PSYC3102 Lecture Notes - Lecture 5: Major Depressive Disorder, Mood Swing, Psychomotor Agitation
Lecture 5 – Bipolar and depressive disorders
●Mood: a pervasive and sustained emotional response that can colour perception
●Leading causes of disability worldwide as measured by years of life lived with a
disability (Andrews, 2007)
○Depression – first on the list at 9.4 years
Epidemiology
●Bipolar I and II disorders combined
○Lifetime risk: ~4%
○Equal prevalence for males and females
●Unipolar disorders
○Lifetime prevalence: ~6%
○More prevalent in females
●Persistent depressive disorder prevalence
○Prevalence: ~3% of all adults
○More prevalent in females
●No race, urban/rural or socioeconomic status distinctions for mood disorders
Depressive disorders
●Disruptive mood dysregulation
●Premenstrual dysphoria
●Other depressive disorders
○Due to general medical condition
○Substance-induced
○Other specified depressive disorder
○Unspecified depressive disorder
Depression
●Major depressive disorder (example: https://youtu.be/se6YOQ4oHzc)
○DSM-5 criteria
A. Five (or more) present during same two week period and represents
change from previous functioning; at least one of the symptoms is either
(I) depressed mood or (II) loss of interest or pleasure
1. Depressed mood
2. Diminished interest or pleasure
3. Significant weight loss or gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue
7. Feelings of worthlessness or excessive/inappropriate guilt
8. Diminished ability to concentrate/indecisiveness
9. Recurrent thoughts of death/suicidality
B. Cause clinically significant distress or impairment in functioning
C. Not attributed to substance or another medical condition
■Presence of at least one Major Depressive Episode
■Not better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified and
unspecified schizophrenia spectrum and other psychotic disorder
■Never been a manic or hypomanic episode
■Specifiers describing most recent episodes e.g.
●Severity/psychotic/remission
●With anxious distress
●With catatonia
●With postpartum onset
●Persistent depressive disorder (dysthymic disorder)
○DSM-5 criteria
A. Present for at least two years (one year in children & adolescents)
B. Presence, while depressed, of two or more of the following
●Poor appetite or overeating
●Insomnia or hypersomnia
●Low energy or fatigue
●Low self-esteem
●Poor concentration or difficulty making decisions
●Feelings of hopelessness
C. Not without symptoms for a two month period
D. Major depressive disorder may be present for two years
E. Never met criteria for manic episode, hypomanic or cyclothymic disorder
F. Not better accounted for by another disorder
G. Not attributed to substance or another medical condition
H. Causes clinically significant distress or impairment
○Differential diagnosis
■Medical conditions
●Neurological problems
○Parkinson’s disease
○Dementing illness
○Epilepsy
○Stroke
○Tumours
●Pharmacological agents e.g. illicit prescription drugs
●Psychiatric disorders e.g. bipolar disorder
■Common comorbidities
●Eating disorders
●Personality disorders
●Schizophrenia
●Alcohol and drug abuse
●Anxiety disorders
●Course
○50% have their first depressive episode before 40
○Untreated episode lasts 6-13 months
○Most treated episodes last ~3 months
○Withdrawal of antidepressants less 3 months upon starting may lead to relapse
○5-10% with an initial diagnosis of MDD have a manic episode 6-10 years after
first episode of depression
●Prognosis
○MDD is fundamentally a cyclic disorder
○Risk of recurrence increased by:
■History of more than one previous depressive episode
■Coexisting
●Dysthymia
●Alcohol and/or drug abuse
●Anxiety symptoms
Bipolar and related disorders
Bipolar disorders
●Bipolar I
○Must have had at least one manic episode for diagnosis
○Most recent episode specifiers
■Manic
A. Distinct period of abnormally and persistently elevated,
expansive or irritable mood & goal-directed activity, energy – at
least one week
B. Three or more of the following:
○Inflated self-esteem/grandiosity
○Decreased need for sleep
○Increased speech, talkativeness, or pressure of speech
○Flight of ideas or racing thoughts
○Distractibility – reported or observed
○Increased goal-directed activities or psychomotor
agitation
○Excessive involvement in pleasurable activities with high
potential for painful consequences
Document Summary
Mood: a pervasive and sustained emotional response that can colour perception. Leading causes of disability worldwide as measured by years of life lived with a disability (andrews, 2007) Depression first on the list at 9. 4 years. No race, urban/rural or socioeconomic status distinctions for mood disorders. Insomnia or hypersomnia: fatigue, feelings of worthlessness or excessive/inappropriate guilt, diminished ability to concentrate/indecisiveness, recurrent thoughts of death/suicidality, cause clinically significant distress or impairment in functioning, not attributed to substance or another medical condition. Presence of at least one major depressive episode. Not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorder. Never been a manic or hypomanic episode. Specifiers describing most recent episodes e. g. severity/psychotic/remission. Dsm-5 criteria: present for at least two years (one year in children & adolescents, presence, while depressed, of two or more of the following. 50% have their first depressive episode before 40.
