CRM 200 Lecture Notes - Lecture 7: Major Depressive Episode, Major Depressive Disorder, Hypomania
3 May 2018
School
Department
Course
Professor
Chapter 7 - MOOD DISORDERS AND SUICIDE
Lecture Outline
A. Depressive Disorders
1. Major Depressive Disorder
2. Persistent Depressive Disorder
3. MDD with peripartum onset
B. Bipolar Disorders
1. Bipolar I
2. Bipolar II
3. Cyclothymic Disorder
C. Causes of Depressive Disorders/edigology
D. Treatment
E. Suicide
An Overview of Depression and Mania
Mood disorders
• “depressive disorders” “affective disorders” “depressive neuroses”
o Called different things
• Gross deviations in mood
o Large different from grade line
Major depressive episode
• Most commonly diagnosed and most severe
• Anhedonia
o Lack of pleasure (positive feelings)
▪ The things they use to like doing they don’t fun it fun anymore
o Not always just sad
Mania
• Extreme pleasure in every activity; excessive euphoria
• Opposite of anhedonia
Hypomanic episode
• Less severe version of manic episode
The Structure of Mood Disorders
Unipolar mood disorder
• Either depression or mania
• Only one type. Not both
Bipolar mood disorder
• Alternate between depression and mania
Mixed features
• Experience of both, e.g., manic but feel somewhat depressed at the same time
• Both at the same time
A.Depressive Disorders
1. Major Depressive Episode Criteria
A. Five (or more) of the following present during the same 2‐week period and represent a
change from previous functioning; at least one of the symptoms is either 1. depressed
find more resources at oneclass.com
find more resources at oneclass.com
mood or 2. loss of interest or pleasure.
o Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad, or empty, or hopeless) or observation made by
others (e.g., appears tearful).
o diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day (as indicated by either subjective account or observation).
o Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5 percent of body weight in a month), or decrease or increase in appetite
nearly every day.
o Insomnia or hypersomnia nearly every day.
• insomnia = Sleep disruption
• Hypersomnia = sleep too much
o Psychomotor agitation or retardation nearly every day (observable by others,
not merely subjective feelings of restlessness or being slowed down).
• Movement become slower/faster
• Retardation = moving slower
o Fatigue or loss of energy nearly every day.
o Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self‐reproach or guilt about being sick).
o Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others).
o Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide.
• Doesn’t have to mean plan to attempt suicide but thoughts about what
would happen if I die
• Can be coming up with plan or just thinking about it or tried
B. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another
medical condition.
Note: Responses to a significant loss
• (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical
illness or disability)
• may include the feelings of intense sadness, rumination about the loss, insomnia, poor
appetite, and weight loss noted in Criterion A, which may resemble a depressive episode.
• such symptoms may be understandable/appropriate to the loss,
• This decision requires the exercise of clinical judgment based on the individual’s history
and the cultural norms for the expression of distress in the context of loss.
o we might experience these when we loss something so need to be taken into
account. If its related to to the loss or actual daily.
o Use clinical judgment to see: can look at if family member had such disorder
D. The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other
specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode. Note: This exclusion
find more resources at oneclass.com
find more resources at oneclass.com
does not apply if all of the manic‐like or hypomanic‐like episodes are substance‐induced
or are attributable to the physiological effects of another medical condition.
o Never had that before
Major Depressive Disorder – has time criteria
• Depressed mood for most of the day, for more days than not for 2 years
• Physical and cognitive symptoms
o Disruptions in sleep, appetite, sexual drive
o Feelings of worthlessness, guilt
• Average duration of first episode if untreated – 9mos
o 1. Can be get a Single episode
o 2. Recurrent
▪ Two or more depressive episodes separated by at least two months
• Chronic course – life long
o Single: median number of episodes is 4‐7 in life time
o Recurrent: Median duration of recurrent episodes 4‐5 months
2. Persistent Depressive Disorder (Dysthymia) Criteria
A. Depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least 2 years
o Note: in children and adolescents, mood can be irritable and duration
must be at least 1 year
B. Presence, while depressed, of two (or more) of the following:
o 1. Poor appetite or overeating.
o 2. Insomnia or hypersomnia
o 3. Low energy or fatigue.
o 4. Low self‐esteem.
o 5. Poor concentration or difficulty making decisions.
o 6. Feelings of hopelessness.
B. During the 2‐year period (1 year for children or adolescents) of the disturbance, the
person has never been without the symptoms in criteria A and B for more than 2 months
at a time.
o Not getting a break.
C. Criteria for major depressive disorder may be continuously present for 2 years.
D. There has never been a manic episode or a hypomanic episode, and criteria have never
been met for cyclothymic disorder.
E. The disturbance is not better explained by a persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.
F. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication) or another medical condition (e.g., hypothyroidism).
G. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
- Longer lasting episode with less server symptoms
- a.k.a. Dysthymia
- Chronic state of depression (20‐30 years) – without a break
- Symptoms are the same as MDD, but less severe
find more resources at oneclass.com
find more resources at oneclass.com
