic Depressive Disorder derive little pleasure from usual activities and pastimes o 1 year for children adolescents o Must have two of the other symptoms of depression o Poor appetite overeating o Sleeping too much or too little o Poor self esteem o Trouble concentrating or making decisions o Feelings of hopelessness DSM does not distinguish between chronic MDD and dysthymia o How chronic the symptoms are is more of predictor of negative outcomes than number of symptoms o 10 year study 95 of patients with dysthymic disorder developed MDD DSM 5 criteria for Premenstrual Dysphoric Disorder o In most menstrual cycles during past year at least 5 of the following symptoms were present in the final week before menses and improved within a few days of menses onset o Affective lability o Irritability o Depressed mood hopelessness or self deprecating thoughts o Anxiety o Diminished interest in usual activities o Difficulty concentrating o Lack of energy o Changes in appetite overeating or food craving o Sleeping too much or too little o Subjective sense of being overwhelmed or out of control o Physical symptoms such as breast tenderness or swelling joint or muscle pain or bloating o Symptoms significant distress of functional impairment o Not an exacerbation of another mood or personality disorder o Confirmed with prospective daily ratings over two cycles o Present when oral contraceptives are not being taken DSM 5 criteria for Disruptive Mood Dysregulation Disorder children adolescents o Severe recurrent temper outbursts in response to common stressors verbal behavioral expressions of temper that are out of proportion in intensity or duration to the provocation o Temper outbursts are inconsistent with development level o The temper outbursts tend to occur at least 3 times per week with persistent negative mood between temper outbursts most days and the negative mood is observable to others o These symptoms have been present for at least 12 months and do not clear for more than 3 o Temper outburst or negative mood are present in at least two settings and are severe in at least months at a time one setting o Age 6 or higher or equivalent developmental level can t diagnose after 18 o Onset before age 10 Epidemiology and Consequences of Depressive Disorders o Depression is very common o 16 2 meet criteria for MDD at some point in their lives o 2 5 meet criteria for dysthymia at some point in their lives o Twice as common among women as among men o Three times as common among people who are impoverished o Prevalence varies across cultures 1 5 in Taiwan 19 in Beirut Lebanon People who have moved to the US from Mexico have lower rates than people of Mexican descent who were born in the US o Symptoms variation across cultures Latino complaints of nerves and headaches Asian complaints of weakness fatigue and poor concentration Closer to the equator longer day length and high fish consumption associated with lower rates of MDD o Symptoms variation across life span Children stomach and headaches Older adults distractibility and forgetfulness o Comorbidity 2 3 of those with MDD will also meet criteria for another anxiety disorder at some point in their lives Bipolar Disorders o Three forms o Bipolar I Bipolar II and Cyclothymia o All have mania Differentiated by severity and duration of mania Usually involves episodes of depression alternating with mania o Depressive episode required for Bipolar II NOT Bipolar I o Mania state of intense elation or irritability o Hypomania symptoms of manic but less intense o Does not involve significant impairment but mania does o Proposed DSM 5 Criteria for Manic and Hypomanic episodes o Distinctly elated or irritable mood for most of the day nearly every day o Abnormally increased activity or energy o At least 3 of the following are noticeably changed from baseline 4 if mood is irritable Increase in goal directed activity or psychomotor agitation Unusual talkativeness rapid speech can t talk fast enough pressured speech Flight of ideas or subjective impression that thoughts are racing Decreased need for sleep diagnostic Increased self esteem belief that one has special talents powers or abilities usually unrealistic Distractibility attention easily diverted Excessive involvement in activities that are likely to have undesirable consequences such as reckless spending sexual behavior or driving o For manic Symptoms last for 1 week or require hospitalization Symptoms cause significant distress or functional impairment Hard to assess with lack of social relationships o For hypomanic episodes Symptoms last at least 4 days Clear changes in functioning that are observable to others but impairment is not marked No psychotic symptoms are present o Bipolar I at least one episode of mania o Bipolar II at least one major depressive disorder with at least one episode of hypomania o Cyclothymic disorder o Milder chronic form of bipolar disorder o Lasts at least 2 years in adults 1 year in children adolescents o Numerous periods with hypomanic and depressive symptoms o Does not meet criteria for mania or major depressive episode o Symptoms do not clear for more than 2 months at a time o Epidemiology and Consequences of Bipolar Disorder o Prevalence rate for Bipolar is lower than MDD 1 in US 6 worldwide for Bipolar I 4 2 for Bipolar II 4 for Cyclothymia o Average age of onset is 20s o No gender differences Women experience more depressive episodes o A severe mental illness 1 3 are unemployed a year after hospitalization High suicide rates o Etiology of


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FSU CLP 4143 - Chapter 5 – Mood Disorders

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