Mood Disorders

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Mood Disorders

• Theodore M. Godlaski
• College of Social Work
• University of Kentucky

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Mood Disorders

•       Major Depressive Episode
•       Manic Episode
•       Mixed Episode
•       Hypomanic Episode
•       Major Depressive Disorder
•       Dysthymic Episode
•       Bipolar I Disorder
•       Bipolar II Disorder
•       Cyclothymic Disorder
•       Bipolar NOS
•       Mood Disorder Due to General Medical
  Condition
•       Substance-Induced Mood Disorder
•       Mood Disorder NOS

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Major Depressive Episode

• A. Five or more of the following SX present
  during the same 2 week period represent a
  change from previous functioning. AND at least
  one of the SX is either 1) depressed mood or 2)
  loss of interest or pleasure.
• 1.  depressed mood most of the day, nearly every
  day
• 2.   markedly diminished interest or pleasure in
  all or almost all activities nearly every day
• 3. significant weight loss when not dieting
• 4. insomnia or hypersomnia

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Major Depressive Episode

• 5. psychomotor agitation or retardation
• 6. fatigue or loss of energy
• 7. feelings of worthlessness or excessive or
  inappropriate guilt
• 8. diminished ability to think, to concentrate,
  to make decisions
• 9. recurrent thoughts about death
• B. The SX do not meet criteria for a Mixed
  Episode
• C. The SX cause clinically significant distress
  or impairment in social, occupational, or other
  areas of functioning. 
• D. The SX are not due to physiological effects
  of a substance or general medical condition. 
• E. The SX are not better accounted for by
  Bereavement (SX continue longer than 2 months,
  etc)

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Major Depressive Disorder

• Characterized by one or more major depressive
  episodes without a manic or hypomanic episode.
• With multiple episodes, must be at least 2 months
  between.
• Can be mild, moderate, severe without psychotic
  features, severe with psychotic features (either
  mood congruent or mood incongruent).
• The actual diagnosis for an episode is Major
  Depressive Disorder, Single Episode. For two or
  more episodes it is Major Depressive Disorder,
  Multiple Episodes.

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Major Depressive Disorder

• 15 of those with HX of MDD die by suicide.
• Lifetime risk in women is 25
• Lifetime risk for men is 12
• 60 of those with MDD may experience complete end
  of the disorder after TX. Other data suggests
  that among those who do not meet MDD criteria,
  20 have depressive SX, just not the full
  disorder.

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Major Depressive Disorder

• 40 still have SX one year later. Other studies
  suggest that 50 60 have a recurrence of MDD
  within two years (even with aggressive TX).
• Individuals with one episode have a 50 chance of
  a second, after the second, chances for a third
  increase to 70, a third episode increases the
  chances of subsequent episodes to 90.
• There is a high degree of co-occurrence with
  alcohol abuse and dependence.

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Dysthymic Disorder

• A. Depressed mood for most of the day, for more
  days than not as indicated by subjective account
  or observation by others for at least 2 years.
• B. Presence, while depressed of 2 or more of the
  following
• 1. Poor appetite or overeating
• 2. Insomnia or hypersomnia
• 3. Low energy or fatigue
• 4. Low self-esteem
• 5. Poor concentration or difficulty making
  decisions
• 6. Feelings of hopelessness

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Dysthymic Disorder

• C. During the 2-year period (1 year for children
  or adolescents) of the disturbance, the person
  has never been without the SXs above for more
  than 2 months at a time.
• D. No MDE has been present during the first 2
  years of the disturbance (1 year for children and
  adolescents) i.e., it is not better accounted
  for by chronic MDD
• E. No Manic, Mixed, or Hypomanic episodes ever
  (has not met criteria for Cyclothymic Disorder

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Dysthymic Disorder

• F. The disturbance does not occur exclusively
  during a chronic Psychotic Disorder.
• G. Not due to substance use, medication, or
  medical disorder.
• H. Symptoms are clinically significant and cause
  significant impairment or distress.
• You can specify Early Onset if onset before age
  21, or Late Onset if after 21.

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Manic Episode

• A. A distinct period of abnormally and
  persistently elevated, expansive, or irritable
  mood, lasting at least 1 week.
• B. During the period of mood disturbance, 3 or
  more of the following have persisted (4 if the
  mood is only irritable) and have been present to
  a significant degree

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Manic Episode

• 1. Inflated self-esteem or grandiosity
• 2. Decreased need for sleep (e.g., 3 hours)
• 3. More talkative than usual pressure of speech
  
• 4. Flight of ideas or subjective belief that
  ideas are racing
• 5. Distractibility
• 6. Increase in goal-directed activity
• 7. Excessive involvement in pleasurable
  activities that have high likelihood of negative
  consequences

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Manic Episode

• C. The SX do not meet criteria for Mixed Episode
• D. The mood disturbance is severe enough to cause
  marked impairment, risk of harm, or requires
  hospitalization
• E. The SX are not due to a general medical
  condition or use of a substance

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Mixed Episode

• A. The criteria are met both for a Manic Episode
  and MDE (except for duration) nearly every day
  during at least a 1-week period.
• B. The mood disturbance is sufficiently severe
  to cause marked impairment in occupational or
  usual social activities or relationships or to
  necessitate hospitalization to prevent harm to
  self or there are psychotic features.
• C. The symptoms are not due to the direct
  physiological effects of a substance or general
  medical condition.

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Hypomanic Episode

• A. A distinct period of persistently elevated,
  expansive, or irritable mood, lasting at least 4
  days that is clearly different from the
  non-depressed mood.
• B. During the period of mood disturbance, 3 or
  more of the following SXs have persisted (4 if
  the mood is irritable) and have been present to a
  significant degree

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Hypomanic Episode

• 1. Inflated self-esteem or grandiosity
• 2. Decreased need for sleep (3 hours)
• 3. More talkative than usual pressure of speech
• 4. Flight of ideas
• 5. Distractibility
• 6. Increase in goal-directed activity
• 7. Excessive pursuit of pleasurable activities

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Hypomanic Episode

• C. The episode is associated with an unequivocal
  change in functioning that is uncharacteristic of
  the person when not symptomatic.
• D. The disturbance in mood and the change in
  functioning are observable by others.
• E. The episode is Not severe enough to cause
  marked impairment in social or occupational
  functioning or to necessitate hospitalization and
  there are not psychotic features.
• F. The SXs are not due to the effects of a
  substance or a general medical condition.

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Bipolar Disorder I

• Presence of Manic Episodes (can alternate with
  Hypomanic Episodes) and MDE.
• Most often begins with depressive episode 67
  for men, 75 for women.
• About 10 - 20 of individuals experience only
  manic episodes.
• Untreated, manic episodes last about 3 months.
• Eventual interval between manic episodes is 6 9
  months.

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Bipolar Disorder I

• Can be single episode or recurrent
• Recurrent comes in 5 types
• Most recent episode hypomanic
• Most recent episode manic
• Most recent episode mixed
• Most recent episode depressed
• Most recent episode unspecified
• About 10 to 15 of individuals with recurrent
  depressive episodes will eventually have a manic
  episode.