Lecture 4-Mood Disorders Feb 1

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16 Aug 2010
Lecture 4
Base rate of disorder and treatment rate. Chapter 8 not included. 60 multiple choice questions.
Mood disorders:
- Many people will experience sadness but not be diagnosed with depression. Characteristics,
behaviors, bodily function effective when in a depressed state. depression is a huge
problem. Number 1 reason for disability worldwide. 40 billion $ loss in country-cost
associated with depression and loss productivity. Canadian data suggest that it cost Canada
2.6 billion associated with depression in 1998. Workplace and depression²in employment
and continues to worsen and harder to carry out daily functions at work. one in five
Canadians indicate symptoms led to a severe interference in ability to do their work.
- 2 major depressive disorder: unipolar (major depression) and bipolar disorder.
Criteria for major depressive episodes
- Depressed mood everyday for most part of the day 2 weeks straight. Few things brighten
- Diminished interest or pleasure in almost all activities.
- Trouble sleeping. Insomnia or hypersomnia. Loss of 2 or more hours a night over sleeping
- Agitation (trouble sitting still) and irritated. Psychomotor agitation or retardation nearly every
- Fatigue or loss of energy nearly everyday
- Feelings of worthlessness or inappropriate guilt (cognitive symptom) focus on past regrets
that they made, color cognitive lens.
- Diminished ability to concentrate or indecisiveness. No concentration of conversations, read
passage from book no remember. Indecisive²even simple things like what I should wear
suicidal process. Some might have a recent suicide attempt.
- DSM-4 2 of the above and 5 other symptoms without an other event causing it such as
substance abuse.
Major depressive disorder
- Statistics: the life time prevalence rate 12.2 %. 12 month period about 8% will get
depressed (incidence-
- More commonly diagnosed. Twice as common in women
- Recurrent nature: 80% will have another episode
- Median life time episode: 4 depressive episode( in a life time) on average will last for 5
months (duration)
- Depression last after 2 years becomes chronic in 15% of patients
- Onset of depression continues to occur earlier in age. Rate of depression increasing and
increasing in those in younger age
- 1 month incidence of being depressed. 15-24 highest. Midlife 45-54 depression rate lowest.
- Clinician needs to determine whether is it a single episode. Absence of hypomania or
mania. 80% will get recurrent type.
Dysthymic disorder:
- mild depression about 50% of the time. Distinct from a real low episode of depression, rating
of major depressive disorder but not as severe. Has to be present for a two year period. The
symptoms are milder and fewer, but they are more chronic.
- Trouble distinguishing b/w dysthymic disorder and major depression.
o Major depressive disorder
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o Dsythymic disorder
o Major depressive disorder in partial recession
o Double depression-dysthymia and superimposed depression²presentation of a lot
of psychopathology-beyond mood problem itself. prognosis much worse-more
chronic and less likely to respond to treatment.
o Dysthymia with past history of depression
Bipolar disorder
- Alternating of manic episodes (grandiose state) to extreme despair. Bipolar I: involves
episodes of mania or mixed episodes that include symptoms of both mania and depression
Criteria for manic episode
- Elevated or irritable mood. Abnormally and persistently elevated, expansive or irritable mood
- Gradiosity: inflated view of RQV self.
- Decrease need of sleep. Sleep for a few hours
- Extremely talkative: rate of speech and the conversation
- Flight of ideas or racing thoughts. No being able to keep up with thoughts. Apparent to
interviewer. Thought loosely connected
- Distractibility: stimuli in the environment WKDWGRHVQ¶WKDYHPXFKLPSRUWDQFHFDWFKHVWKH
attention of the patient
- Engage in risky behaviors, bad decisions (sexual indiscretions, buying sprees, and foolish
- 1st symptom Elevated mood and 3 or more symptoms. Last for 7 days. Outcomes severe²
usually lands in a hospital.
- Greater overrepresentation diagnosed with bipolar in the creative arts.
- Bipolar I prevalence is 1% avg person develops it in their 20 (peak of onset) disorder is
common in both men and women. Disorder continues to be recurring (50% will have either 4
recurring manic or depressive episodes)
- Bipolar II
o Less severe form of bipolar I. bipolar II hypomanic episodes, not full fledged mania.
Hypomanic episodes last for 4 days and less symptoms, not as severe consequence
as manic episode. Elevated state but no serious outcomes.
- Clythomic disorder
o Rarely seen and diagnosed. Person alternates b/w manic and depressed state, but
none meet the DSM criteria. Person moves mild depression and hypomania. If some
is diagnosed with this condition it has to last for 2 years. it is chronic. People seem
develop bipolar disorder.
- 10-13 % of people diagnosed with bipolar 2 tend to become bipolar 1
- When diagnosing a mood disorder: other features of mood disturbances must be considered
o Atypical presentation: major depression and bipolar 1. Tendency to oversleep,
overeat. Gain a lot of weight and a lot of anxiety.
o Melancholy: more severe semantic symptoms. Weight loss, loss of sex drive.
Reduce ability to enjoy pleasurable things. Occurs more in the elderly. Trigger less
by stressors. More biological vulnerability. No as much stress events
o Chronic: depressive episode for 2 yrs or more
o Catatonic features: absent of movement. Person sitting fixed, hunched over
o Psychotic depression: 5-15% who become depressed will have psychotic feature of
depression with hallucinations and delusions. Combine antidepressants with
antipsychotic meds
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