PSYCH 260 Ch. 8: Mood Disorders

What criteria must be met for the diagnosis of a major depressive episode?

Severe depression or loss of interest/pleasure(anhedonia) including 5+ of the following cognitive symptoms for at least 2 weeks:

Feelings of worthlessness

Altered sleep patterns

Changing appetite and weight

Notable loss of energy

Slowing down

Fatigue

Concentration problems

Thoughts of death

What criteria must be met for a diagnosis of major depressive disorder (MDD)?

A: 5+ of the following in a 2-week period; at least one of which must be either (1) or (2):

1. Depressed mood most of the day, every day

2. Diminished interest or pleasure in almost all activities (anhedonia)

3. Significant weight loss or weight gain or decreased/increased appetite nearly every day

4. Insomnia or hypersomnia

5. Psychomotor agitation (fidgety) or retardation (very still)

6. Fatigue/loss of energy

7. Worthlessness or excessive guilt

8. Concentration problems/indecisiveness

9. Recurrent thoughts of death, suicidal ideation, planning or attempt

E: No previous manic/hypomanic episode

What criteria must be met for a diagnosis of Persistent Depressive Disorder (dysthymia)?

A: Relatively unchanged depressed mood for 2+ years (1 year for children)

B: While depressed, 2+ of the following

1. poor appetite/overeating

2. insomnia/hypersomnia

3. low energy

4. low self-esteem

5. poor concentration or decision making

6. hopelessness

C: Never without symptoms A or B for 2+ months

D. Can meet Major Depressive Episode criteria for 2+ years straight (MDE never ends)

How does Persistent Depressive Disorder (dysthymia) differ from Double Depression?

Double Depression is Persistent Depressive Disorder with a less severe baseline mood but with very severe Major Depressive Episodes

Specifiers are symptoms that may accompany a depressive disorder. What specifier refers specifically to MDE’s?

Single or recurrent episodes?

Specifiers are symptoms that may accompany a depressive disorder. What specifier is a mandatory part of an MDD diagnosis?

Mild, moderate, or severe

What are the eight specifiers for depressive disorders used by clinicians (apart from “single or recurrent episodes” and “mild, moderate, severe”

1. With psychotic features

2. With anxious distress

3. With mixed features (of mania and depression but not quite bipolar)

4. With melancholic features (no capacity for pleasure, symptoms worse in morning)

5. With atypical features (mood able to brighten)

6. With catatonic features (paralysis, mutism)

7. With peripartum onset (pre or postpartum, lasts 2+ weeks)

8. With seasonal pattern

What is the average age of onset for Major Depressive Disorder?

~25 years, but the mean age is lowering

What disorder is characterized by the following?

1-2 weeks prior to _____: Physical symptoms, severe mood swings, irritability/anger, severe depressed/anxiety during ____, unease, dissatisfaction with body, impairment, distress

Resolves at menopause but can be retriggered by hormone therapy

Evidence of a biological genetic basis

Premenstrual Dysphoric Disorder

What disorder is characterized by the following?

Patients 6-18 years old ONLY

Chronic irritability, anger, aggression, hyperarousal, frequent temper tantrums (more persistent, severe, and out of proportion than normal tantrums), intense negative affect, issues regulating mood

Misdiagnosed as Bipolar even though mania is not present

Disruptive Mood Dysregulation Disorder

Experiencing depressive symptoms following soon after the death of a loved one

Acute Grief

Grief that evolves from acute grief into a condition in which the individual accepts the finality of a death and adjusts to the loss.

Integrated grief

A distinct clinical disorder occurring when the natural healing process is impeded by a superimposed, maladaptive response, keeping the individual "stuck" in acute grief for 12+ months (6+ in children)

Complicated grief or Prolonged Grief Disorder

Chronic (at least two years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes.

Cyclothymic disorder

A. 1+ manic episode

CAN have depressive episodes

Alternation of major depressive episodes with full manic episodes.

Bipolar Disorder I

Alternation of major depressive episodes with hypomanic episodes (never full manic episodes).

Bipolar Disorder II

What is the following diagnostic criteria for?

