6. Mood Disorders and Suicide

Mood

a disposition to respond emotionally in a particular way that may last for hours, days, or even weeks, perhaps at a low level and without the person knowing what prompted the state

Normal Sadness

temporary and situational, passes within days or weeks, and does not severely impair functioning

Clinical Depression

intense and prolonged sadness that significantly interferes with daily life and is accompanied by other symptoms

Depression

a devastating “low” characterized by extreme lack of energy, interest, confidence, and enjoyment of life

Depression

persistent feelings of sadness and hopelessness

Mania

a frantic “high” with extreme overconfidence and energy, often leading to reckless behavior

Mania

individuals this state find extreme pleasure in every activity

Beginning DSM-III

In this version, mood-related conditions were broadly categorized under labels like "depressive disorders," "affective disorders," or "depressive neuroses."

DSM-III (1980)

The American Psychiatric Association grouped these problems under "mood disorders," emphasizing their core characteristic—gross deviations in mood.

Flight of Ideas

rapid, incoherent speech due to attempting to express many exciting ideas at once

Major Depressive Episode

extremely depressed mood lasting at least two weeks, including cognitive symptoms and disturbed physical functioning, leading to loss of interest and pleasure

at least 2 weeks

Duration of Major Depressive Episode

Major Depressive Episode

the most commonly diagnosed and most severe depression

Anhedonia

loss of energy and inability to engage in pleasurable activities or feel “fun”

Manic Episode

a period lasting at least one week of abnormally elevated mood, irritability, or energy, often with decreased need for sleep and grandiosity

Hypomanic Episode

a less severe form of mania lasting at least four days, not causing marked impairment in functioning

Unipolar Mood Disorder

involves depression or mania but usually develops into depression alone

Bipolar Mood Disorder

alternates between depression and mania

Mixed Features

the presence of manic symptoms alongside depression or anxiety

1 week (less if severe that require hospitalization)

Duration of a manic episode

3-4 months

Duration of a manic episode if untreated

4 days

Duration of a hypomanic episode

Disruptive Mood Dysregulation Disorder

DMDD meaning

Major Depressive Disorder

MDD meaning

Persistent Depressive Disorder

PDD meaning

Premenstrual Dysphoric Disorder

PMDD meaning

1.sad
2.empty
3.irritable mood

Common features of Depressive Disorders

1.duration
2.timing
3.presumed etiology

Differences in Depressive Disorders

Disruptive Mood Dysregulation Disorder (DMDD)

chronic irritability and severe temper outbursts with onset before age 10

6–18 y.o.

Age qualified for a diagnosis of DMDD

before 10 y.o.

The age onset of criteria A-E in DMDD should be

at least 2 and severe in at least 1

How many among these settings—at home, school, with peers, the criteria A and D of DMDD should be present

Major Depressive Disorder (MDD)

depressed mood or loss of interest for at least two weeks, causing significant impairment

5

Of the 10 symptoms of Criteria A of MDD, how many should be present during the 2 week period?

depressed mood or loss of interest or pleasure

Criteria A of MDD should have at least one of the two symptoms

Hypersomnia

Excessive daytime sleepiness, a condition where people fall asleep repeatedly during the day

can occur at any age

MDD onset

Negative affectivity (neuroticism)

well-established risk factor for the onset of MDD

Adverse childhood experiences

ACEs meaning

Adverse childhood experiences (ACEs)

strong risk factors for MDD

40%

Heritability % of MDD

Persistent Depressive Disorder (Dysthymia)

depressed mood most days for at least 2 years (1 year in children), with at least 2 additional symptoms and no symptom-free period longer than two months

21 y.o.

Onset of PDD before this age is associated with higher likelihood of coexisting personality and substance use disorders.

2 years

At least how many years should PDD be diagnosed when symptoms appear

Double Depression

alternating periods of major depression and dysthymia, creating chronic, severe impairment

PDD

combines DSM-IV dysthymic disorder and chronic major depressive episode

Premenstrual Dysphoric Disorder (PMDD)

mood symptoms occurring during the premenstrual phase and ceasing after menstruation

Premenstrual Dysphoric Disorder

meaning of PMDD

5

At least how many symptoms must be present in the final week before the onset of menses of PMDD

any time after menarche

PMDD onset

somatic (physical) delusions

believing that their bodies are rotting internally and deteriorating into nothingness

mood-congruent

the content of a person’s delusions or hallucinations matches their current emotional state or mood

Mood-Incongruent Hallucination or Delusion

the content of the hallucination or delusion does not match the person’s current mood or emotional state.

Mood-Incongruent Hallucination or Delusion

A person is extremely sad and hopeless (depressed mood), but they have delusions of grandeur (“I’m chosen by God to save the world”) or paranoid delusions (“The government is spying on me”.

Melancholic Features Specifier

This specifier applies only if the full criteria for a major depressive episode have been met, whether in the context of a PDD or not. 

Include some of the more severe somatic (physical) symptoms, such as early-morning awakenings, weight loss, loss of libido (sex drive), excessive or inappropriate guilt, and anhedonia (diminished interest or pleasure in activities).

