Bipolar Disorders and Cyclothymia Quiz

Mood Disorders

• Mood is a pervasive and sustained emotion that influences behavior and perception.
• Mood disorders, also called affective disorders, are an important category of psychiatric illness featuring depressive and bipolar disorders.
• Two broad types of mood disorders exist: those involving only depressive symptoms and those involving manic symptoms (bipolar disorders).
• DSM-IV-TR mood disorders include major depressive disorder and dysthymia.
• DSM-V added premenstrual dysphoric disorder and disruptive mood dysregulation disorder to the depressive disorders list.
• DSM-IV-TR/DSM-5 bipolar disorders include bipolar I disorder, bipolar II disorder, and cyclothymia.
• Mood disorders are often characterized by rapid fluctuations between extremes of emotion (e.g., laughter followed by tears).
• Changes in activity level, cognitive abilities, vegetative functions (e.g., sleep, appetite, sexual activity), and other biological rhythms, are also associated symptoms of mood disorders.
• Mood disorders often significantly impair interpersonal, social, and occupational functioning.
• Patients with only major depressive episodes are diagnosed with major depressive disorder or unipolar depression.
• Patients with both manic and depressive episodes or those with only manic episodes have bipolar disorder.
• "Unipolar mania" or "pure mania" are terms sometimes used for bipolar patients without depressive episodes.

DSM-5 Criteria for Major Depressive Disorder

• Sad mood or loss of interest/pleasure (anhedonia).
• Symptoms present nearly every day for at least two weeks.
• Symptoms aren't caused by normal bereavement.
• Four or more of the following symptoms are present:
  • Sleeping too much or too little.
  • Psychomotor retardation or agitation.
  • Poor/increased appetite and weight changes.
  • Loss of energy.
  • Feelings of worthlessness or excessive guilt.
  • Difficulty concentrating, thinking, or making decisions.
  • Recurrent thoughts of death or suicide.

Major Depressive Disorder (MDD)

• Recurrent episodes are common.
• The average number of episodes is four.
• Subclinical depression includes sadness plus three other symptoms for ten days, and significant functioning impairments despite not meeting all diagnostic criteria.

Persistent Depressive Disorder

• Depressed mood is present for at least two years (one year for children/adolescents).
• Other symptoms include poor appetite/overeating, sleep disturbances, poor self-esteem, difficulty concentrating, and hopelessness.
• The duration of symptoms, rather than the number of symptoms, is a stronger predictor of negative outcomes.

DSM-5 Criteria for Premenstrual Dysphoric Disorder

• At least five of the following symptoms are present during the week before menses in most menstrual cycles:
  • Affective lability.
  • Irritability.
  • Depressed mood/hopelessness.
  • Anxiety.
  • Diminished interest in usual activities.
  • Difficulty concentrating.
  • Lack of energy.
  • Changes in appetite, overeating, or food craving.
  • Sleep disturbances.
  • Subjective feeling of being overwhelmed.
  • Physical symptoms (e.g., breast tenderness, joint pain, bloating).
  • Symptoms typically improve within a few days of menses onset.

DSM-5 Criteria for Disruptive Mood Dysregulation Disorder

• Recurrent temper outbursts, both verbal and behavioral, that are disproportionate to the provocation.
• Outbursts occur at least three times weekly.
• Persistent negative mood is present most days between outbursts.
• Symptoms have been present for at least 12 months.
• Symptoms are present in at least two settings (e.g., home, school, with peers).
• Onset is before age 10.

Epidemiology and Consequences

• Depression is common.
• Lifetime prevalence rates are 16.2% for major depressive disorder (MDD) and 2.5% for dysthymia.
• Depression is twice as common in women as in men and is three times as common among people in poverty.
• Two-thirds of those with MDD also meet criteria for an anxiety disorder at some point.
• The average age of onset for MDD is now in the late teens/early 20s, and the age of onset appears to get younger in successive generations.

