Psychopathology Chapter 5- Depression and Mania

Depression

• Intense and debilitation sadness

• melancholy

• Pessimistic worldview

• loss of interest in previously enjoyed activities

Mania

• opposite of depression

• euphoric mood

• boundless energy

• distorted sense of ones ability

Depressive Episode

Two or more weeks of either

• intense sadness or depressive mood

• loss of interest in activities

other symptoms include change in appetite, sleep disturbance, tiredness, indecisiveness, feelings of worthlessness, lethargy or restlessness, and suicidal feelings.

Manic Episode

One or more weeks of

• elevated mood

• high energy

• intense goal directed activity

often involves inflated self-esteem, grandiosity, decreased need for sleep, extreme talkativeness, racing thoughts, distractibility, and impulsive/risky behavior.

Hypomanic episode

Shorter duration and milder episode of mania

DSM-5-TR says symptoms must last 4 days to a week

ICD-11 simply says several days

Mixed episode (ICD)

Manic and depressive symptoms rapidly alternate or co-occur for at least two weeks

Major Depressive Disorder (MDD) (DSM-5-TR)

One or more depressive episodes

Must have no history of mania or hypomania (bipolar is diagnosed if there is)

Single-Episode or Recurrent Depressive Disorder (ICD-11)

• Single episode: only one depressive episode

• recurrent: two or more depressive episodes

• has never had a manic or hypomania episode (bipolar)

Bipolar 1

DSM and ICD

• At least one manic episode: Required.

• Hypomanic and depressive episodes: Common but not required.

Bipolar 2

DSM and ICD

• At least one hypomanic episode: Required.

• At least one depressive episode: Required.

• There has never been a manic episode. (or mixed episode ICD)

Cyclothymic Disorder

Diagnosed when there is consistent hypomanic and depressive SYMPTOMS, neither of which reach the level of episode

• symptoms must be present half the time for two or more years

• never absent for more than two months

Persistant Depressive Disorder (PDD) (DSM)

chronic depression that lasts two or more years

• may not meet criteria for major depressive disorder

• symptoms never absent for more than two months

• Two or more of these symptoms: change in appetite, change in sleep habits, tiredness or reduced energy, decreased self-esteem, trouble with concentration or decision-making, feels hopeless.

• never been hypomanic or manic episode, or cyclothymic disorder

Dysthymic Disorder (ICD)

• depressed mood most days for at least two years.

• For first two years, depressive symptoms don’t meet criteria for a depressive episode.

• Symptoms such as: loss of pleasure in activities, tiredness or reduced energy, trouble with concentration or decision-making, feeling guilty and unworthy, suicidal thoughts, change in sleep habits, change in appetite, physically agitated/restless or lethargic.

•  No history of manic, hypomanic, or mixed episodes.

Premenstrual Dysphoric Disorder (PMDD)

diagnosed in women who consistently show depressive symptoms during the week before their menstrual periods. (Symptoms can be physical)

• ICD categorizes this with disorders that affect genitals rather than mental disorders

Disruptive mood dysregulation disorder (DMDD)

diagnosis for children and adolescents who show depressive symptoms combined with temper outbursts

• onset before age 10; cant be diagnosed before 6 or after 18

• ICD doesn’t include DMDD, but it can be coded as a form of oppositional defiant disorder

Postpartum depression

depression in women who are pregnant or have given birth during the last four weeks.

Seasonal affective disorder (SAD)

describes those who become depressed during the winter when there are fewer hours of daylight

threshold problems

uncertainty over how severe mood symptoms must be to rise to the level of disorder.

Bereavement Exclusion

DSM-IV criterion for major depressive disorder that discouraged clinicians from diagnosing major depression in people grieving the loss of a loved one; removed starting with DSM-5.

PDM on depression

PDM-2 complements DSM and ICD by describing the psychodynamics behind mood problems, emphasizing personality patterns and the subjective experience of depression. It identifies two types of depression:

• anaclitic: characterized by helplessness and guilt

• introjective: characterized by feelings of inferiority and self-criticism.

PDM on Mania

Manic episodes in bipolar disorder are characterized by irritability, grandiosity, restlessness, and impulsivity. These individuals often crave fame, have boundless energy, and experience chaotic interpersonal relationships.

• establishing a productive psychotherapy relationship can be difficult

Melancholia in Ancient Greece

Ancient Greek medicine divided madness into three kinds: frenzy, mania, and melancholy 

• Melancholy, broader than modern depression, included symptoms like hallucinations.

• Ancient Greek humoral theory attributed melancholia to imbalances in black bile.

• Melancholia was also often attributed to unrequited love

• Treatments for mania and melancholia included bloodletting and leeching