pysch 3230 chapter 7

Overview of Mood Disorders

• Mood disorders encompass a range of conditions including depressive disorders, bipolar and related disorders, and suicide.

Depressive Disorders

• Types include major depressive disorder, persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, and disruptive mood dysregulation disorder.

Bipolar and Related Disorders

• Categories include Bipolar I disorder, Bipolar II disorder, and Cyclothymic disorder.

Major Depressive Disorder (MDD)

• Major Depressive Disorder (MDD) is a mental health condition that significantly impacts an individual's emotional and physical well-being. The diagnosis of MDD necessitates the identification of five or more symptoms that occur during the same two-week period. These symptoms must indicate a noticeable deviation from the individual's previous level of functioning. This requirement emphasizes the disorder's severe impact on a person's daily life, highlighting how critical it is to examine emotional, behavioral, and cognitive changes closely.
• At least one of the symptoms must reflect a depressed mood or a profound loss of interest or pleasure in activities that were previously enjoyable, which is referred to as anhedonia. These two specific symptoms serve as core indicators of the disorder and are crucial for establishing the diagnosis. Many individuals describe this emotional state as a heavy cloud hanging over them or a pervasive sense of emptiness that clouds their ability to experience joy or find motivation.
• The range of symptoms associated with MDD includes: persistent depressed mood, diminished interest or pleasure in nearly all activities, significant weight loss or gain (or changes in appetite), insomnia (difficulty falling or staying asleep) or hypersomnia (excessive sleep), psychomotor agitation (such as fidgeting or inability to sit still) or retardation (slowed speech or movement), fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicidal ideation. The diverse array of symptoms underscores the multifaceted nature of depression, affecting a person's psychological, physical, and social functioning.
• Research indicates that approximately 50% of individuals diagnosed with MDD will experience only a single episode throughout their lives; however, this can vary significantly depending on several factors. For instance, relapse can occur if there are underlying risk factors or inadequate treatment. This statistic highlights the unpredictable nature of MDD, where individuals may experience significant distress and impairment for a brief period, while others may grapple with ongoing challenges.
• Recurrence rates are notably higher among younger individuals, those who have experienced particularly severe episodes, and those who have a history of multiple prior episodes. The increased likelihood of recurrence in these groups indicates the importance of early intervention and effective treatment strategies, as well as the potential need for continued therapy or support to prevent future episodes. Understanding the demographic and clinical factors that contribute to recurrence can assist healthcare providers in designing personalized treatment plans.
• While many individuals eventually recover within a year, this recovery is not uniform across all cases. Various factors, including the severity of the disorder, the individual's support system, and their responsiveness to treatment, can significantly impact recovery timelines. Some people may regain their baseline functioning relatively quickly, while others may take longer to navigate the complexities of recovery. During this period, individuals may benefit from therapy, medication, and support groups, which can help provide tools for managing symptoms and enhancing overall resilience.
• Highly threatening or severe life events are recognized as strong predictors of MDD onset. Events such as the loss of a loved one, a significant life change (like job loss or divorce), or chronic stress from caregiving responsibilities can trigger the onset of depressive symptoms. This relationship between life events and the onset of depression underscores the need for increased awareness and preventive measures, especially during times of heightened stress. By recognizing potential triggers, individuals and healthcare providers can work together to implement strategies aimed at diminishing the impact of stressors on mental health.

Major Depressive Disorder (MDD)

• Major Depressive Disorder (MDD) is a mental health condition that significantly impacts an individual's emotional and physical well-being. The diagnosis of MDD necessitates the identification of five or more symptoms that occur during the same two-week period. These symptoms must indicate a noticeable deviation from the individual's previous level of functioning. This requirement emphasizes the disorder's severe impact on a person's daily life, highlighting how critical it is to examine emotional, behavioral, and cognitive changes closely.
• At least one of the symptoms must reflect a depressed mood or a profound loss of interest or pleasure in activities that were previously enjoyable, which is referred to as anhedonia. These two specific symptoms serve as core indicators of the disorder and are crucial for establishing the diagnosis. Many individuals describe this emotional state as a heavy cloud hanging over them or a pervasive sense of emptiness that clouds their ability to experience joy or find motivation.
• The range of symptoms associated with MDD includes: persistent depressed mood, diminished interest or pleasure in nearly all activities, significant weight loss or gain (or changes in appetite), insomnia (difficulty falling or staying asleep) or hypersomnia (excessive sleep), psychomotor agitation (such as fidgeting or inability to sit still) or retardation (slowed speech or movement), fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicidal ideation. The diverse array of symptoms underscores the multifaceted nature of depression, affecting a person's psychological, physical, and social functioning.
• Research indicates that approximately 50% of individuals diagnosed with MDD will experience only a single episode throughout their lives; however, this can vary significantly depending on several factors. For instance, relapse can occur if there are underlying risk factors or inadequate treatment. This statistic highlights the unpredictable nature of MDD, where individuals may experience significant distress and impairment for a brief period, while others may grapple with ongoing challenges.
• Recurrence rates are notably higher among younger individuals, those who have experienced particularly severe episodes, and those who have a history of multiple prior episodes. The increased likelihood of recurrence in these groups indicates the importance of early intervention and effective treatment strategies, as well as the potential need for continued therapy or support to prevent future episodes. Understanding the demographic and clinical factors that contribute to recurrence can assist healthcare providers in designing personalized treatment plans.
• While many individuals eventually recover within a year, this recovery is not uniform across all cases. Various factors, including the severity of the disorder, the individual's support system, and their responsiveness to treatment, can significantly impact recovery timelines. Some people may regain their baseline functioning relatively quickly, while others may take longer to navigate the complexities of recovery. During this period, individuals may benefit from therapy, medication, and support groups, which can help provide tools for managing symptoms and enhancing overall resilience.
• Highly threatening or severe life events are recognized as strong predictors of MDD onset. Events such as the loss of a loved one, a significant life change (like job loss or divorce), or chronic stress from caregiving responsibilities can trigger the onset of depressive symptoms. This relationship between life events and the onset of depression underscores the need for increased awareness and preventive measures, especially during times of heightened stress. By recognizing potential triggers, individuals and healthcare providers can work together to implement strategies aimed at diminishing the impact of stressors on mental health.

