Mood Disorders: Unipolar and Bipolar

Mood Disorders

• People with Unipolar Mood Disorder experience either depression or mania, remaining at one "pole" of the depression-mania spectrum.
• Unipolar Depression involves no history of mania; individuals return to a normal state when their depression subsides.
• Bipolar Disorders are characterized by alternating periods of mania and depression.
• Depression often develops in individuals with Unipolar Mood Disorder.
• Major Depressive Episode is the most frequently diagnosed and most severe condition.
• Hypomania represents a less severe form of mania without significant social or occupational impairment.
• Anhedonia is marked by a loss of energy and an inability to engage in pleasurable activities.
• Mania involves extreme pleasure in every activity, which leads to extraordinary activity, reduced sleep, and grandiose plans. People believe they can achieve anything they desire.
• There is a persistent increase in goal-directed activity or energy.

Bipolar I, Bipolar II, & Cyclothymic Disorder

• Bipolar I (BP1) requires at least one manic episode.
• BP1 onset typically occurs between ages 20 and 30 but can happen throughout life.
• Children should be assessed against their baseline to determine if behavior is normal or indicative of a manic episode.
• The initial episode is typically depressive, and its symptoms are the most frequent over the long term; individuals usually seek help for depression.
• Factors to consider before diagnosing Major Depressive Disorder (MDD) include family history of Bipolar Disorder, onset in early 20s, past episodes, psychotic symptoms, and lack of response to antidepressant treatment.
• The diagnosis becomes Bipolar I disorder with psychotic features if psychotic symptoms occur exclusively during manic and major depressive episodes.
• Symptoms of mania in BP1 manifest in distinct episodes, typically beginning in late adolescence or early adulthood.
• Assessing Mania in children necessitates symptoms representing a clear change from the child's typical behavior.
• Symptoms of mood lability and impulsivity must indicate a distinct illness episode or a noticeable increase from the individual’s baseline, justifying an additional BP1 diagnosis.
• Bipolar II (BP2) features major depressive episodes with hypomanic episodes rather than full manic episodes.
• BP2 can start in late adolescence through adulthood, slightly later than bipolar disorder but earlier than MDD.
• BP2 often starts with depressive episodes.
• BP2 is highly recurrent and has seasonal mood variation compared to BP1.
• The number of lifetime episodes is usually higher for BP2 than for MDD or BP1.
• Once a hypomanic episode occurs, it does not revert back to MDD.
• Switching from depression to manic or hypomanic can occur spontaneously or during depression treatment.
• BP2 differs from cyclothymic disorder by having one or more hypomanic episodes and one or more MDE.
• BP2 diagnosis with psychotic features applies if psychotic symptoms occur exclusively during major depressive episodes.
• Avoid double-counting symptoms of ADHD and BP2; clarify if symptoms represent a distinct episode and present a noticeable increase over baseline for BP2 diagnosis.
• Mania may be linked to low serotonin activity with high norepinephrine activity.
• Irregularities in ions among bipolar individuals may cause neurons to fire too easily.

Cyclothymic and Disruptive Mood Disorders

• In cyclothymic disorder, symptoms involve milder but more chronic bipolar disorder with presentation that do not meet criteria for depressive and hypomanic episodes
• It usually begins in adolescence or early adulthood.
• It is sometimes considered a reflection of temperamental predisposition to other disorders.
• These people experience onset of mood symptoms before 10 years old.
• The anxious distress specifier involves at least two symptoms during the majority of days of the current manic, hypomanic, or MDE.
• The rapid cycling specifier indicates at least 4 mood episodes in the previous 12 months that meet the manic, hypomanic, or MDE criteria.
• Treatments include Lithium, Interpersonal and Social Rhythm Therapy, and CBT.
• Disruptive Mood Dysregulation Disorder (DMDD) onset must be before 10 years of age, with a developmental age younger than 6 years.
• DMDD diagnosis must consider the presence or absence of multiple other conditions.
• DSMM is not episodic.
• DMDD diagnosis cannot be assigned to a child who has experienced a full duration hypomanic or manic episode or one lasting more than 1 day.
• Hallmark symptoms include severe and frequently recurrent outbursts and persistent disruption in mood between outbursts.
• Severe impairment is required in at least one setting with mild to moderate impairment in a second setting.
• It is possible to receive a comorbid diagnosis of ADHD.
• Children with DMDD may also exhibit symptoms that meet the criteria for an anxiety disorder.

MDD and Persistent Depressive Disorder

• MDD is likely to manifest with puberty
• The chronicity of depressive symptoms raises the likelihood of underlying personality, anxiety, and substance use disorders and decreases the likelihood that treatment will lead to full symptom resolution.
• Inquire about the last 2 months when individuals presenting with depressive symptoms were entirely free of depressive symptoms.
• Depression with an earlier age of onset is more familial and involves personality disturbances more often.
• MDD and Persistent Depressive Disorder (PDD) can be diagnosed simultaneously if criteria are met for both
• Irritability is confined to the major depressive episodes.
• When depressive symptoms meet the full criteria for a MDE, a diagnosis of other specified depressive disorder may be made in addition to the diagnosis of psychotic disorderDistractibility and intolerance can occur in both ADHD and MDE
• If the criteria are met for both, then ADHD may be diagnosed in addition to the mood disorder
• May be further described as seasonal, catatonic, peripartum, and melancholic

PMS and other

• Onset starts at any point after menarche
• PMS doesn't require min of five symptoms
• PMS mood related symptoms if less
• In double depressions, patients suffer both depression - MDE & PDD with fewer symptoms
• Specific specifiers for PDD = psychotic features/anxious features
• Integrated - acknowledgement of circumstances after grief
• Complicated grief reaction can develop without pre = existing depressed state
• Bipolar may be more severe variations of disorders
• Disorders may be inherited separately Hypothesis - Permissive, Serotonin Stress reduces dopamine levels.

Suicide and Depression

• Anxiety is first response to stressful event
• Cognitive triad = errors to thinking
• Childhood negative event leading to system
• Therapy - combination. Introjection = feelings for loved one Symbolic or imagined, equals loss of loved one Theorist proposes - dependence Learned helplessness equals avoidance

Sleep and eating disorders

Self soothing or self stimulating Disturbance requires high AN, BN, BED and other disorders

###Sexual health in brief terms Disoreder - BDD, SAD treatment Medication or the body