CHAPTER 7: MOOD DISORDERS AND SUICIDE

What characterizes a Major Depressive Episode (MDE)?

A Major Depressive Episode is characterized by an extremely depressed mood state that lasts at least 2 weeks.

What are some cognitive symptoms associated with Major Depressive Episode (MDE)?

Cognitive symptoms may include feelings of worthlessness and indecisiveness.

What are some disturbed physical functions observed in Major Depressive Episode (MDE)?

Disturbed physical functions can include altered sleeping patterns, significant changes in appetite and weight, or a notable loss of energy.

Physical Changes (Somatic or Vegetative Symptoms)

Most central indicators of a full major depressive episode.

Anhedonia

Inability to engage in pleasurable activities.

Duration of MDE, If Untreated

Approximately 4 to 9 months

What characterizes a Manic Episode?

A Manic Episode is characterized by abnormally exaggerated elation, joy, or euphoria, with extreme pleasure in every activity, extraordinary hyperactivity, a need for little sleep, and the development of grandiose plans.

What is "Flight of Ideas" in the context of a Manic Episode?

refers to the expression of many exciting ideas at once, often seen in individuals experiencing a manic episode.

How long does a Manic Episode typically last?

A Manic Episode typically lasts for 1 week, or less than a week if severe enough to require hospitalization. If untreated, it can last 3 to 4 months.

How does a Hypomanic Episode differ from a Manic Episode?

A Hypomanic Episode is a less severe version of a manic episode, with no marked impairment in social or occupational functioning.

What is the duration of a Hypomanic Episode?

lasts only 4 days.

What are the general criteria for diagnosing a Major Depressive Episode (MDE)?

Five (or more) of the following symptoms must be present during the same 2-week period, representing a change from previous functioning, with at least one symptom being either (1) depressed mood or (2) loss of interest or pleasure.

What is the first symptom of a Major Depressive Episode?

Depressed mood most of the day, nearly every day, as indicated by subjective report (e.g., feels sad, empty, or hopeless) or observation by others (e.g., appears tearful). In children and adolescents, this can be an irritable mood.

What is the second symptom of a Major Depressive Episode?

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day, as indicated by subjective account or observation.

What is the third symptom related to weight in a Major Depressive Episode?

Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. In children, consider failure to make expected weight gain.

What is the fourth symptom regarding sleep in a Major Depressive Episode?

Insomnia or hypersomnia nearly every day.

What is the fifth symptom related to psychomotor activity in a Major Depressive Episode?

Psychomotor agitation or retardation nearly every day, observable by others (not merely subjective feelings).

What is the sixth symptom of a Major Depressive Episode?

Fatigue or loss of energy nearly every day.

What is the seventh symptom related to self-perception in a Major Depressive Episode?

Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.

What is the eighth symptom regarding cognitive function in a Major Depressive Episode?

Diminished ability to think or concentrate, or indecisiveness, nearly every day, either by subjective account or as observed by others.

What is the ninth symptom related to thoughts of death in a Major Depressive Episode?

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

What is required for the symptoms of a Major Depressive Episode to be clinically significant?

The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

What must be ruled out when diagnosing a Major Depressive Episode?

The episode must not be attributable to the physiological effects of a substance or another medical condition.

Unipolar Mood Disorder

• Experience either depression or mania.

• Remains at one “pole” of the usual depression–mania continuum.

Bipolar Mood Disorder

• Alternates between depression and mania.

• Traveling from one “pole” of the depression–elation continuum.

What are Mixed Features in the context of mood episodes?

Mixed Features refer to the experience of manic symptoms while simultaneously feeling somewhat depressed or anxious.

How are symptoms characterized in Mixed Features?

Individuals may be depressed with a few symptoms of mania.

What is required when diagnosing Mixed Features?

It requires specifying whether a predominantly manic or predominantly depressive episode is present.

What must be noted regarding symptoms in Mixed Features?

It is important to note if enough symptoms of the opposite polarity are present to meet the mixed features criteria.

Full Remission

Recover fully for at least two months between episodes.

Partial Remission

Partially recover retaining some depressive symptoms.

Information about Manic episodes

Manic episodes alone may be somewhat more frequent in adolescents.

MAJOR DEPRESSIVE DISORDER (MDD)

The presence of depression and the absence of manic, or hypomanic episodes, before or during the disorder

Recurrent

If two or more major depressive episodes occurred and were separated by at least 2 months.

Median Lifetime Number of MDE

4 to 7

Median Duration of Recurrent MDE

4 to 5 months

What characterizes Persistent Depressive Disorder (Dysthymia)?

