Psychology Chapter on Depression and PMDD

Clinical Psychiatry - Mood Disorders

• Mood disorders are a category of illnesses describing significant mood changes.
• They are common, with high morbidity and mortality rates.
• Mood changes are often accompanied by changes in activity levels.
• Most mood disorders are recurrent, with episodes often linked to stressful events.

Mood Episodes

• A mood episode is a period of abnormally happy or sad feelings.
• Types of mood episodes include major depressive episodes, manic episodes, and hypomanic episodes.

1-Major Depressive Episode (DSM-V Criteria)

• Episode must include depressed mood or loss of interest/pleasure for at least two weeks.
• This mood change should be different from usual mood, and significantly impact social, occupational, or other functioning.
• Five or more of the following symptoms must be present:
  • Depressed mood most of the day
  • Markedly diminished interest or pleasure in activities
  • Significant weight loss or gain
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or inappropriate guilt
  • Diminished ability to think or concentrate
  • Recurrent thoughts of death or suicide attempts
• The episode is not due to substance use or medical conditions.

Epidemiology of 1-Major Depressive Episode

• Higher prevalence in women than men (approximately 2:1 ratio).
• Most common in young women (ages 20-40).
• The opposite trend is seen in older adults.
• Single and divorced individuals are more likely to experience depression than married individuals.
• There is an inverse relationship between social class and depressive symptoms; the opposite is true for bipolar disorder.
• Mood disorders are more prevalent in the late fall or early winter.

Types of Depressive Disorders (DSM-5)

• Major depressive disorder
• Persistent depressive disorder (PDD)/Dysthymic disorder
• Disruptive mood dysregulation disorder (DMDD)
• Premenstrual dysphoric disorder (PMDD)
• Seasonal affective disorder
• Postpartum depression

Major Depressive Disorder

• Loss of interest or pleasure in usual activities.
• Social and occupational functioning impaired for at least two weeks.
• Criteria for major depression episode: five or more of the following for at least two weeks:
  • Depressed mood
  • Anhedonia
  • Guilt
  • Sleep Disturbance
  • Appetite
  • Energy
  • Concentration
  • Psychomotor
  • Suicidality

Other Symptoms of Major Depressive Disorder

• Dysfunctional grieving
• Low self-esteem
• Powerlessness
• Social isolation
• Disturbed thought processes
• Self-care deficits

Case Study Example

• Michael, a 55-year-old accountant, presented with symptoms like hopelessness, and unmotivated feelings for six months. These feelings prompted a significant decrease in his overall well-being and difficulty managing daily tasks.
• He attributes the onset of his low mood to life stressors, including the death of a friend and financial problems.
• Diagnosis: Major Depressive Disorder (MDD)

Persistent Depressive Disorder (Dysthymia)

• Chronic, low-level depression (less severe than major depressive disorder)
• Sad or "down in the dumps" mood most of the day, for at least two years (one year in children).
• At least two of the following symptoms must be present during periods of depressed mood:
  • Insomnia or hypersomnia
  • Poor appetite or overeating
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration
  • Feelings of hopelessness
  • Trouble at work or school

Major Depressive Disorder vs Persistent Depressive Disorder

• Major Depressive Disorder (MDD) shows more extreme fluctuations in mood than Persistent Depressive Disorder (PDD).
• PDD is longer-lasting than MDD, with periods lacking the extreme symptoms found in MDD.
• Symptoms in PDD are not as severe as those experienced in MDD

Disruptive Mood Dysregulation Disorder (DMDD)

• Chronic, severe, and with persistent irritability displayed through temper tantrums or outbursts.
• Symptoms must present before the age of 10, and a diagnosis should not be made before the age of 6 or after 18 (years).
• Tantrums or outbursts occur frequently (3 or more times per week).

Premenstrual Dysphoric Disorder (PMDD)

• A health issue similar to premenstrual syndrome (PMS) but more severe.
• Characterized by depressed mood, anxiety, mood swings, and decreased interest in activities.
• Symptoms begin during the week prior to menses and typically subside after menstruation starts.

Depressive Disorder due to Another Medical Condition

• Depression symptoms stemming from another medical condition.
• Similar symptoms to other depressive disorders (e.g., bipolar or major depressive disorder).
• Crucial step in diagnosis: determining if the individual has a non-neuropsychiatric medical condition.

Seasonal/Postpartum Depression

• Seasonal Affective Disorder (SAD): Major depressive disorder triggered by seasonal changes, often appearing in fall and winter and resolving in spring and summer.
• Postpartum Depression: Depression that can occur after childbirth, lasting from a few weeks to several months. Associated with hormonal changes and often requiring antidepressant and psychosocial therapy.

Substance/Medication-Induced Depressive Disorder

• Mood disorder caused by substance use, abuse, withdrawal, or prescription medications.
• Symptoms include changes in mood, emotions, or behavior.
• Substances can include alcohol, drugs, prescription meds, or toxins that affect brain neurotransmitters.
• Each case varies with specific symptoms.

Biological Theories of Depressive Disorders

• Genetics: Hereditary factors play a role in depressive disorders, particularly evident in twin studies.
• Biochemical Influences: Deficiency in norepinephrine, serotonin, and dopamine is implicated in mood disorders.

