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PSYP2-WK 2- Mood Disorders

-MDD and BP (bipolar disorder) are associated with one of the highest levels of disability of all psychiatric and physical illnesses. They significantly impact an individual's daily functioning, social life, and overall quality of life.
Persistent depressive disorder: previously known as dysthymia.
Anhedonia: inability to feel pleasure

MDD: discrete episodes of at least 2 weeks during which a person experiences a depressed mood for most of the day nearly every day, and/or diminished interest or pleasure in activities that were previously enjoyed. Additional sx include:

  • sig. Weight changes: a decrease or increase of more than 5\% of body weight in a month, or a significant change in appetite nearly every day.
  • sleep disturbances: persistent insomnia (difficulty falling or staying asleep) or hypersomnia (sleeping excessively).
  • psychomotor agitation or slowing: observable by others as restlessness (e.g., pacing, hand-wringing) or slowed movements and speech.
  • Fatigue or low energy: feeling tired or lacking energy nearly every day.
  • Feelings of worthlessness: exaggerated feelings of worthlessness or inappropriate, excessive guilt, which may be delusional.
  • excessive guilt
  • impairments in decision making or concentration: a diminished ability to think, concentrate, or indecisiveness nearly every day.
  • recurrent thoughts of death or suicidal behavior: 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.
    MDD dx is given when 5 or more of these sx are present in a 2 wk period, one of which must be depressed mood of anhedonia and substantial distress, functional impairment or both. MDD follows a recurrent course and is highly comorbid with other mental disorders (anxiety, impulse control disorders, and substance use disorders). MDD is strongly associated with physical illness (DM, asthma, CVD).

Persistent depressive disorder: dx when depressed mood occurs most of the day, more days than not, for at least 2 years, with no periods of sx remission longer than 2 months. Requires 2 or more further dx:

  • low energy: ongoing feelings of fatigue.
  • low self esteem
  • disrupted sleep: persistent insomnia or hypersomnia.
  • changes in appetite: either significantly increased or decreased appetite.
  • poor concentration
  • feelings of hopelessness

BP-1: characterized by at least one lifetime episode of mania. No period of depression is required for dx.

Manic Episode: individual must have exp. A period of at least 1 week in which elevated, expansive, or irritable mood is present along with increase in energy and goal directed activity, and marked functional impairment. 3 additional sx must be present for most of the day, nearly everyday (4 if mood is only irritable):

  • inflated self esteem: grandiosity, which can range from uncritical self-confidence to delusional proportions.
  • decreased need for sleep: feeling rested after only a few hours of sleep (e.g., 3 hours), not feeling tired.
  • pressured speech: rapid, continuous, and often loud speech that is difficult to interrupt.
  • racing thoughts: a subjective experience of thoughts speeding through the mind, often leading to flight of ideas.
  • distractibility: attention too easily drawn to unimportant or irrelevant external stimuli.
  • psychomotor agitation: increase in goal-directed activity (e.g., excessive involvement in multiple projects) or purposeless non-goal-directed activity.
  • excessive involvement in activities that have a high potential for painful consequences (e.g., unrestrained buying sprees, sexual indiscretions, foolish business investments).

Hypomanic episode: identical to manic episode with the exception of sx duration, must be at least 4 consecutive days but less than 1 week, and the level of functional impairment is not as great. While noticeable by others, it does not cause marked impairment in social or occupational functioning or necessitate hospitalization.

BP-2: presence of at least one lifetime major depressive episode (MDE) and one lifetime episode of hypomania.

*mean age of onset for BP1 and BP2 is 18 and 20 y.o. Comorbid substance use disorders are higher for BP than any other psychiatric condition.

Cyclothymic disorder: dx in cases in which alternating periods of hypomania and depression persist for 2 years or more but never fulfill the criteria for an episode of mania, hypomania, or major depression.

Assessments:
Hamilton Rating Scale for Depression(HRSD): interview based, most commonly used interview-based measure of depressive symptom severity.
Quick Inventory of Depressive Symptoms: interview based, provides full coverage of the nine depressive symptoms within the DSM.
Beck Depression Inventory-II(BDI-II): SRP measure, more useful of measuring depression at higher levels.
Quick Inventory of Depressive symptoms: SRP measure
Patient Health Questionnaire(PHQ-9): SRP measure
Center for epidemiological studies depression scale(CES-D): SRP measure, more useful for epidemiological samples with less severe symptoms.

Psychotherapies:
Cognitive-behavioral therapy: rooted in the cognitive-behavioral model of depression, which proposes that MDD is both triggered and maintained by negative patterns of thinking. CBT for BP depression focuses on helping patients identify and modify negative patterns of thinking and maladaptive behaviors that contribute to depressive symptoms.
Interpersonal Therapy(IPT): targets problems in several different interpersonal domains linked to depression including interpersonal disputes, grief, and role transitions.
Behavioral Activation(BA): focuses exclusively on helping patients identify and modify maladaptive patterns of behaviors contributing to depression. Focuses on behavioral change strategies aimed at helping depressed individuals gradually increase exposure to rewarding experiences (e.g., engaging in hobbies, social interactions).
Mindfulness-based cognitive therapy(MBCT): integration of mindfulness training with traditional cognitive therapy skills, aimed at preventing relapse by teaching patients to observe depressive thoughts without judgment.
Family-focused therapy(FFT): patients and family members attend up to 21 sessions of psychoeducation about BP, communication skills training, and problem solving training. This therapy helps improve family dynamics and support for the individual with BP.
Interpersonal and social rhythm therapy(IPSRT): targets problems in interpersonal domains. Tx focuses on correcting social and circadian rhythm irregularities, which are critical in managing bipolar disorder.

Pharmacological Tx:
-Antidepressant medications known as monoamine oxidase inhibitors (MAOIs)
-Tricyclic antidepressant (TCAs)
-first line of pharmacological tx for acute mania should be a combination of an atypical antipsychotic medication and a mood stabilizer.
-Antidepressant medications can induce manic ep in BP patients and should be used with caution, often only in conjunction with a mood stabilizer.