It is characterized by a depressed mood that continues for at least 2 years, with the individual unable to be symptom-free for more than 2 months.

How does Persistent Depressive Disorder (Dysthymia) differ from Major Depressive Disorder (MDD)?

Dysthymia differs in the number of symptoms required, chronicity, severity, higher rates of comorbidity with other mental disorders, less responsiveness to treatment, and a slower rate of improvement over time.

What does "with pure dysthymic syndrome" indicate in the context of Dysthymia?

It indicates that the individual has not met the criteria for a major depressive episode in at least the preceding two years.

What does "with persistent major depressive episode" mean in relation to Dysthymia?

It indicates the presence of a major depressive episode over at least a two-year period.

What is meant by "with intermittent major depressive episodes" in the context of Dysthymia?

This refers to "double depression," where the individual experiences both Persistent Depressive Disorder (PDD) and Major Depressive Episodes (MDE).

PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA) differs in MDD

• The number of symptoms required, and the chronicity.

• More severe.

• Higher rates of comorbidity with other mental disorders.

• Less responsive to treatment

• Slower rate of improvement over time.

What does "with pure dysthymic syndrome" indicate in Persistent Depressive Disorder (Dysthymia)?

It indicates that the individual has not met the criteria for a major depressive episode in at least the preceding two years.

What does "with persistent major depressive episode" mean in relation to Dysthymia?

It signifies the presence of a major depressive episode that occurs over at least a two-year period

What is meant by "with intermittent major depressive episodes" in the context of Dysthymia?

This refers to "double depression," where the individual experiences both Persistent Depressive Disorder (PDD) and Major Depressive Episodes (MDE).

DOUBLE DEPRESSION

W/ both major depressive episodes and persistent depression with fewer symptoms.

What is the U-shaped pattern of depression onset?

Depression is highest in young adults, decreases across middle adulthood, and then increases again in older age.

What is the typical duration of the first episode of depression if untreated?

The typical duration is between 2 to 9 months.

How long can Persistent Depressive Disorder (PDD) last?

PDD may last 20 to 30 years or more.

What is the median duration of Persistent Depressive Disorder (PDD) in adults?

The median duration is approximately 5 years.

What is the median duration of Persistent Depressive Disorder (PDD) in children?

The median duration is approximately 4 years.

What characterizes Normal Grief?

Normal Grief involves the natural emotional response to loss, where individuals experience sadness and mourning but eventually adjust to the loss over time.

What is Integrated Grief?

Integrated Grief occurs when the finality of death and its consequences are acknowledged, and the individual adjusts to the loss, incorporating it into their life.

What characterizes Complicated Grief?

Complicated Grief involves being caught up in rumination about the circumstances of the death, worrying about its consequences, or excessively avoiding reminders of the loss.

How do rituals relate to Complicated Grief?

In Complicated Grief, the rituals intended to help individuals face and accept death are often ineffective, leading to prolonged distress.

What are Psychotic Features Specifiers in the context of mood episodes?

During a major depressive (or manic) episode, individuals may experience psychotic symptoms.

What are Mood Congruent Psychotic Features?

These features are directly related to the depression, including:

• Somatic (Physical) Delusions: Beliefs that the body is rotting internally and deteriorating into nothingness.

• Auditory Hallucinations: Hearing voices.

Somatic (Physical) Delusions:

Beliefs that the body is rotting internally and deteriorating into nothingness.

Auditory Hallucinations

Hearing voices.

Mood-Incongruent

Not consistent with the depressed mood.

Delusions Of Grandeur

Believing they are supernatural or supremely gifted.

How do psychotic features affect treatment response and impairment?

Individuals with psychotic features typically have a poor response to treatment, greater impairment, and fewer weeks with minimal symptoms.

What is the Anxious Distress Specifier?

It refers to the presence and severity of accompanying anxiety in individuals with mood disorders.

What are the implications of having an Anxious Distress Specifier?

The presence of anxious distress indicates a more severe condition, increases the likelihood of suicidal thoughts and completed suicide, and predicts a poorer outcome from treatment.

What is the Mixed Features Specifier?

It refers to predominantly depressive episodes that include several (at least three) symptoms of mania.

What is the Melancholic Features Specifier?

This specifier applies only if the full criteria for a major depressive episode have been met and includes some of the more severe somatic (physical) symptoms.

What are some symptoms associated with Melancholic Features?

Symptoms include:

• Early-morning awakenings

• Weight loss

• Loss of libido

• Excessive or inappropriate guilt

• Anhedonia (loss of pleasure)

What is the Catatonic Features Specifier?

