Mood Disorders 4/12/24

Mood episodes: Persistent moods (lasting for days or weeks) that cause significant distress or impair functioning

  • Generally not just a “feeling”

  • Diagnosis of mood disorders requires that the changes in mood are not due to a different medical condition (thyroid problems or caused by a substance)

  • Standardized diagnostic classifications help health providers communicate with each other and also aid researchers

    APA, 1952: Creation of the first Diagnostic and Statistical Manual

  • Six major revisions, latest in 2013

  • Characterizes mental illness as combinations of symptoms

  • Limited in cultural context and potentially too broad in classification, but still very useful

Major Depressive Episode (MDE)

Feeling depressed or down and or experience diminished interest or pleasure in almost all activities (ANHEDONIA)

  • Some symptoms may be:

  • Change in sleep

  • restless/agitated

  • Exceptionally tired or lacking energy

  • Feeling worthless, exceptionally inappropriately guilty

Manic or Hypomanic Episode

A distinct period of unusually strong and persistent euphoric or irritable mood and persistently increased energy and / or work

  • For mania, must last a week or requires hospitalization

  • For hypomania, four days or longer (and many not impair functioning)

  • Additionally, three of the following with euphoria (four for irritability)

    -Inflated self-esteem or grandiosity (one has special abilities or powers)

    -Increased goal-directed activity or agitation

  • Reduced need for sleep

    Unipolar Mood Disorders

  • Unipolar: Characterized by one mood

  • Major depressive disorder: One or more major depressive episodes, but no history or manic or hypomanic episodes

Persistent depressive disorder: Feeling depressed more often than not for at least two years, as well as two of the following

-Poor appetite or overeating

-Sleeping too little or too much

-Low energy or fatigue

Bipolar Mood Disorders

Bipolar: Characterized by two major emotional states

  • Three major types in the DSM

  • Bipolar I DIsorder: A single or recurrent manic episode

  • Bipolar II Disorder: A single or recurrent hypomanic episode, and depressive episodes

  • Cyclothymic Disorder: Numerous alternating periods of hypomania and depression, lasting for at least two years and causing significant distress or impairment

  • The periods of depression cannot meet the criteria for an MDE

Specifiers

  • Both MDEs and manic episodes can be further characterized by psychiatrists based on additional symptoms or timings

  • Psychotic features: When episodes are accompanied by delusions (strong false beliefs) or hallucinations (perceptual disturbances that do not reflect reality

  • Seasonal pattern: A mood episode occurs at the same time of year for two consecutive years (commonly fall or winter)

  • Peripartum onset: Occurs during pregnancy or within four weeks of the birth of a child

About 1 in 200 people experience PDD over a given 12-month period

  • Gender: women experience a 2x-3x higher rate of depression than men, beginning in puberty (childhood depression shows no gender differences)

  • Socioeconomic status: Lower income/ social status → higher rate of MDD

  • Genetic factors Depressive disorders tend to run in families, although no single genetic variant significantly increases risk of MDD

  • Stressful life events: Events with long-ter, consequences

  • Early adversity, like child abuse

  • Attributional style: Pessimistic People may develop it more

Factors Influencing Bipolar Disorders

  • Researchers are still pinning done the exact mechanisms of BD, especially episode onset and relapse

  • Genetics: genetic factors play a large role in getting BD, but do not predict as well as the course of BD over a lifetime

  • Differences in brain function: People vulnerable to BD may process emotional stimuli differently, but which parts of the brain differ are not clear

  • Severe stressors: People with BD are more likely to relapse after severe stress

  • Positive life events: May trigger manic episodes

  • Circadian vulnerability: sleep cycle

Electroconvulsive therapy (ECT): NOT LIKE THE MOVIES: The brain is stimulated with electrical current while the person is anesthetized and given muscle relaxants

Repetitive transcranial magnetic stimulation (rTMS): a strong magnet is pulsed near certain parts of the skull

BD treated with medication

-Lithium

-Anticonvulsants

Interpersonal and social rhythm therapy: focuses on keeping a predictable schedule