A. Abnormally and persistent elevated, expansive, or irritable mood, goal-directed activity, or energy for 1+ week

B. 3+ of following symptoms (4 if mood is only irritable)

1. inflated self esteem/grandiosity

2. Decreased need for sleep

3. More talkative/pressured speech

4. Flight of ideas/racing thoughts

5. Distractibility

6. Increased goal-directed activity

7. Involvement in high risk activities

Manic Episode

This Bipolar Disorder specifier is used when a patient experiences 4+ manic episodes within 1 year

Rapid Cycling Specifier

T or F: The onset of Bipolar Disorder symptoms happens gradually over time

False, acute onset

___% of Cyclothymic Disorder patients are women -onset in teens

60

What is the average age of onset for Bipolar I Disorder?

18

What is the average age of onset for Bipolar II Disorder?

22

Compared to those without these disorders, people with Bipolar disorders are at ___-___x greater risk of suicide

20-30

T or F: Women are 2X as likely to develop Bipolar disorders I and II, but their prevalence of depression is about equal to men

False, Women 2X as likely to develop depression, prevalence of bipolar disorders equal

Trans and nonbinary depression rates range between ___-___%

50-60%

Why are somatic symptoms of mood disorders more commonly recognized cross-culturally than the subjective (how we feel) symptoms? In what type of culture are these subjective symptoms most commonly recognized?

Culture does not affect the presentation of somatic symptoms and they are more external than the internal subjective symptoms which are more common in individualistic cultures where looking inward is more socially accepted than in collectivistic cultures where the focus is on the external world (including body)

The prevalence of mood disorders among indigenous peoples in Canada is __-__X higher than in the general population

3-4x

What is the heritability of mood disorders?

37%

What is the heritability of bipolar disorders, is this higher in men or women?

~60%, higher in women

The prevalence of mood disorders in people who have a relative with a diagnosed mood disorder are __-__X higher than those without a diagnosed relative

2-3x

The ____ the onset and the ___ severe the symptoms of a patient’s mood disorder, the ___ likely a relative of the patient will develop it too

Earlier, more, more

The _____ vulnerability to mood disorders may have something to do with a ____ to anxiety and mood disorders

Biological, predisposition

T or F: The genetic contributions to mania are also thought to contribute to depression

False, may be different genetic contributors

looks at how much the overlap or covariance between two traits is driven by the same underlying genes.

Joint Heritability

There may be joint heritability among ___, ___, and ___. This may be linked to ____, but ___ are also implicated

depression, anxiety, panic. temperament, genes

T or F: There is no evidence that the levels of brain serotonin in depressed individuals is lower than those who aren’t depressed

True, levels vary

Why did early theories of depression focus primarily on serotonin?

Serotonin is thought to impact mood and regulate emotions. First gen antidepressants (TCAs and MOAs) worked by keeping serotonin available in brain for longer and 50% of patients responded to these drugs.

Why can’t we currently measure the levels of brain serotonin?

Blood/urine levels don’t reflect brain serotonin as body serotonin doesn’t cross the blood brain barrier. Measuring brain levels of serotonin would require advanced brain scans and invasive psychosurgery

T or F: Mood disorders are caused by more than just chemical imbalance

True

The balance of the of many neurotransmitters (rather than serotonin levels alone) are implicated in mood disorders, name the 5 mentioned in class

serotonin, dopamine, norepinephrine, glutamate, GABA

What is the first priority in the treatment of mood disorders and how does this inform treatment effectiveness?

Sleep and circadian rhythms, good sleep can positively affect treatment effectiveness

Most patients with mood disorders report problems with ___

Sleep

What 2 processes is REM sleep responsible for?

Memory consolidation and emotional processing

How does the onset of REM sleep differ between depressed and non-depressed people?

After falling asleep, REM sleep begins sooner in depressed people

Depressed people experience more ___ REM activity

Intense

T or F: people with depression experience more intense, vivid, and emotional (negative) dreams

True, due to REM activity

What type of sleep is reduced in depressed people?

Slow wave/deep sleep

What 2 processes is slow wave/deep sleep responsible for?

memory processing, recovery (brain tissue, body, immune system, etc.)

People who experience ___ are at higher risk for developing depression

Insomnia

Psychological experiences (stress, trauma, major negative life events) don’t cause depression themselves, what does determine the development of depression?

Interpretation of psychological events

T or F: Genetic vulnerability to depression may lead people to unconsciously seek seek out high risk situations in life (e.g. abusive relationships)

True

Persistent stressful psychological experiences both provoke ___ and prevent ___

Relapse, recovery