PS371: Mood Disorders I

Mood

A measurable affective state, the way that someone is feeling, a conscious state of mind or emotion

Depression

Any downturn in mood, relatively brief, perhaps due to something trivial

Mania

A state of lifted spirits and anxiety, may encompass agitation, anxiety, assumed to be at risk for depression

Mood disorders

• Adjustment disorders may present with depressed mood, with anxiety, or with a mixed picture of depressed mood and anxiety following experience of stressor

• Mood disorders: more severe, pervasive, persistent, impact functioning

• DSM-5: Depressive disorders, Bipolar mood disorders

Major depressive episode

• > 5 symptoms that are present, nearly continuously, for at least two consecutive weeks

• Must include depressed mood and or anhedonia

Major depressive episodes additional symptoms

• Weight change (without attempt to gain or lose weight)

• Sleep disturbance

• Psychomotor agitation / retardation (observable by others)

• Fatigue / loss of energy

• Worthlessness / excessive or inappropriate guilt

• Concentration problems / indecisiveness

• Recurrent thoughts of death / suicidal ideation

Manic episode [criterion A]

• Abnormally and persistently elevated, expansive, or irritable mood and/or abnormally or persistently increased goal directed activity lasting > 1 week

• Any duration if hospitalized

Manic episode [criterion B]

3 additional symptoms (> 4 if irritable)

• Inflated self-esteem/grandiosity

• Less need for sleep

• Hyper-verbal/pressured speech

• Flight of ideas

• Distractibility

• Increased goal-directed activity (social, work, school, sexual)

• Excessive involvement in pleasurable activities with potential for painful consequences

Manic episode: symptoms must be sufficiently severe to

• Cause marked impairment in usual functioning, or

• Cause marked impairment in usual social relationships, or

• Necessitate hospitalization to prevent harm to self / others, or

• Psychotic features (hallucinations, delusions) are present

Hypomanic episode [criterion A]

Abnormally and persistently elevated, expansive, or irritable mood and/or abnormally and persistently increased goal-directed activity or energy lasting at least four days

Hypomanic episode [criterion B]

symptoms are same as for manic episode

Hypomanic episode

• Distinct from manic in terms of duration and severity of symptoms

• Not associated with functional impairment

• Rather:

  • associated with unequivocal change in functioning that is uncharacteristic of the individual, and

  • disturbance in mood / change in functioning observable by others

DSM-5 Criteria: Major Depressive Disorder

• Meet criteria for Major Depressive Episode, and

• Not explained by psychotic disorder, and

• Never met criteria for manic or similar episode

DSM-5 Criteria: Persistent Depressive Disorder

• Also known as Dysthymia

• Less severe symptoms than with Major Depressive Episode, longer duration

• During 2-year period of disturbance

• Never without symptoms for > 2 months

• No history of manic or similar episodes

• NEW TO DSM-5: Symptoms may overlap with Major Depressive Episode

Persistent depressive disorder [criterion A]

Depressed mood and/or anhedonia

Most of the day, more days than not, > 2 years

Persistent depressive disorder [criterion B]

At least two additional symptoms including appetite change, sleep disturbance, low energy/fatigue, low self-esteem, poor concentration/indecisive helplessness

Bipolar I

>1 Manic episode

Bipolar II

>1 Major depressive episode and >1 Hypomanic episode

Cyclothymia

Similar to Persistent Depressive Disorder … >2 years … hypomanic symptoms and depressive symptoms (don’t meet criteria for Major Depressive Episode)

Specifiers: bipolar disorders

• Severity

  • mild, moderate, severe

• Symptoms in retreat

  • in partial or full remission

• Symptom patterns (including):

  • with rapid cycling (bipolar I, II)

  • with melancholic features

  • with psychotic features

• Always risk of return, keep eye on status (do not say no mental illness)

Who is affected?: MDD

• 16% lifetime prevalence

• Female > male (2 or 3:1 ratio) After age 65, female = male

• Prevalence 2-3x higher among LGBT adolescents, young adults

• Hispanic, Caucasian > African American

• Unrelated to education, income, marital status

Duration: MDD

• 6 to 9 months (untreated)

• 10% to 25% Persistent Depressive Disorder → Major Depressive Episode

• Up to 15% with severe MDD die by suicide

Comorbidity: MDD

• Anxiety, Substance, Eating, Personality

• Suicidal gestures more common as symptoms improve

Who is affected?: PDD

• 4% to 6% lifetime prevalence

• Female > male (2 or 3:1 ratio)

• Course: Generally chronic

  • Early, slow onset

  • Median duration ≈ 5 years

Who is affected?: bipolar

• Prevalence: BP I ≈ 0.4% to 1.6% BP II ≈ 0.5%

  • Cyclothymia likely in the middle

• Age of onset: BP I ≈ 18 years BP II ≈ 22 years

• Course: Generally chronic, <10% only one episode

• 60% to 70% manic / hypomanic episodes occur immediately before or after MDE

• Duration (manic episode): 3 to 6 months (untreated)

Who is affected?: bipolar (cont.)

5% to 15% > 4 episodes within 12 months (rapid cycling)

5% to 13% Bipolar II → Bipolar I

15% to 50% Cyclothymia → Bipolar I or Bipolar II

Suicide risk high (15% to 20%), usually during MDE

Comorbidity: Substance, Eating, ADHD, Anxiety-related (panic, social phobia), Borderline personality