Mood Disorders
Classified in two broad categories unipolar and bipolar
Depressive Disorders
Involve change in mood in direction of depression. Major Depressive Disorder; Persistent Depressive Disorder
Bipolar and Related Disorders
Involve periods of depression cycling with periods of mania. Bipolar I; Bipolar II; Cyclothymia; Rapid Cycling Specifier
Major Depressive Disorder
“Common cold” of mental disorders. Exists on a continuum (mild feelings of sadness to the severe, persistent, debilitating feelings)
Diagnostic Criteria (MDD)
Five or more of the following symptoms have been present during the same 2 week period and represent a change from previous functioning. At least 1 symptom is either (1) depressed mood or (2) loss of interest.
1) Depressed mood most of the day, nearly everyday or observation by others
2) Diminished interest or pleasure in all, or almost all activities of the day, nearly every day
3) Significant weight loss when not dieting or weight fain or decrease or increase in appetite nearly everyday
4) Insomnia or hypersomnia nearly every day
5) Psychomotor agitation or retardation nearly every day
6) Fatigue or loss of energy nearly every day
7) Feelings of worhtlessness or excessive or inappropiate guilt (which may be delusional) nearly every day
8) Diminished ability to think or concentrate, or indecisiveness, nearly every day
9) Recurent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for commiting suicide
Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Persistent Depressive Disorder
A chronic low mood lasting for at least two years, along with at least three associated symptoms (may also experience recurrent episodes of MDD)
PDD Criteria
Depressed mood for most of the day, for more days than not, indicated by either subjective account or observation by others for at least 2 years (in children and adolescents, mood can be irritable and duration must be at least 1 year)
Presence while depressed for two (or more) of the following:
1) Poor appetite or overeating
2) Insomnia or hypersomnia
3) Low energy or fatigue
4) Low self esteem
5) Poor concentration or difficulty making decisions
6) Feelings of hopelessness
Mania
Distinct period of elevated, expansive or irritable mood that lasts at least one week and is accompanied by at least three associated symptoms
Hypomania
Less severe form of mania that involves a similar number of symptoms, but those symptoms need to be present for only four days
Bipolar I
Individual has a history of one or more manic episodes with or without one or more major depressive episodes
Bipolar II
Defined as a history of one or more hypomanic episodes with one or more major depressive episodes
Diagnostic Criteria for Manic Episode
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least one week and present most of the day nearly everyday.
During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if mood is only irritable) are present to a significant degree and represent a noticeable change from usual behaviour
1) Inflated self esteem or grandiosity
2) Decreased need or sleep (eg. feels rested after only 3 hours for sleep)
3) More talkative than usual or pressure to keep talking
4) Flight of ideas or subjective experience that thoughts are racing
5) Distractability (eg attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed
5) Increase in goal directed activity (either socially, at work or school or sexually) or psychomotor agitation (eg. purposeless non goal directed activity)
7) Excessive involvement in activities that have a high potential for painful consequences (eg. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Cyclothymia
Chronic less severe form of bipolar disorders. Involves a history of at least two years of alternative hypomanic episodes and episodes of depression that do not meet the full criteria for major depression. Mood swings are mild and hypomania may be enjoyable –> often do not seek treatment
Rapid Cycling Specifier
Presence of four or more manic and/or major depressive episodes in a 12 - month period. Episodes are separated by at least two months or by a switch to the opposite mood state
Seasonal Affective Disorder (SAD)
Recurrent depressive episodes tied to the changing seasons. Focused on melatonin - as the sun provides increased light in the morning, melatonin release is normally lowered causing body temps to rise, triggering the body process to move to their awake state. May need more light to trigger decreased melatonin secretion
Mood Disorders with Peri or Postpartum Onset
Women can experience mood swings and feelings of depression up to two weeks after childbirth. Most of the time theses symptoms resolve themselves but sometimes it’s chronic. Mood disorders can occur in the peripartum period, which refers to the last month of gestation or the first few months after delivery
Premenstrual Dysphoric Disorder (PMDD)
Characterized by marked affective lability, irritability/anger, depressed mood, and/or anxiety, plus the presence of additional symptoms of loss of interest in activities, concentration difficulties, low energy, changes in appetit and/or sleep, feelings of loos of control, and/or physical symptoms. 5 symptoms must be present to meet DSM - 5 criteria and they must interfere with the woman’s functioning. Symptoms must be present fo rmost menstrual cycles in the year.
Psychodynamic Personality Theories (Etiology)
Blatt theories that these personality styles, which develop as a function of maladaptive parenting styles and/or traumas early in development, render people vulnerable to depression when they face a stressful life event that triggers the personality theme
Cognitive Theories
All or nothing thinking; Overgeneralization; Magnification (catastrophizing); Jumping to conclusions; Diathesis Stress Model
Cognitive Distortions
Aaron T. Beck proposed that a person’s emotional response to a situation is determined by how they evaluate it. People with depression/prone to depression are more likely to appraise situations negatively –> more likely to experience negative mood in response to such situations
All or Nothing Thinking
Se things in black or white categories (ex. getting a C on a math exam and thinking “total failure”)
Overgeneralization
See a single negative event as a never ending pattern of defeat by using words such as “always” or “never” when thinking about it (ex. late for a dr appt “I am always screwing up”)
Magnification (Catastrophizing)
Exaggerate the importance of your errors or problems (ex. forget someone’s name when introducing him/her and you tell yourself “this is terrible”)
Jumping to Conclusion
Interpret things negatively when there are no definite facts to support your conclusion (ex. Your partner doesn’t return your call and you think they don’t care about you buy they are busy visiting a grandparent)
