Mood Disorders and Suicide - A less severe episode of mania that does not cause impairment in

social or occupational functioning is known as a hypomanic episode.

Understanding and Defining Mood Disorders > need last only 4 days rather than a full week.
An Overview of Depression and Mania
- Fundamental experiences of depression and mania contribute, The Structure of Mood Disorders
either singly or together, to all the mood disorders. - An episode of mania coupled with anxiety or depression is known
- Most commonly diagnosed and most severe depression is called a as a mixed episode or mixed state.
major depressive episode. - Manic episodes are characterized by dysphoric (anxious or
- in other cases a major depressive episode will last at least two depressive) features more commonly than was thought, and
years (chronic major depressive episode). dysphoria can be severe.
Time; 2 weeks - An individual who suffers from episodes of depression only is said
Cognitive symptoms (such as feelings of worthlessness and to have a unipolar disorder.
indecisiveness) and disturbed physical functions (such as altered - An individual who alternates between depression and mania has a
sleeping patterns, significant changes in appetite and weight, or a bipolar disorder
notable loss of energy) to the point that even the slightest activity
or movement requires an overwhelming effort. Depressive Disorders
- General loss of interest in things and an inability to experience any - Major depressive disorder defined by the absence of manic, or
pleasure from life, including interactions with family or friends or hypomanic episodes before or during the disorder.
accomplishments at work or at school. > Single episode or recurrent, but it is always time-limited; in
- Most central indicators of a full major depressive episode are the another form of depression.
physical changes (sometimes called somatic or vegetative > If two or more major depressive episodes occurred and were
symptoms). separated by at least 2 months during which the individual was not
Anhedonia (loss of energy and inability to engage in pleasurable depressed, the major depressive disorder is noted as being
activities or have any “fun”) is more characteristic of these severe recurrent.
episodes of depression. - Single-episode occurrences of major depressive disorder later
- The duration of a major depressive episode, if untreated, is experience a second episode
approximately 4 to 9 months. > unipolar depression is often a chronic condition that waxes and
- In mania, individuals find extreme pleasure in every activity; some wanes over time but seldom disappears.
patients compare their daily experience of mania with a continuous - The median lifetime number of major depressive episodes is 4 to 7
sexual orgasm. - The median duration of recurrent major depressive episodes is 4
Time; manic episode require a duration of only 1 week, less if the to 5 months
episode is severe enough to require hospitalization.
Diagnostic Criteria for Major Depressive Disorder - In some cases, fewer symptoms are observed than in a major
A. At least one major depressive episode (DSM-5 Table 7.1 Criteria depressive episode but they persist for at least two years
A–C). (dysthymia).
B. The occurrence of the major depressive episode is not better - Persistent depressive disorder (dysthymia) is defined as depressed
explained by schizoaffective disorder, schizophrenia, mood that continues at least 2 years.
schizophreniform disorder, delusional disorder, or other specified - It is considered more severe, since patients with persistent
and unspecified schizophrenia spectrum and other psychotic depression present with higher rates of comorbidity with other
fidisorders. mental disorders, are less responsive to treatment, and show a
C. There has never been a manic episode or hypomanic episode. slower rate of improvement over time.
Note: This exclusion does not apply if all of the manic-like or - In cases of double depression, a form of persistent depressive
hypomanic-like episodes are substanceinduced or are attributable disorder, an individual experiences both major depressive episodes
to the direct physiological effects of another medical condition. and dysthymia.
Specify the clinical status and/or features of the current or most - Patients suffering from double depression had not recovered from
recent major depressive episode: the underlying pattern of depressive symptoms 2 years after follow-
Single episode or recurrent episode up.
Mild, moderate, severe
With anxious distress Diagnostic Criteria for Persistent Depressive Disorder (Dysthymia)
With mixed features A. Depressed mood for most of the day, for more days than not, as
With melancholic features indicated by either subjective account or observation by others, for
With atypical features at least 2 years. Note: In children and adolescents, mood can be
With mood-congruent psychotic features irritable and duration must be at least 1 year.
