Mood Disorders & Suicide

Manic Episode

A. Period of abnormally and persistently elevated/irritable mood w/increased activity or energy. Must last at least two weeks or require hospitalization.

B. 3 or more of the following symptoms

1. Inflated self-esteem/grandiosity

2. Decreased need for sleep

3. More talkative, or feeling pressure to talk more

4. Flight of ideas/racing thoughts

5. Distractibility

6. Increase in goal-directed activity or psychomotor agitation

7. Excessive involvement in activites that could cause harm

Hypomanic Episode

Same symptoms as manic episode but doesn’t cause severe impairment. Last for at least 4 days and doesn’t result in hospitalization

Bipolar II Disorder

At least one full manic and depressive episode

Bipolar II disorder

At least one hypomanic and depressive episode

Cycothymic Disorder

Hypomanic and depressive symptoms that do not meet the criteria for bipolar. Essentially, a chronic form of bipolar that must last at least 2 years (1 in children/adolescents). Symptoms cannot have more than a 2-month break.

Treatment for Bipolar

Lithium helps prevent manic episodes because it is a mood-stabilizing drug. But too much can cause poisoning.Therapy can help people be consistent with taking medication, because they often stop taking meds when in a manic episode.

Major Depressive Disorder

A. At least one depressive episode, which includes 5/+ symptoms within 2 weeks

1. Depressed mood (must include)

2. Lack of interest/pleasure in activities (must include)

3. Significant change in weight or appetite

4. Insomnia/hypersomnia

5. Psychomotor agitation/retardation

6. Fatigue/loss of energy

7. Excessive guilt/worthlessness

8. Indecisiveness and concentration problems

9. Recurrent SI

Persistant Depressive Disorder (Dysthymia)

A. Less severe, but more chronic form of depression

B. Depressed mood for most days for 2 years (1 yr in childhood/adolescence). Cannot be without symptoms for more than two months. must have 2/more symptoms

1. Poor appetite/overeating

2. Insomnia/hypersomnia

3. Low energy/fatigue

4. Low self-esteem

5. Indecisiveness and concentration problems

6. Hopelessness

Double Depression

Having both Dysthymia and Major Depressive Disorder at the same time

Premenstrual Dysphoric Disorder

A. 5/+ symptoms in the week before they cycle that disappear afterward

B. 1/+ symptoms from this area

1. Affective lability (mood swings, sadness)

2. Irritability, anger, interpersonal conflict

3. Depressed mood, hopelessness, self-deprecating thoughts

4. Anxiety, tension, feeling on edge

C. 1/+ symptoms

1. Ahedonia

2. Concentration issues

3. Change in appetite, eating, and cravings

4. Hypersomnia/insomni

5. Feeling overwhelmed/out of control

6. Physical symptoms, such as bloating and breast tenderness

Disruptive Mood Dysregulation Disorder (DMDD)

Symptoms must begin before age 10, but usually diagnosed between ages 6/12

1. Recurrent temper outbursts w/verbal/physical/behavior manifestations (e.g, aggression, crying)

2. Outbursts are unexpected for developmental leavall

3. Outbursts occur 3/+ time a week and are present in 2 settings

4. Mood is irritable between outbursts and is present in 2 settings

Potential causes of mood disorders

1. Genetics

2. Neurotransmitters: low serotonin increases levels of dopamine and norepinephrine

3. Endocrine system: higher HPA-axis activation (more cortisol), shrinkage of hippocampus which helps with memory

4. Sleep: Bi-directional relationship. More intense REM, deep sleep doesn’t occur in sleep if it does at all.

5. Brain activation: Less activation in prefrontal corex and more in amygdala

6. Stress/trauma: Stress may trigger depression or cause people to seek out stressful events-reciprocal model, while pos events trigger mania

7. Learned helplessness

8. Negative attributions: internal, stable, and global

9. Negative cognitive style: cognitive distortions

10. Interpersonal stress/marital conflict

Treatments for depression

1. Antidepressants, antipsychotics, and ketamine

2. Electroconvulsive therapy

3. Transcranial Magnetic Stimulation

4. CBT and ACT

5. Interpersonal Psychotherapy and couples therapy

Electroconvulsive therapy (ECT)

Shocks that induce seizures. Controversial and not used a ton because it can cause headaches and memory loss.

Transcranial Magnetic Stmulation

Magnetic coil on head administers electromangnetic pulse

Interpersonal psychotherapy

Resolving relationship problems and working on creating more healthy relationships.

Risk factors for suicide

1. Family history of suicide and genetics

2. Neurobiology, low levels of serotonin

3. Psychological disorders

4. Hopelessness and feeling like a burden

5. Alcohol and drug use

6. stressful life events: breakups, abuse, isolation

Steps to a crisis/safety plan

1. Warning signs

2. Coping strategies

3. Distractions

4. Supports

5. Environmental modifications: reducing risk

Nonsuicidal self-injury disorder

Must occur for at least 5 days a year. Intentional self-inflicted damage to body not done w/suicidal intent. Done to resolve interpersonal problems, gain relief, and induce a pos state

Other mood disorders to know

1. Substance/medication-induced depressive disorder

2. Depressive disorder due to another medical condition

3. Other specified and unspecified depressive disorder