Download Chapter 4

Mood disorders
Vulnerability Risk Factors: Women in young adulthood, Men in early middle age,
Women than men (2 times), Negative life events, A lack of social support, Loss of
significant others, Deficiencies(Depression)/Excess(Manic) of serotinin or Dopamine in
synapse.
Treatment:
(a) ECT
(b) Medications (medications working on levels of Dopamine, serotinin, acetylcholine, or
GABA)
-Tricyclic antidepressants (i.e., Elavil): By increasing functional levels of
dopamine or serotinin by blocking reuptake of the neurotransmitters in the
synapse.
-MAO inhibitors (i.e., Nardil): Break down chemicals such as Reserpi depleting
storage of
neurotransmitters.
-2nd generation heterocyclics (i.e., Wellbutrin, Prozac)
-Antimanic medications (i.e., Lithium, Tegretol)
(c) Psychodynamic (i.e., guilt or self-punishing over anger and aggression).
(d) Humanistic-Existential: Narrow a gap between ideal-self and real-self.
(e) Social skill training
(f) CBT
Key Diagnostic Criteria
1. Major Depressive Episode: 5 or more of the following symptoms during the same 2
week period. Either (a) or (b) must be present.
(a) Depressed mood
(b) Markedly diminished interest or pleasure
(c) Diminished ability thinking or concentrating (i.e.,
(d) Fatigue or loss of energy.
(e) Psychomotor agitation (i.e., restlessness).
(f) Sleep disturbances (insomnia, hypersomnia) nearly everyday.
(g) Suicidal ideation or attempts.
(h) Weight loss.
(i) Worthlessness or inappropriate guilt.
2. Manic Episode: A distinct period of persistently elevated, expansive, or irritable mood
lasting at least 1 week, manifested by 3 (4 if mood is irritable) or more of the following
symptoms. The episode is severe enough to cause marked impairment in social and
occupational functioning. Hospitalization may be necessary to prevent harm to self and
others. May have some psychotic features. Not meet the criteria for a Mixed Episode.
(a) Decreased need for sleep (i.e., feel rested after only few hours of sleep)
(b) Distractibility (i.e., attention too easily drawn to unimportant or irrelevant things).
(c) Excessive involvement in pleasurable activities that have a high potential for
painful harm (i.e., unrestrained buying spree, sexual indiscretions, foolish
business investments).
(d) Flight of ideas or racing thoughts.
(e) Increase in goal-directed activity (i.e., socially, occupationally, sexually, and
academically) or psychomotor agitation.
(f) Inflated self-esteem or grandiosity.
(g) More talkative than usual or pressure to keep talking.
3. Hypomanic Episode: A distinct period of persistently elevated, expansive, or irritable
mood lasting at least 4 days, manifested by 3 or more of the following symptoms. The
episode is not severe enough to cause marked impairment in social and occupational
functioning. No hospitalization is necessary. No psychotic features.
Same as Manic Episode
4. Mixed Episode
The criteria are met both for a Major Depressive Episode and for a Manic Episode nearly
everyday during at least 1 week period.
Actual/Official Diagnoses
1. Major Depressive Disorder, single episode.
(a) Presence of a single Major Depressive Episode
(b) There has never been a Manic, Mixed, or a Hypomanic Episode.
(c) Specify Severity (mild, moderate, severe without psychotic features, or severe
with psychotic features).
(d) Specify Features
-Catatonic (i.e., motoric immobility/stupor, excessive/purposeless motor activity,
extreme negativism/motiveless resistance to all instructions, peculiarities of
voluntary movements such as stereotyped movements, or echolaia/echopraxia).
-Melancholic (i.e., loss of pleasure in almost all activities, lack of reactivity to
usually pleasurable stimuli, distinct quality of depressed mood, depression
regularly worse in the morning, early morning awakening, psychomotor
retardation or agitation, anorexia or weight loss, or excessive guilt).
-Atypical(Mood reactivity (i.e., mood brightness in response to actual or potential
events, significant weight gain or increase in appetite, hypersomnia, leaden
paralysis such as heavy feelings in arms and legs, interpersonal rejection
sensitivity).
-Postpartum Onset (Onset of episode within 4 weeks postpartum).
-Chronic (last 2 years).
2. Major Depressive Disorder, Recurrent
(a) Presence of 2 or more Major Depressive Episodes.
(b) There has never been a Manic, Mixed, or a Hypomanic Episode.
(c) Specify Severity (mild, moderate, severe without psychotic features, or severe
with psychotic features).
(d) Specify Features
-Catatonic (i.e., motoric immobility/stupor, excessive/purposeless motor activity,
extreme negativism/motiveless resistance to all instructions, peculiarities of
voluntary movements such as stereotyped movements, or echolaia/echopraxia).
-Melancholic (i.e., loss of pleasure in almost all activities, lack of reactivity to
usually pleasurable stimuli, distinct quality of depressed mood, depression
regularly worse in the morning, early morning awakening, psychomotor
retardation or agitation, anorexia or weight loss, or excessive guilt).
-Atypical(Mood reactivity (i.e., mood brightness in response to actual or potential
events, significant weight gain or increase in appetite, hypersomnia, leaden
paralysis such as heavy feelings in arms and legs, interpersonal rejection
sensitivity).
-Postpartum Onset (Onset of episode within 4 weeks postpartum).
(e) Specify Chronic.
(f) With Seasonal pattern (i.e., fall)
(g) Specify longitudinal course specifiers (With Full Interepisode Recovery, Without
Interepisode Recovery).
3. Persistent Depressive Disorder (dysthymia):
Depressed mood for at least 2 years.
(a) Presence of 2 or more of hopelessness, insomnia/hypersomnia, low self-esteem,
low energy, poor appetite, and poor concentration.
(b) No Major Depressive, Manic, Hypomanic, or Mixed Episode has been present for
the period.
(c) Specify Early Onset or Late Onset (age 21)
(d) Specify With Atypical Features.
4. Premenstrual dysphoric disorder: 5 symptoms in the final week before the onset of
menses and start improving within a few days after the onset of menses.
5. Substance/medication induced depressive disorder
6. Other specified depressive disorder: Not met for other mood disorders, but depressive
symptoms negatively affecting various functioning.
7. Mood Disorder Due to a General Medical condition (i.e., cancer). 13. Substance
Induced M/D
8. Disruptive Mood Dysregulation Disorder:
a. Severe recurrent anger outbursts
b. 3 or more per week.
c. At least two of home, work, and peers settings)
d. No first time DX before 6 or after 18.
Bipolar Disorders (manic episode that was preceded and followed by hypomanic or
MDE).
1. Bipolar I Disorder, Current or most recent episode of manic, hypomanic, depressed, or
unspecified.
2. Bipolar II Disorder (current or past Major Depressive Episode and current or past
Hypomanic Episode): Presence of 1 or more MDE and Hypomanic Episode. No past
Manic or Mixed episode. Specify currently Hypomanic or Depressed types.
3. Cyclothymic Disorder: The presence of numerous sub-hypomanic and numerous subDepressive Symptoms for the last 2 years. No past MDE, Manic, Mixed for the first 2
years.