Psychology 2070A/B Lecture Notes - Lecture 1: Tricyclic Antidepressant, Comorbidity, Remittance
29 May 2018
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53456p-=p-Chapter 7: Mood Disorders and Suicide
Chapter 7 (212-234)
Understanding and Defining Mood Disorders
An Overview of Depression and Mania
• Mood disorders (Depressive Disorders, Affective Disorders, Depressive Neuroses): characterized
by gross deviations in mood
• Depression and mania contribute to mood disorders singly or together
• Major Depressive Episode → an extremely depressed mood state that lasts at least 2 weeks and
includes cognitive symptoms (feelings of worthlessness/indecisiveness) and disturbed physical
function (altered sleeping patterns, changes in appetite/weight, loss of energy) to the point that
even the slightest activity or movement requires an overwhelming effort.
o Most commonly diagnosed and most severe depression
o Accompanied with general loss of interest
o Inability to experience pleasure
o Physical changes → somatic or vegetative symptoms (central indicators of full
depressive episode) along with the ehaioal ad eotioal shutdo,
o Anhedonia: loss of energy and inability to engage in pleasurable activities or have fun
▪ State of low positive affect and not just high negative affect
• Manic Episode → second fundamental state in mood disorders is abnormally exaggerated
elation, joy, euphoria
o Find extreme pleasure in every activity
o Hyperactivity
o Require little sleep
o Develop grandiose ideas (believe they can accomplish anything they desire)
▪ pesistetl ieased goal-dieted atiit o eeg
o Rapid speech and may become incoherent
o Flight of Ideas: attempting to express so many exciting ideas at once
o Duration of 1 week
▪ Less is if the episode is server enough to cause hospitalization
• Hypomanic Episode → less severe version of a manic episode the does not cause marked
impairment in social or occupational functioning
o Duration of 4 days
The Structure of Mood Disorders
• Individuals who experience either depression or mania → Unipolar mood disorder
o Mood remains at one pole of the depression-mania continuum
• Someone who alternates from one side of the pole to the other is said to have bipolar mood
disorder
• Bipolar Mood Disorder label a e isleadig…
o Depression and elation may not be at opposite ends
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o Can experience mania but feel depressed and anxious
o Can experience depression with bouts of mania
▪ Episode characterized as having Mixed Features
• Manic episode characterized by dysphoric (anxious/depressive) features are common
• Bipolar depressed episodes also had manic symptoms
o Flight of ideas
o Distractibility
o Agitation
• In DSM-5 the term ied featues euies speifig hethe a pedoiatl ai ad
predominantly depressive episode is present, and then noting if enough symptoms of the
opposite polarity are present to meet the mixed features criteria.
• Temporal course (recurrence and remittance)
o Treatment to help relieve depressive episode but also prevent future episodes
Depressive Disorders
• Differ in frequency and severity
o Chronic (almost continuous) or non-chronic
• Most important descriptor of mood disorders is severity and chronicity
• CLINICAL DESCRIPTIONS
o Major Depressive Disorder (MDD): absence of manic or hypomanic episodes before or
during disorder
▪ Rare to have one isolated depressive episode in a lifetime
o Recurrent → patient has 2 or more Major Depressive Episodes (MDE) separated by at
least 2 months
▪ Important in predicting future course and choosing appropriate treatment
▪ 35% - 85% with singe-episode occurrences of MDD experience a second episode
▪ Risk of reoccurrence is 20% in first year, rises to 40% in second year
o Unipolar depression is a chronic condition (waxes and wanes but seldom disappears)
o Median lifetime number of MDE → 4-7 episodes
▪ 25% experienced 6 or more
o Median duration of recurrent MDE → 4-5 months
o Persistent Depressive Disorder (PDD) (dysthymia): depressed mood that continues at
least 2 years, during which patient cannot be symptom free for more than 2 months at a
time even though they may not experience all of the symptoms of MDD
▪ shares symptoms with MDD but differs in course
▪ Fewer symptoms but depression remains unchanged over long periods of time
(20-30 years)
▪ Considered more severe
• Higher rates of comorbidity with other mental disorders
• Less responsive to treatment
• Slower rate of improvement over time
o 22% of people suffering from persistent depression with fewer symptoms (called
dysthymia) eventually experienced a major depressive episode
o Double Depression: typified by MDE super imposed over a background of PDD
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▪ also alled Pesistet Depessie disode ith iteittent major depressive
episodes
▪ suffer from both major depressive episodes and persistent depression with
fewer symptoms.
o Types of PDD;
▪ Mild depessie sptos ithout a ajo depessie episodes ith pue
dsthi sdoe
▪ Mild depressive symptoms with additional major depressive episodes occurring
iteittetl peiousl alled doule depessio
▪ Majo depessie episode lastig 2+ eas ith pesistet ajo depessie
episode
Additional Defining Criteria for Depressive Disorders
• 8 basic specifiers (symptoms) that accompany depressive disorders
o Psychotic Features specifiers: Major depressive episodes which also include some
psychotic features;
▪ Hallucinations → seeing or hearing things that ae’t thee audito
hallucination,
▪ Delusions → strongly held but inaccurate beliefs (somatic/physical delusions)
▪ Mood Incongruent → hallucinations or delusions that are not consistent with
the depressed mood (signifies serious type of depressive episode that may
progress to schizophrenia)
▪ Delusions of grandeur → unfounded belief that one is more famous/important
than is true (mood congruent with manic episode)(mood incongruent with
depressive episodes)
o Anxious Distress Specifier: the presence and severity of accompanying anxiety
(comorbid aniet disode o aiet sptos that do’t eet iteia fo disode
▪ Presence of anxiety indicates a more severe condition
▪ Makes suicidal thoughts and complete suicide more likely
▪ Predicts poorer outcome for treatment
o Mixed Features Specifiers: depressive episodes that have several (@ least 3) symptoms
of mania
o Melancholic Features Specifier: applies only if full criteria for MDE have been met
▪ Severe somatic/physical symptoms → early morning awakenings, weight loss,
loss of libido, excessive/inappropriate guilt, anhedonia
o Catatonic Features Specifier: involves an absence of movement (stuporous state) or
catalepsy (muscles are waxy and semi-rigid—patients limbs remain in any position in
which they are placed
▪ Associated with schizophrenia
▪ More common in depression than schizophrenia
▪ Coo ed state eatio to feeligs of iiet doo
o Atypical Features Specifier: applies to depressive episodes (whether in context of PDD
or not)
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Document Summary
Less is if the episode is server enough to cause hospitalization: hypomanic episode less severe version of a manic episode the does not cause marked impairment in social or occupational functioning, duration of 4 days. Incidence of depression and consequent suicide are steadily increasing: duration for first episode is 2-9 month if untreated, onset before the age of 21 years old (or earlier) is associated with these characteristics, 1. ) Relatively poor prognosis (poor response to treatment: 3. ) Increased risk to develop bipolar i or bipolar ii. Life span developmental influences on mood disorders: may believe that depression requires some experience with life and an accumulation of negative events or disappointments, not necessarily true, evidence that 3 month old babies can become depressed. In the elderly: late onset depression is associated with marked sleep difficulties, illness anxiety disorders, and agitation, depression can attribute to physical disease, anxiety frequently accompanies depression, first time the sex ratio for depression is balanced.