It refers to the presence of excessive but random or purposeless movement, as well as the absence of movement.

What are the characteristics of Catatonia?

Characteristics include:

• Excessive but random or purposeless movement.

• Absence of movement.

What is Catalepsy in the context of Catatonic Features?

Catalepsy is a stuporous state where:

• Muscles are waxy and semirigid.

• Arms or legs remain in any position in which they are placed.

What characterizes the Atypical Features Specifier?

Individuals consistently oversleep and overeat during their depression and may react with interest or pleasure to some things.

What are the demographic and severity implications of Atypical Features?

Atypical features are associated with a greater percentage of women, an earlier age of onset, more symptoms, more severe symptoms, more suicide attempts, and higher rates of comorbid disorders.

What does the Peripartum Onset Specifier refer to?

It refers to the period surrounding childbirth, including the time before and just after the birth.

What is the Peripartum Period?

The Peripartum Period includes pregnancy and the 6-month period immediately following childbirth.

What are Baby Blues?

They typically last a few days and occur in 40% to 80% of women between 1 and 5 days after delivery.

How does the incidence of depression postpartum compare to during pregnancy?

There is a somewhat higher incidence of depression found postpartum than during the period of pregnancy itself.

What is the Seasonal Pattern Specifier?

It refers to episodes of depression that occur during certain seasons, such as winter depression.

What is the most usual pattern of seasonal depression?

A depressive episode that begins in late fall and ends with the beginning of spring.

What characterizes Seasonal Affective Disorder (SAD)?

SAD occurs for at least two years with no evidence of nonseasonal major depressive episodes during that time, often linked to seasonal changes in melatonin production.

What is the Phase Shift Hypothesis in relation to SAD?

It suggests that SAD is a result of phase-delayed circadian misalignment.

What are the treatments for Seasonal Affective Disorder (SAD)?

• Phototherapy: Exposure to 2 hours of bright light (2,500 lux) immediately upon awakening, which helps slow melatonin production.

• Cognitive Behavioral Therapy (CBT): Shows similar effects to phototherapy after a 1-year follow-up and is more effective after a 2-year follow-up.

What is Cabin Fever?

It refers to a sad mood due to less winter sunlight.

What are the characteristics of individuals with winter depression?

The majority tend to experience excessive sleep, increased appetite, and weight gain.

PREMENSTRUAL DYSPHORIC DISORDER (PMDD

A combination of physical symptoms, severe mood swings, and anxiety are associated with incapacitation during this period of time.

What is Disruptive Mood Dysregulation Disorder (DMDD)?

DMDD is characterized by chronic and severe irritability and difficulty regulating emotions, resulting in frequent temper tantrums.

What are the long-term risks associated with DMDD?

Adults with a history of DMDD are at increased risk for developing mood and anxiety disorders.

What characterizes Bipolar I Disorder?

Bipolar I Disorder is defined by the presence of a major depressive episode (MDE) accompanied by a full manic episode.

What characterizes Bipolar II Disorder?

Bipolar II Disorder involves major depressive episodes (MDE) alternating with hypomanic episodes.

What is required for a Separate Manic Episode in Bipolar II Disorder?

There must be a symptom-free period of at least 2 months between episodes.

What is Cyclothymic Disorder?

It is a milder but more chronic version of bipolar disorder.

How long must Cyclothymic Disorder last for diagnosis?

It must last for at least 2 years (1 year for children and adolescents).

What is the Rapid-Cycling Specifier in Bipolar Disorders?

It is characterized by experiencing at least four manic or depressive episodes within a year.

What are some characteristics of individuals with Rapid-Cycling?

• Does not respond well to standard treatments.

• Higher probability of suicide attempts.

• More severe episodes of depression.

• 60% to 90% of those affected are female.

What is Rapid Switching in the context of Bipolar Disorders?

It refers to cycling between mania and depression without any break, representing a treatment-resistant form of the disorder.

What is an Ultra-Rapid Cycle in Bipolar Disorders?

An Ultra-Rapid Cycle lasts only for days to weeks.

What is Ultra-Ultra-Rapid Cycling?

It refers to mood cycling that occurs in less than 24 hours.

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

The average age of onset for Bipolar I Disorder is between 15 and 18 years.

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

The average age of onset for Bipolar II Disorder is between 19 and 22 years.

Is it common for someone to develop bipolar disorder after the age of 40?

It is rare for someone to develop bipolar disorder after the age of 40.

What is the association between bipolar disorder and suicide?

Bipolar disorder is associated with a high risk of suicide attempts and suicide death.