Chapter 7: Mood Disorders and Suicide (copy)

major depressive episode

The most commonly diagnosed and most severe depression

major depressive episode

it as an extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms (such as feelings of worthlessness and indecisiveness) and disturbed physical functions (such as altered sleeping patterns, significant changes in appetite and weight, or a notable loss of energy) to the point that even the slightest activity or movement requires an overwhelming effort.

major depressive episode

it is typically accompanied by a general loss of interest in things and an inability to experience any pleasure from life, including interactions with family or friends or accomplishments at work or at school.

physical changes, behavioral and emotional shutdown

most central indicators of a full major depressive episode

somatic or vegetative symptoms

other term for physical changes

anhedonia

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

anhedonia

it reflects that these episodes represent a state of low positive affect and not just high negative affect

major depressive episode

diagnostic criteria:

A. At least five of the following symptoms must occur in the same 2-week period, including either depressed mood or loss of interest/pleasure:

1. Feeling sad, empty, or tearful most of the day, almost every day (or irritable mood in children/teens).

2. Loss of interest or enjoyment in most activities.

3. Significant weight or appetite changes (gain or loss of more than 5% of body weight in a month).

4. Sleeping too much or too little.

5. Restlessness or slowed movements (noticeable to others).

6. Feeling tired or lacking energy almost every day.

7. Feeling worthless or having excessive guilt.

8. Trouble thinking, concentrating, or making decisions.

9. Repeated thoughts of death or suicide.

B. Symptoms must interfere with daily life (social, work, or other important areas).

C. Symptoms must not be caused by drugs, medication, or a medical condition.

4 to 9

The duration of a major depressive episode, if untreated, is approximately ___ months

mania

The second fundamental state in mood disorders

mania

abnormally exaggerated elation, joy, or euphoria.

mania

In this episode, individuals find extreme pleasure in every activity; some patients compare their daily experience of mania with a continuous sexual orgasm.

mania

in this episode, they become extraordinarily active (hyperactive), require little sleep, and may develop grandiose plans, believing they can accomplish anything they desire.

mania

describes persistently increased goal-directed activity or energy

flight of ideas

Speech is typically rapid and may become incoherent, because the individual is attempting to express so many exciting ideas at once

1

DSM-5 criteria for a manic episode require a duration of only __ week, less if the episode is severe enough to require hospitalization.

irritability

it is often part of a manic episode, usually near the end

anxious or depressed

Paradoxically, being _____ is also commonly part of mania

3 to 4

The duration of an untreated manic episode is typically 3 to 4 months

hypomanic episode

a less severe version of a manic episode that does not cause marked impairment in social or occupational functioning and need last only 4 days rather than a full week.

hypo

it means below

hypomanic episode

it is not in itself necessarily problematic, but its presence does contribute to the definition of several mood disorders

unipolar mood disorder

mood remains at one “pole” of the usual depression—mania continuum.

mixed features

in this episode, someone can feel manic (energetic and impulsive) but still have some depression or anxiety, or feel depressed but have a few manic symptoms.

mixed features

it requires specifying whether a predominantly manic or predominantly depressive episode is present and then noting if enough symptoms of the opposite polarity are present to meet its criteria.

course or temporal patterning

It is important to determine the ____ of the depressive or manic episodes.

For example, do they tend to recur? If they do, does the patient recover fully for at least two months between episodes (termed “full remission”) or only partially recover retaining some depressive symptoms (“partial remission’)? Do the depressive episodes alternate with manic or hypomanic episodes or not?

temporal course

patterns of recurrence and remittance

temporal course

its importance makes the goals of treating mood disorders somewhat different from those for other psychological disorders.

major depressive disorder

it is defined by the presence of depression and the absence of manic, or hypomanic episodes, before or during the disorder

recurrent major depressive disorder

If someone has two or more major depressive episodes with at least 2 months of no depression in between, it is called ____

dysthymia

other term for persistent depressive disorder

persistent depressive disorder

it shares many of the symptoms of major depressive disorder but differs in its course.

persistent depressive disorder

it is defined as depressed mood that continues at least 2 years, during which the patient cannot be symptom free for more than 2 months at a time even though they may not experience all of the symptoms of a major depressive episode.

persistent depression disorder

patients with this disorder present with higher rates of comorbidity with other mental disorders, are less responsive to treatment, and show a slower rate of improvement over time

double depression

happens when a person has both major depressive episodes and persistent depression with fewer symptoms

persistent depressive disorder with pure dysthymic syndrome

it means one has not met criteria for a major depressive episode in at least the preceding two years

persistent depressive disorder with persistent major depressive episode

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

persistent depressive disorder with intermittent major depressive episodes

means a person has long-term, mild depression (dysthymia) but also experiences periods of more severe depression (major depressive episodes) from time to time.

