Mood disorders
“Mood Swings are Persistent”
- Mood: Major depressive disorder
- Swings: Bipolar disorder
- Persistent: Persistent depressive disorder
Mania
Mania: an elevated mood that feels like being “on the top of the world”.
- Accompanied by high energy and high physical activity.
- For some mania makes them feel agitated or restless.
Manic episode definition
Manic episode definition: A distinct period of unusually elevated or irritable mood and increased activity lasting at least one week.
How long do manic episodes last
True manic episodes last at least one week.
Manic episode symptoms
Symptoms:
- Inflated self-esteem or grandiosity (feeling overly important).
- Decreased need for sleep (eg. feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Having racing thoughts or feeling unable to focus.
- Easily distracted by unimportant things.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (purposeless non-goal-directed activity).
- Engaging in risky activities with potential negative consequences (eg. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
- Some individuals may experience severe thought disturbances and hallucinations during mania.
Bipolar I Disorder
Bipolar I Disorder: A disorder characterized by extremely elevated moods during manic episodes, and, frequently, depressive episodes as well.
- Main cause of impairment: manic episodes.
- Bipolar I disorder is characterized more by manic episodes than by depression.
- Although those with bipolar I disorder often have depressive episodes, these episodes are not necessary for a DSM-5 diagnosis.
- Manic episodes in bipolar I disorder significantly disrupt daily functioning and may require hospitalization.
Manic Episode - Sample Case
Case summary: A 14-year-old boy is intensely focused on a science project, believing it will save the world.
Symptoms:
- Skipping school to work on the project.
- Constantly talking about the project, not letting others speak.
- High levels of enthusiasm and energy.
- Reduced need for sleep, staying up late to work on the project.
- Difficulty following his train of thought.
- Overall, the boy’s behavior shows signs of a manic episode, including heighted energy, reduced need for sleep, and intense focus on a single goal.
Bipolar II Disorder
Bipolar II Disorder: A disorder characterized by alternating periods of extremely depressed and mildly elevated moods.
- Main cause of impairment: major depressive episodes.
- People with bipolar II disorder experience less extreme mood elevations compared to those with Bipolar I disorder.
Hypomania
Hypomania: In bipolar II disorder, individuals experience episodes of hypomania, which are milder forms of elevated mood.
- Hypomania is characterized by heightened creativity and productivity, and they can be pleasurable and rewarding.
- Impacts: Hypomania can disrupt daily life to some extent, but it doesn’t cause significant impairment or require hospitalization like full-blown manic episodes.
- To be diagnosed with bipolar II, individuals must experience at least one major depressive episode.
Origin of bipolar disorders
- A family history of bipolar disorder is a significant risk factor for bipolar disorders.
- The concordance rate for bipolar disorders in identical twins are higher than in fraternal twins.
- Higher concordance rates in identical twins suggest a stronger genetic influence on the trait or disorder being studied.
- In the 1980s, the Amish community was involved in a genetic research study.
- Amish keep genealogical records, and few outsiders marry into their community.
- Families where bipolar disorder occurred among members, all seemed to have similar genetic traits or differences compared to other families.
- These genetic similarities were linked to the presence of bipolar disorder within those specific families.
- Bipolar disorders are inherited through a combination of genes, not just one.
- Scientists are looking at many genes that might be involved.
- In families with bipolar disorders, each new generation tends to have more severe symptoms starting at younger ages.
What is the main cause of impairment for people with bipolar I disorder?
Extreme manic episodes - the DSM-5 does not require depressive episodes for the diagnosis of bipolar I disorder.
What is the main cause of impairment for people with bipolar II disorder?
Major depressive episodes.
Major depressive episodes are a requirement for a bipolar II diagnosis.
Differences between Bipolar I and Bipolar II
- The main differences between bipolar I and bipolar II are the presence of manic episodes and the presence and severity of depression.
- Bipolar I disorder: Manic episodes are present and can occur without depressive episodes.