Atypical Features

individuals with this specifier experience significant weight gain or increased appetite and hypersomnia. they can react with pleasure to some things, unlike most depressed individuals

Psychotic Features

presence of delusions or hallucinations during depressive episodes; can be mood-congruent (consistent with depressive themes) or mood-incongruent (not matching mood)

Anxious Distress Specifier

prominent anxiety symptoms during a depressive episode such as feeling tense, unusually restless, or fearing something awful might happen

Mixed Features Specifier

Predominantly depressive episodes that have several (at least three) symptoms of mania would meet this specifier, which applies to major depressive episodes both within major depressive disorder and persistent depressive disorder.

Mixed Features Specifier

means that symptoms of the opposite mood state are present during a mood episode.

Catatonic Features Specifier

This specifier involves an absence of movement (a stupurous state) or catalepsy

Catalepsy

this response may be a common "end state" reaction to feelings of imminent doom and is found in many animals about to be attacked by a predator

Peripartum Onset

onset of depressive episodes just before and just after pregnancy, can apply to both major and manic episodes

peri

means “surrounding”

Seasonal Pattern Specifier

This temporal specifier applies to recurrent major depressive disorder (and also to bipolar disorders). It accompanies episodes that occur during certain seasons (for example, winter depression).

Seasonal Affective Disorder

depressive episodes occur regularly during a specific season (usually fall or winter) and remit during another (usually spring), linked to changes in light exposure

Seasonal Affective Disorder

SAD meaning

phase shift hypothesis

According to this, SAD is a result of phase-delayed circadian misalignment, meaning that the patient's circadian rhythm is misaligned with the environmental day-night cycle

Bereavement

the experience of losing a loved one to death. It generally triggers a grief response that may be intense and may involve many features that overlap with symptoms characteristic of a major depressive episode

integrated grief

finality of death and its consequences are acknowledged and the individual adjusts to the loss

first 6-12 months after death

duration of acute grief

Bipolar I Disorder

manic or mixed episodes lasting at least seven days or requiring hospitalization, depressive episodes may also occur

Bipolar II Disorder

alternating depressive episodes (lasts 2 weeks and hypomanic episodes but no predominant manic or mixed episodes

Cyclothymic Disorder

A mild form of bipolar disorder that do not meet the criteria for a hypomanic episode and experience depressive symptoms that do not meet criteria for major depressive episode for at least two years

with anxious distress

specifier for Cyclothymic Disorder

adolescence or early adulthood

onset of Cyclothymic Disorder

before age 10

vast majority of youth with cyclothymic disorder have mood symptoms starting at this age

between 20 and 30 y.o.

peak age onset of bipolar I disorder

mid-20s

average onset of bipolar II disorder

at least 2 years (at least 1 year in children and adolescents)

duration of Cyclothymic Disorder

anticonvulsants and mood stabilizers

medication may be more effective for patients with rapid cycling

Ultra-Rapid Cycling

Rapid cycling episodes last days to weeks

Ultra-Ultra-Rapid Cycling

Rapid cycling episodes last less than 24 hours, linked to circadian rhythm

• Selective-Serotonin Reuptake Inhibitors (SSRIs)

• Mixed Reuptake Inhibitors

• Tricyclic antidepressants

• Monoamine oxidase (MAO) inhibitor

four basic types of antidepressants used to treat depressive disorders

Selective Serotonin Reuptake Inhibitors (SSRIs)

antidepressants that increase serotonin levels by preventing its reabsorption in the brain

Lithium Carbonate

a mood stabilizing drug effective in preventing and treating manic episodes

Lithium Carbonate

Remains the gold standard for treatment of bipolar disorder

Electroconvulsive Therapy (ECT)

administered once every other day for a total of 6-20 treatments, using controlled electric shocks to the brain

Transcranial Magnetic Stimulation (TMS)

treatment altering electrical activity in the brain by setting up a strong magnetic field

Vagus Nerve Stimulation

Involves implanting a pacemaker-like device that generates pulses to the vagus nerve in the neck, which, in turn, is thought to influence neurotransmitter production in the brain stem and limbic system

Deep Brain Stimulation

Electrodes are surgically implanted in the limbic system. The electrodes are connected to a pacemaker-like device

Cognitive-Behavior Therapy (CBT)

Clients are taught to examine carefully their thought processes while they are depressed and to recognize “depressive” errors in thinking

Interpersonal Psychotherapy (IPT)

focuses on resolving problems in existing relationships and learning to form new interpersonal relationships

Light Therapy

treatment for SAD

1. Universal Programs

2. Selected Interventions

3. Individual Interventions

Three types of prevention program delineated by Institute of Medicine (IOM)

Interpersonal and Social Rhythm Therapy (IPSRT)

Regulates circadian rhythms by helping patients regulate their eating and sleep cycles and other daily schedules as well as cope more effectively with stressful life events, particularly interpersonal issues for bipolar disorder

Family-Focused Treatment

Treatment directed at helping families to understand symptoms and develop new coping skill and communication.

CBT

Psychological treatment effective for bipolar patients with rapid-cycling feature

11th

ranking of Suicide as the leading causes of death in the U.S.

4

Males are how many times more likely to commit suicide than females (every country except China)