psychotic features specifiers

Some individuals in the midst of a major depressive (or manic) episode may experience psychotic symptoms, specifically hallucinations (seeing or hearing things that aren't there) and delusions (strongly held but inaccurate beliefs)

hallucinations

seeing or hearing things that aren't there

delusions

strongly held but inaccurate beliefs

somatic delusions

believing, for example, that their bodies are rotting internally and deteriorating into nothingness.

auditory hallucinations

hearing voices telling them how evil and sinful they are

mood congruent hallucinations

false sensory experiences (like hearing voices or seeing things) that match a person's mood.

For example, a depressed person might hear voices saying they are worthless, while a manic person might hear voices telling them they have special powers.

delusion of grandeur

believing, for example, they are supernatural or supremely gifted

mood-incongruent hallucination or delusion

hallucinations or delusions that do not seem consistent with the depressed mood

mood-incongruent hallucination or delusion

Although quite rare, this condition signifies a serious type of depressive episode that may progress to schizophrenia

mood congruent

what is the state of congruence of delusions of grandeur accompanying a manic episode

anxious distress specifier

The presence and severity of accompanying anxiety, whether in the form of comorbid anxiety disorders (anxiety symptoms meeting the full criteria for an anxiety disorder) or anxiety symptoms that do not meet all the criteria for disorders

anxiety

its presence indicates a more severe condition, makes suicidal thoughts and completed suicide more likely, and predicts a poorer outcome from treatment.

mixed features specifier

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

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 persistent depressive disorder or not

melancholic features specifier

it includes 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)

catatonic features disorder

This specifier can be applied to major depressive episodes whether they occur in the context of a persistent depressive order or not, and even to manic episodes, although it is rare—and rarer still in mania.

stuporous state

state involving the absence of movement

catalepsy

condition in which the muscles are waxy and semirigid, so a patient's arms or legs remain in any position in which they are placed

catatonic symptoms

these symptoms may also involve excessive but random or purposeless movement.

catalepsy

it was thought to be more commonly associated with schizophrenia, but some recent studies have suggested it may be more common in depression than in schizophrenia

atypical features specifier

This specifier applies to both depressive episodes, whether in the context of persistent depressive disorder or not. While most people with depression sleep less and lose their appetite, individuals with this specifier consistently oversleep and overeat during their depression and therefore gain weight, leading to a higher incidence of diabetes

atypical features

although patients with these features also have considerable anxiety, they can react with interest or pleasure to some things, unlike most depressed individuals

peri

it means surrounding

peripartum onset specifier

means depression or mood episodes that start just before and just after the birth. It includes feelings of extreme sadness, anxiety, or mood swings that can affect daily life.

peripartum period

it is the pregnancy and the 6 month period immediately following childbirh

baby blues

During this period, new mothers may be tearful and have some temporary mood swings, but these are normal responses to the stresses of childbirth and disappear quickly;

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

it is a type of depression that happens during certain seasons, usually in fall and winter, when there is less sunlight. Symptoms include low energy, sadness, and changes in sleep or appetite, but they improve in spring or summer.

winter depression

people with this seasonal depression tend toward excessive sleep (rather than decreased sleep) and increased appetite and weight gain (rather than decreased appetite and weight loss), symptoms shared with atypical depressive episodes.

seasonal affective disorder

According to this “phase shift hypothesis,” ___ is a result of phase-delayed circadian misalignment, meaning that the patient’s circadian rhythm is misaligned with the environmental day-night cycle

integrated grief

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

integrated grief

it often recurs at significant anniversaries, such as the birthday of the loved one, holidays, and other meaningful occasions, including the anniversary of the death.

syndrome of complicated grief

it is intense, long-lasting grief that makes it hard to move on after losing a loved one. The person may feel extreme sadness, guilt, or longing for the deceased for a long time, interfering with daily life.

acute grief within normal limits

what do these symptoms describe:

• Recurrent, strong feelings of yearning, wanting very much to be reunited with the person who died; possibly even a wish to die in order to be with deceased loved one

• Pangs of deep sadness or remorse, episodes of crying or sobbing, typically interspersed with periods of respite and even positive emotions

• Steady stream of thoughts or images of deceased, may be vivid or even entail hallucinatory experiences of seeing or hearing deceased person

• Struggle to accept the reality of the death, wishing to protest against it; there may be some feelings of bitterness or anger about the death