With mood-incongruent psychotic features B. Presence, while depressed, of two (or more) of the following:
With catatonia 1. Poor appetite or overeating
With peripartum onset 2. Insomnia or hypersomnia
With seasonal pattern (recurrent episode only) 3. Low energy or fatigue
In partial remission, in full remission 4. Low self-esteem
5. Poor concentration or difficulty making decisions
- Persistent depressive disorder (dysthymia) shares many of the 6. Feelings of hopelessness
symptoms of major depressive disorder but differs in its course. C. During the 2-year period (1 year for children or adolescents) of the
- depression remains relatively unchanged over long periods, disturbance, the person has never been without the symptoms in
sometimes 20 or 30 years or more. criteria A and B for more than 2 months at a time.
D. Criteria for major depressive disorder may be continuously there have been periods of at least 8 weeks in at least the preceding
present for 2 years. 2 years with symptoms below the threshold for a full major
E. There has never been a manic episode or a hypomanic episode, depressive episode.
and criteria have never been met for cyclothymic disorder. With intermittent major depressive episodes, without current
F. The disturbance is not better explained by a persistent episode: if full criteria for a major depressive episode are not
schizoaffective disorder, schizophrenia, delusional disorder, or other currently met, but there has been one or more major depressive
specified or unspecified schizophrenia spectrum and other psychotic episodes in at least the preceding 2 years.
disorder. In full remission, in partial remission
G. The symptoms are not attributable to the physiological effects of
a substance (e.g., a drug of abuse, a medication) or another medical Additional Defining Criteria for Depressive Disorders
condition (e.g., hypothyroidism). In addition to rating severity of the episode as mild, moderate, or
H. The symptoms cause clinically significant distress or impairment severe, clinicians use eight basic specifiers to describe depressive
in social, occupational, or other important areas of functioning. disorders.
Specify if: 1. Psychotic features specifiers. Some individuals in the midst of a
Current severity: Mild, moderate, severe major depressive (or manic) episode may experience psychotic
With anxious distress symptoms;
With mixed features hallucinations (seeing or hearing things that aren’t there)
With melancholic features > Some may hear voices telling them how evil and sinful they are
With atypical features (auditory hallucinations).
With mood-congruent psychotic features delusions (strongly held but inaccurate beliefs)
With mood-incongruent psychotic features > somatic (physical) delusions, believing, for example, that their
With peripartum onset bodies are rotting internally and deteriorating into nothingness.
Early onset: If onset is before age 21 years - hallucinations and delusions are called mood congruent, because
Late onset: If onset is at age 21 years or older. they seem directly related to the depression.
Specify (for most recent 2 years of dysthymic disorder): - other types of hallucinations or delusions
With pure dysthymic syndrome: if full criteria for a major depressive > delusions of grandeur (believing, for example, they are
episode have not been met in at least the preceding 2 years. supernatural or supremely gifted) This is a mood-incongruent
With persistent major depressive episode: if full criteria for a major hallucination or delusion.
depressive episode have been met throughout the preceding 2-year > this condition signifies a serious type of depressive episode that
period. may progress to schizophrenia (or may be a symptom of
With intermittent major depressive episodes, with current episode: if schizophrenia to begin with).
full criteria for a major depressive episode are currently met, but
2. Anxious distress specifier. The presence and severity of 7. Peripartum onset specifier. Peri means “surrounding”, in this case
accompanying anxiety, whether in the form of comorbid anxiety the period of time just before and just after the birth. This specifier
disorders. can apply to both major depressive and manic episodes.
(anxiety symptoms meeting the full criteria for an anxiety disorder) 8. Seasonal pattern specifier. This temporal specifier applies to
or anxiety symptoms that do not meet all the criteria for disorders. recurrent major depressive disorder (and also to bipolar disorders).
Most important addition to specifiers for mood disorders in DSM-5. It accompanies episodes that occur during certain seasons (for
For all depressive and bipolar disorders. example, winter depression).
3. Mixed features specifier. Predominantly depressive episodes that Seasonal affective disorder (SAD)
have several (at least three) symptoms of mania. The most usual pattern is a depressive episode that begins in the
4. Melancholic features specifier. This specifier applies only if the full late fall and ends with the beginning of spring. (In bipolar disorder,
criteria for a major depressive episode have been met, whether in individuals may become depressed during the winter and manic
the context of a persistent depressive disorder or not. during the summer.)
