PSYC 4430 Lecture 1: Chapter 6: Mood Disorders and Suicide (Chapter 6)

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15 Feb 2018
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Chapter 6: Mood Disorders and Suicide
1. Overview of Depression and Mania
a. Mood disordersgross (not normal) deviations in mood
b. Composed of different types of mood “episodes”—periods of depressed or
elevated mood lasting days or weeks, including:
i. Major depressive episodes
ii. Manic or hypomanic episodes
iii. Persistent depression
2. Types of Mood Episodes
a. Major depressive episode
i. Extremely depressed mood and/or loss of pleasure (anhedonia)
1. Lasts most of the day, nearly every day for at least 2 weeks
ii. At least 4 of these additional physical or cognitive symptoms
1. Indecisiveness
2. Feelings of worthlessness
3. Fatigue
4. Appetite change
5. Restlessness or feeling slowed down
6. Sleep disturbance
b. Manic episode
i. Elevated, expansive mood for at least 1 week
ii. Inflated self-esteem, decreased need to sleep, excessive talkativeness,
flight of ideas or sense that thoughts are racing, easy distractibility,
increase in goal-directed activity or psychomotor agitation, excessive
involvement in pleasurable but risky behaviors (e.g. sex, drugs, driving
fast, etc.)
iii. Impairment in normal functioning
c. Hypomanic episode
i. Shorter, less severe version of manic episodes
ii. Last at least 4 days
iii. Have fewer and milder symptoms
iv. Associated with less impairment than a manic episode (e.g. less risky
behaviors)
v. May not be problematic in and of itself, but usually occurs in the context
of a more problematic mood disorder
d. Mixed featuresterm for a mood episode with some elements reflecting the
opposite valence of mood
i. Example: depressive episode with some manic features
ii. Example: manic episode with some depressed/anxious features
3. Major Depressive Disorder
a. Clinical features
i. One or more major depressive episodes separated by periods of
remission
ii. Single episodes are highly unusual
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iii. Recurrent episodes are more common
b. From grief to depression
i. Previously could not be diagnosed during periods of mourning
ii. Now recognized that major depression may occur as part of the grieving
process
4. Persistent Depressive Disorder
a. At least 2 years of depressive symptoms
i. Depressed mood most of the day on more than 50% of days
ii. No more than 2 months symptom free
iii. Symptoms can persist unchanged over long periods
iv. May include periods of more severe major depressive symptoms
1. Major depressive symptoms may be intermittent or last for the
majority or the entirety of the time period
b. Types of PDD
i. Mild depressive symptoms without any major depressive episodes (with
pure dysthymic syndrome)
ii. Mild depressive symptoms with additional major depressive episodes
occurring intermittently (previously called “double depression”)
iii. Major depressive episodes lasting 2 + years (“with persistent major
depressive episode”)
5. Other Depressive Disorders
a. Premenstrual dysphoric disorder
i. Different from PMS
ii. Significant depressive symptoms occurring prior to menses during the
majority of cycles, leading to distress or impairment
iii. Controversial diagnosis
1. Advantage: legitimizes the difficulties some women face when
symptoms are very severe
2. Disadvantage: pathologizes an experience many consider to be
normal
b. Disruptive mood dysregulation disorder
i. Severe temper outbursts occurring frequently, against a backdrop of
angry or irritable mood
ii. Diagnosed only in children 6-18
iii. Criteria for manic/hypomanic episode are not met
iv. Designed in part to combat over-diagnosis of bipolar disorder in use
6. Bipolar I Disorder
a. Overview and defining features
i. Alternations between full manic episodes & major depressive disorders
b. Facts and statistics
i. Average age of onset is 15-18 years
ii. Can begin in childhood
iii. Tends to be chronic
iv. Suicide is a chronic consequence
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7. Bipolar II Disorder
a. Overview and defining features
i. Alternations between persistent depressive and hypomanic episodes
b. Facts and statistics
i. Average age of onset is 19-22 years
ii. Can begin in childhood
iii. 10%-25% of cases progress to full bipolar I disorder
iv. Tends to be chronic
8. Cyclothymic Disorder
a. Overview and defining features
i. Chronic version of bipolar disorder
ii. Alternating between periods of mild depressive symptoms and mild
hypomanic symptoms
1. Episodes do not meet criteria for full major depressive episode,
full hypomanic episode, or full manic episode
iii. Hypomanic or depressive mood states may persist for long periods
iv. Must last for at least 2 years (one year for children and adolescents)
b. Facts and statistics
i. Average age of onset is 12-14 years
ii. More common among females
iii. Cyclothymia tends to be chronic and lifelong
iv. 1/3 to ½ develop full-blown bipolar
9. Prevalence of Mood Disorder
a. Worldwide lifetime prevalence
i. 16% for major depression
ii. 6% have experienced major depression in the past year
b. Sex differences
i. Females are twice as likely to have major depression
ii. Bipolar disorders affect males and females approximately equally
iii. Women more likely to experience rapid cycling
iv. Women more likely to be in depressive periods
c. Occurs less often in prepubertal children
d. Rapid rise in adolescents
e. Adults over 65 have about 50% less prevalence than general population
f. Bipolar same in childhood, adolescents, and adults
g. Prevalence of depression seems to be similar across subcultures
10. Life Span Developmental Influences on Mood Disorders
a. 3 month olds can show depressive symptoms
b. Young children typically don’t show classic mania or bipolar symptoms
c. Mood disorder may be misdiagnosed as ADHD
d. Children are being diagnosed with bipolar at increasingly high rates
e. Depression in elderly between 14% and 42%
i. Co-occurrence with anxiety disorders
ii. Less gender imbalance after 65 years of age
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