Psychological Factors of Depressive Disorders

• Major Life Events: Significant life changes or events can increase risk of developing depressive disorders
• Distorted Thinking: Negative thoughts and patterns of thought can contribute to development and maintenance of depressive disorders
• Loss of Hopefulness: Pessimistic outlook and view can contribute to depressive disorders

Management of Mood Disorders

• Medication: Various medications can be used to manage mood disorders, including antidepressants, mood stabilizers, or anti-anxiety medications
• Electroconvulsive Therapy (ECT): A treatment option for severe cases that involves inducing a seizure to alter brain activity. Often employed for major depressive disorder or acute manic episodes. Used only in severe cases where other treatments are unsuitable.
• Psychotherapy: Psychological therapy to teach coping mechanisms, distress tolerance strategies, and address the root cause of mood disturbances. Techniques include individual therapy, family therapy, group therapy, cognitive therapy, and psychoeducation.
• Stress Management: Strategies that assist in reducing stress response.
• Increasing Self-Esteem: Techniques to build positive self-beliefs and address self-image.
• Psychosocial Treatments: Support services like crisis hotlines, support groups, legal and financial assistance.

Bipolar Disorders

• Etiological Implications: Strong hereditary influence and possible excess of dopamine, norepinephrine, and serotonin.
• Physiological Influences: Potential alterations in electrolyte transfer, brain lesions, medication side effects, steroids, amphetamines, and antidepressants.

Types of Bipolar Disorder

• Bipolar I Disorder: Characterized by one or more manic episodes, often accompanied by major depressive episodes.
• Bipolar II Disorder: Includes episodes of major depression and hypomania (less severe than mania).
• Cyclothymic Disorder: Characterized by chronic, fluctuating mood swings between hypomania and mild depression.

2-Major Depressive Episode-Bipolar Disorder

• A distinct period of abnormally and persistently elevated, expansive, or irritable mood.
• Lasting for at least 1 week (or less if hospitalization is required).
• At least three additional symptoms:
  • Inflated self-esteem
  • Decreased need for sleep
  • Pressure of speech
  • Flight of ideas
  • Distractibility
  • Increased involvement in goal-directed activity
  • Excessive involvement in pleasurable activities

3-Hypomanic Episode

• Similar to mania but less severe.
• Episodes typically lasting for four days, and hospitalization is not required.

Bipolar Disorder Symptoms (Manic Episode)

• Feelings of extreme energy
• Increased activity and restlessness
• Trouble sleeping
• Racing thoughts
• Impulsive behaviors, like reckless spending
• Risky behaviors

Bipolar Disorder Symptoms (Depressive Episode)

• Extreme sadness, hopelessness, and emptiness
• Decreased activity levels
• Difficulty sleeping (insomnia or excessive sleepiness)
• Trouble concentrating or making decisions
• Loss of interest or pleasure in activities
• Thoughts of death or suicide

Case Study Example: Bipolar Disorder

• Sarah (32-year-old marketing manager) presented to the emergency room experiencing a manic episode. Her symptoms included significant energy, racing thoughts, and sleeping very little, accompanied by intense activity and reckless spending habits.
• The episode was significant in disrupting her relationships, finances and work.
• Diagnosed with Bipolar disorder.

Bipolar Disorder - Epidemiology

• Marital Status: Single, divorced, or widowed individuals have a greater risk of suicide attempts than married individuals.
• Gender: Women have higher rates of suicide attempts than men but men have higher rates of successful suicide.
• Age: Suicide risk highest in individuals over 50 and adolescents.
• Socioeconomic Status: Higher suicide rates in highest and lowest socioeconomic statuses compared to middle class individuals.
• Professionals: Professional healthcare workers and business executives are at higher risk.

Bipolar Disorders - Presenting Symptoms/Medical-Psychiatric Diagnosis

• Mood disorders, major depression, and bipolar disorders are common disorders that precede suicide.
• Other disorders that may present as symptoms include anxiety disorders and schizophrenia.

Bipolar Disorders - Suicidal Ideas/Acts

• Assessing prior suicide attempts
• Identifying direct statements, such as "I want to die."
• Recognizing indirect statements, like "I have nothing to live for."

Bipolar Disorders - Imbalanced Nutrition and Disturbed Sensory Perception

• Individuals with bipolar disorders may struggle with nutritional imbalances from disrupted eating patterns.
• Disturbed sensory perception can also be caused by brain alterations or sleep deprivation related to bipolar.

Bipolar Disorders - Treatments

• Medication Management
• Electroconvulsive Therapy (ECT)
• Psychotherapy
• Individual therapy
• Group therapy
• Family focus therapy
• Cognitive therapy
• Psychoeducation
• Support Services
• Crisis hotline
• Support groups
• Legal/financial assistance.

Bipolar Disorders-Psychopharmacology

• For Depression: Maprotiline, Amoxapine, Trazodone
• For Mania: Lithium carbonate, Anticonvulsants, Verapamil, Olanzapine

Bipolar Disorders-Recommendations

• Ensuring the client's physical and emotional safety, as well as the safety of those around them.
• Setting clear behavioral limits when necessary.
• Encouraging and reminding the client to respect personal space and distances between people.
• Communicating effectively using simple and direct statements.
• Prioritizing rest and promoting self-care.
• Protecting the client's dignity during interactions.
• Directing the client's energy into socially acceptable forms of activity.

This quiz covers key concepts related to depression and premenstrual dysphoric disorder (PMDD) as outlined in psychology texts. It explores the prevalence of depression among different genders and social classes, the classification of depressive disorders, and the specific criteria for diagnosing PMDD. Test your understanding of these important mental health topics.