Include some of the more severe somatic (physical) symptoms. These episodes must have occurred for at least two years with no
5. Catatonic features specifier. This specifier can be applied to major evidence of nonseasonal major depressive episodes occurring
depressive episodes whether they occur in the context of a during that period of time.
persistent depressive order or not, and even to manic episodes,
although it is rare—and rarer still in mania. Other Depressive Disorder
This serious condition involves an absence of movement or Premenstrual Dysphoric Disorder (PMDD)
catalepsy, in which the muscles are waxy and semirigid. - similar to premenstrual syndrome (PMS) but is more serious.
Also involve excessive but random or purposeless movement. PMDD causes severe irritability, depression, or anxiety in the week
Catalepsy was thought to be more commonly associated with or two before your period starts.
schizophrenia. Symptoms usually go away two to three days after your period
6. Atypical features specifier. Individuals with this specifier starts.
consistently oversleep and overeat during their depression and Symptoms: Depression (mood); Irritability; Anxiety
Treatments: Selective serotonin reuptake inhibitor
therefore gain weight, leading to a higher incidence of diabetes.
Depression with atypical features, compared with more typical
Disruptive Mood Dysregulation Disorder
depression, is associated with a greater percentage of women and
a childhood condition of extreme irritability, anger, and frequent,
an earlier age of onset.
intense temper outbursts.
Has more symptoms, more severe symptoms, more suicide
Symptoms; go beyond a being a “moody” child—children with
attempts, and higher rate of comorbid disorders including alcohol
DMDD experience severe impairment that requires clinical
abuse.
attention.
- children up to 12 years of age as suffering from a diagnosis termed - The causes of mood disorders lie in a complex interaction of
disruptive mood dysregulation disorder rather than have them biological, psychological, and social factors.
continue to be mistakenly diagnosed with bipolar disorder or - From a biological perspective, researchers are particularly
perhaps conduct disorder interested in the stress hypothesis and the role of neurohormones.
- Psychological theories of depression focus on learned helplessness
Bipolar Disorders and the depressive cognitive schemas, as well as interpersonal
- Tendency of manic episodes to alternate with major depressive disruptions.
episodes in an unending roller-coaster ride from the peaks of
elation to the depths of despair. Treatment of Mood Disorders
- Bipolar disorders are parallel in many ways to depressive - A variety of treatments, both biological and psychological, have
disorders. For example, a manic episode might occur only once or proved effective for the mood disorders, at least in the short term.
repeatedly. For those individuals who do not respond to antidepressant drugs
Bipolar II disorder, in which major depressive episodes alternate or psychosocial treatments, a more dramatic physical treatment,
with hypomanic episodes. hypomanic episodes are less severe. electroconvulsive therapy, is sometimes used.
Bipolar I disorder are the same, except the individual experiences a - Two psychological treatments
full manic episode. > cognitive therapy and interpersonal psychotherapy— seem
During manic or hypomanic phases, patients often deny they have a effective in treating depressive disorders.
problem. - Relapse and recurrence of mood disorders are common in the long
- The key identifying feature of bipolar disorders is an alternation of term, and treatment efforts must focus on maintenance treatment;
manic episodes and major depressive episodes. Cyclothymic that is, on preventing relapse or recurrence.
disorder is a milder but more chronic version of bipolar disorder.
Suicide
Prevalence of Mood Disorders - Suicide is often associated with mood disorders but can occur in
- Mood disorders in children are fundamentally similar to mood their absence or in the presence of other disorders.
disorders in adults. - It is the 11th leading cause of death among all people in the United
- Symptoms of depression are increasing dramatically in our elderly States, but among adolescents, it is the 3rd leading cause of death.
population. - In understanding suicidal behavior, three indices are important:
- The experience of anxiety across cultures varies, and it can be > suicidal ideation (serious thoughts about committing suicide)
difficult to make comparisons—especially, for example, when we > suicidal plans (a detailed method for killing oneself)
attempt to compare subjective feelings of depression. > suicidal attempts (that are not successful).
- Important, too, in learning about risk factors for suicides is the
Causes of Mood Disorders psychological autopsy, in which the psychological profile of an
individual who has committed suicide is reconstructed and
examined for clues.