- Impairments to daily life are from manic episodes.
A major depressive episode is not required for a bipolar I diagnosis.
Bipolar II disorder: In bipolar II disorder, hypomanic episodes occur instead of full-blown manic episodes. These episodes involve similar symptoms to mania but are less severe.
- Impairments to daily life are from major depressive episodes.
- Major depressive episodes are a requirement for a bipolar II diagnosis.
Bipolar I Disorder - Sample Case
- A 20 year old musician goes to the physician. He is experiencing depression, fatigue, and lack of motivation. He seeks help to regain inspiration.
- His initial treatment: prescribed fluoxetine (common antidepressant).
In a follow-up visit (2 weeks later):
- Girlfriend brings the patient back to the clinic. Her concern is about the financial implications and the patient’s unrealistic aspirations/goals.
-The patients behavior:
Playing guitar excessively, day and night.
Spending money on new musical instruments.
Overly ambitious, trying to book tours with famous bands like the Rolling Stones.
- Patient’s Self-Report:
- Feeling better than ever
- He talks rapidly and enthusiastically about upcoming musical opportunities.
- Expresses urgency to continue practicing for a big gig.
Bipolar disorders more common in men or women?
Bipolar disorders are equally common in men and women.
When do bipolar disorders typically emerge?
Bipolar disorders typically emerge during late adolescence or early adulthood.
- Bipolar I disorder is usually diagnosed at a younger age than bipolar II disorder.
Depressive disorders
The common feature of all depressive disorders is the presence of sad, empty, or irritable mood along with bodily symptoms and cognitive problems that interfere with daily life.
Major depressive disorder
Major depressive disorder: A disorder characterized by severe negative moods or a lack of interest in normally pleasurable activities.
- Tend to experience extremely depressed moods for short periods of time.
- According to DSM-5 criteria to be diagnosed with major depressive disorder:
A person must experience a major depressive episode.
Major depressive disorder symptoms
Symptoms:
- Depressed mood or loss of interest in activities (anhedonia). Can be an irritable mood in adolescents and children.
- Loss of interest or pleasure in most daily activities.
- Changes in weight or appetite.
- Sleep disturbances: insomnia or hypersomnia (excessive sleep).
- Psychomotor agitation (a state of increased physical activity or restlessness. Can manifest as pacing, fidgeting, or inability to sit still) or psychomotor retardation (slowing down of physical movements and responses, people may have slow speech and slow movement).
- Loss of energy or fatigue
- Feelings of worthlessness or excessive guilt.
- Difficulty concentrating or making decisions.
9Thoughts of death, suicidal ideation, or suicidal attempt.
Case study of a 56 year. old woman diagnosed with depression
- She described herself as overwhelmed with feelings of guilt, worthlessness, and hopelessness.
- Twisted her hands continuously
- Played nervously with hair
- Said her family would be better off without her
- Said she had suicidal ideation
Persistent depressive disorder (dysthymia)
Persistent depressive disorder (dysthymia): A form of depression that is not severe enough to be diagnosed as major depressive disorder but lasts longer.
- Experience mildly or moderately depressed moods for longer periods of time.
- Depression that lasts for 2 years or longer.
- Most individuals with persistent depressive disorder describe their mood as “down” or “low”.
- Symptoms are similar to major depressive disorder but less intense.
- A depressed mood most of the day, more days than not.
Common cold
Depression is very common, often called the “common cold” of psychological disorders.
Stigma
Stigma around depressive disorders is a major issue, especially in developing countries:
- Treatment is hard to access.
- People avoid treatment to avoid admitting they are depressed.
Women and Depression
- Twice as many women as men experience depressive disorder.
- High rate of depression among women.
- Women often balance multiple roles: wage earners, family caregivers. Stress from these roles can increase depression.
- Overwork, unrealistic societal expectations, lack of structural and financial support.
- Having multiple identities (wife, mother, employee) can be beneficial if roles are manageable.