Persistent Depressive Disorder (Dysthymia)

• Features a depressed mood for most of the day, more days than not, for at least 2 years in adults, or 1 year in children/adolescents.
• Characterized by milder or fewer symptoms than MDD.
• Symptoms can include: poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, and feelings of hopelessness.
• Can persist unchanged over long periods, up to 20 years.
• Early onset (before age 21) is associated with greater chronicity, poorer prognosis, and more comorbid diagnoses.

Premenstrual Dysphoric Disorder

• In most menstrual cycles, 5 symptoms are present in the final week before menses, start to improve after menses onset, and are minimal/absent in the week postmenses.
• Symptoms can include affective lability (mood swings), irritability/anger, interpersonal conflict, depressed mood, hopelessness, anxiety/tension, decreased interest, poor concentration, lethargy, changes in appetite/sleep, feeling overwhelmed/out of control, and physical symptoms.
• Prevalence is between 2% and 6% over 12 months.
• Symptoms may worsen with age until menopause.
• Found across cultures, with significant heritability (30-50%).
• Treatment includes SSRIs, CBT, and birth control.

Bipolar I Disorder

• Defined by the presence of one or more manic episodes or mixed episodes (depression and mania).
• Individuals typically have or will experience major depressive episodes.
• Mania involves a distinct period of elevated, expansive, or irritable mood and abnormally increased goal-directed activity or energy lasting at least one week.
• Diagnosed with 3 or more symptoms such as: inflated self-esteem/grandiosity, decreased need for sleep, more talkative/pressured speech, flight of ideas/racing thoughts, distractibility, increased goal-directed behavior, and excessive involvement in pleasurable activities.
• Average age of onset is 18 years.
• 90% or more individuals with a manic episode will have recurrent mood episodes.
• It tends to be chronic with functional recovery lagging behind symptoms recovery.
• Suicide is a common consequence, occurring 15 times higher than in the general population.

Bipolar II Disorder

• Defined by meeting criteria for a current or past hypomanic episode and a current or past depressive episode.
• The primary difference from mania is that hypomanic symptoms are not severe enough to cause serious impairment or hospitalization.
• Individuals usually seek treatment for depression and hypomania is revealed by informants.
• Many are not diagnosed with BP-II until after multiple depressive episodes.
• Average age of onset is in the mid-20s, but it can begin in childhood.
• 5-15% of cases progress to full Bipolar I disorder.
• It tends to be chronic and impairing, with a suicide risk as high as Bipolar I (32% vs 36% report a lifetime suicide attempt).

Cyclothymic Disorder

• A more chronic version of bipolar disorder (at least 2 years in adults, 1 year in children).
• Involves numerous periods of hypomanic symptoms and depressive symptoms that do not meet the criteria for major depression.
• Characterized by manic or depressive mood states for at least half the time, without remitting for greater than 2 months.
• Major depression, Bipolar I, and Bipolar II are more common in.

Symptom Specifiers for Mood Disorders

• Anxious distress: tense, restless, worry, catastrophic thoughts, concern about losing control.
• Mixed features: symptoms of mania or hypomania during depressive episodes.
• Atypical features: mood reactivity, weight gain/appetite increase, hypersomnia, sensitivity to rejection.
• Melancholic features: near absence of pleasure, not reactive to pleasurable stimuli, profound despair, symptoms worse in the morning, EMAs, anorexia or weight loss, guilt.
• Catatonic features: absence of movement, very serious.
• Psychotic features: mood-congruent or mood-incongruent hallucinations/delusions.
• Peripartum onset: depressive episodes during pregnancy or within 4 weeks of childbirth.
• Seasonal pattern: relationship between the onset of depressive episodes and seasons.

Worldwide Lifetime Prevalence of Mood Disorders

• Major Depression: 16.1% (7% for 12-month prevalence).
• Dysthymia: 3.6%.
• Bipolar Disorder: 1.3% (0.6% for 12 months; 0.8% for BP-II).