• Somatic distress, e.g., uncontrollable sighing, digestive symptoms, loss of appetite, dry mouth, feelings of hollowness, sleep disturbance, fatigue, exhaustion or weakness, restlessness, aimless activity, difficulty initiating or maintaining organized activities, and altered sensorium

• Feeling disconnected from the world or other people, indifferent, not interested, or irritable with others

integrated grief within normal limits

what do these symptoms describe:

• Sense of having adjusted to the loss

• Interest and sense of purpose, ability to function, and capacity for joy and satisfaction are restored

• Feelings of emotional loneliness may persist

• Feelings of sadness and longing tend to be in the background but still present

• Thoughts and memories of the deceased person accessible and bittersweet but no longer dominate the mind

• Occasional hallucinatory experiences of the deceased may occur

• Surges of grief in response to calendar days or other periodic reminders of the loss may occur

complicated grief

what do these symptoms describe:

• Persistent intense symptoms of acute grief

• The presence of thoughts, feelings, or behaviors reflecting excessive or distracting concerns about the circumstances or consequences of the death

persistent complex bereavement disorder

it is intense, long-lasting grief that doesn’t ease over time and interferes with daily life. The person may feel extreme sadness, longing, or difficulty accepting the loss for over a year (or 6 months in children), struggling to move forward.

premenstrual dysphoric disorder

it is a severe form of PMS that causes intense mood swings, irritability, depression, and physical symptoms a week or two before a period. These symptoms disrupt daily life but go away after menstruation starts.

disruptive mood dysregulation disorder

it is a condition in children (ages 6-18) marked by severe, frequent temper outbursts that are out of proportion to the situation. Between outbursts, the child has a persistently irritable or angry mood almost every day.

bipolar disorders

The key identifying feature of these disorders is the tendency of manic episodes to alternate with major depressive episodes in an unending roller-coaster ride from the peaks of elation to the depths of despair.

bipolar II disorder

disorder in which major depressive episodes alternate with hypomanic episodes rather than full manic episodes.

bipolar I disorder

disorder in which major depressive episodes alternate with full manic episodes.

manic or hypomanic phase

During this phase, patients often deny they have a problem

cyclothymic disorder

A milder but more chronic version of bipolar disorder

cyclothymic disorder

it is a chronic alternation of mood elevation and depression that does not reach the severity of manic or major depressive episodes.

cyclothymic disorder

Individuals with this disorder tend to be in one mood state or the other for years with relatively few periods of neutral (or euthymic) mood. This pattern must last for at least 2 years (1 year for children and adolescents) to meet criteria for the disorder.

cyclothymic disorder

it is a milder form of bipolar disorder where a person has mood swings between mild depression and mild mania (hypomania) for at least 2 years. The mood changes are not as extreme as in bipolar disorder but still affect daily life.

women

they are approximately twice as likely as men to be diagnosed with a mood disorder.

depression

It’s often difficult to diagnose this in the elderly because its symptoms are similar to those of medical ailments or dementia.

somatic symptoms

these symptoms characterizing mood disorders are nearly equivalent across cultures.

cortisol

it is called a stress hormone because it is elevated during stressful life events.

neurohormones

these are chemicals that act as both hormones and messengers in the brain. They are released by nerve cells and travel through the bloodstream to affect different organs and brain functions, influencing mood, stress, and body processes.

dexamethasone

it is a glucocorticoid that suppresses cortisol secretion in normal participants.

dexamethasone suppression test

it is a medical test used to check how the body regulates cortisol (a stress hormone).

dexamethasone suppression test

It helps diagnose depression and other conditions by seeing if cortisol levels drop after taking dexamethasone, a synthetic steroid.

cortisol

If this neurohormone stays high, it may indicate issues with stress hormone regulation.

hippocampus

it is responsible for keeping stress hormones in check and serves important functions in facilitating cognitive processes such as short-term memory.

gene-environment correlation model

means that genetic endowment might increase the probability that we will experience stressful life events

learned helplessness theory of depression

it suggests that people become depressed when they feel they have no control over bad events in their life. If they repeatedly experience failure or hardship and believe nothing they do can change it, they stop trying, leading to feelings of helplessness and depression.

arbitrary inference

it is evident when a depressed individual emphasizes the negative rather than the positive aspects of a situation

arbitrary inference

Making a conclusion without enough evidence or with incorrect reasoning (e.g., "My friend didn’t text back, so they must hate me").

overgeneralization

Applying one negative experience to everything (e.g., "I failed one test, so I’ll fail all my exams and never succeed").