Bipolar Disorders

• Three forms: Bipolar I, Bipolar II, and Cyclothymia.
• Mania is a defining feature of each form.
• Bipolar I involves at least one episode of mania.
• Bipolar II involves at least one major depressive episode with at least one hypomanic episode. Cyclothymia is a chronic form, lasting at least two years in adults and one year in children/adolescents, characterized by numerous periods of hypomanic and depressive symptoms. Symptoms do not clear for more than two months at a time.
• Bipolar disorders have a lower prevalence than MDD. Worldwide prevalence for bipolar I is 0.6%, while it is 0.4%-2% for bipolar II. Cyclothymia has a prevalence of 4%.
• Average age of onset is in the 20s.
• Women experience more depressive episodes.
• Suicide rates are high.

Etiology of Mood Disorders: Neurobiological Factors

• Genetic factors: Heritability estimates for MDD are approximately 37% (Sullivan et al., 2000), while they are 93% for Bipolar Disorder (Kieseppa et al., 2004).
• Neurotransmitters (NTs): Original models emphasized absolute levels of norepinephrine, dopamine, and serotonin in MDD and mania. Lower levels of NTs in MDD and higher levels of norepinephrine and dopamine in mania, respectively.
• However, medication alters levels immediately, but relief of symptoms typically takes 2-3 weeks, suggesting a more complex mechanism. Newer models focus on sensitivity of postsynaptic receptors, rather than absolute levels. Some studies found dopamine receptors may be less sensitive in individuals with MDD.
• Dopamine receptors may be less sensitive in MDD.
• Depleting tryptophan (a serotonin precursor) causes depressive symptoms in individuals with a history of depression.
• Individuals vulnerable to depression may have less sensitive serotonin receptors.

Etiology of Mood Disorders: Neuroendocrine System

• Overactivity of the HPA axis: This axis releases cortisol, a stress hormone.
• Excessive cortisol is linked to depression, as suggested by studies on the amygdala and Cushing's syndrome.
• Injecting cortisol into animals produces depressive symptoms.

Etiology of Mood Disorders: Social Factors

• Life events: Stressful life events (e.g., romantic breakup, loss of job, death of a loved one) are associated with a higher risk of depression onset.
• Interpersonal difficulties: High levels of expressed emotion, critical or emotional involvement from family members, predict relapse in mood disorders.
• Marital conflict is linked with depression.

Etiology of Mood Disorders: Psychological Factors

• Beck's Theory of Depression: Key aspects include the negative triad (negative views of self, world, and future) and negative schemas (underlying tendencies to see the world negatively). These negative schemas cause cognitive biases and a tendency to process information negatively.
• Hopelessness Theory: Hopelessness is a key trigger of depression, wherein individuals feel that desirable outcomes will not occur and they have no ability to change their situation.

Psychological Treatment of Mood Disorders

• Interpersonal Psychotherapy (IPT): Short-term psychodynamic therapy that focuses on current relationships.
• Cognitive-behavioral therapy (CBT): Monitors and identifies automatic thoughts, aiming to replace negative thoughts with neutral or positive ones.
• Mindfulness-based cognitive therapy (MBCT): Includes meditation to prevent relapse, often used as an adjunct to other therapies for mood disorders.
• Psychoeducational approaches: Educates about symptoms, course, triggers, and treatments.

Biological Treatment of Mood Disorders

• Electroconvulsive Therapy (ECT): Reserved for treatment resistant cases. Induces seizures and momentary unconsciousness to rapidly relieve suicidal ideations, severe depression, or severe mania.
• Side effects include memory loss, but it is sometimes more effective than medication, although its mechanism is unclear.

Medications for Treating Mood Disorders

• Various categories of medications are used to treat mood disorders, each with unique side effects and potential for efficacy.

Medications for Bipolar Disorder

• Lithium is a common mood stabilizer, but it can cause potentially serious side effects such as lithium toxicity.
• Newer mood stabilizers like anticonvulsants (e.g., Depakote) and antipsychotics (e.g., Zyprexa) are also frequently used, but they also come with side effects.

Test your knowledge on Bipolar Disorders and Cyclothymia with this quiz! Questions cover the DSM-IV-TR/DSM-5 classifications, defining characteristics, and differences between various mood disorders. Perfect for psychology students and professionals alike.