CRM 200 Lecture Notes - Lecture 7: Major Depressive Episode, Major Depressive Disorder, Hypomania

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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 dont 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 2week period and represent a
change from previous functioning; at least one of the symptoms is either 1. depressed
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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 selfreproach 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
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does not apply if all of the maniclike or hypomaniclike episodes are substanceinduced
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 47 in life time
o Recurrent: Median duration of recurrent episodes 45 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 selfesteem.
o 5. Poor concentration or difficulty making decisions.
o 6. Feelings of hopelessness.
B. During the 2year 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 (2030 years) without a break
- Symptoms are the same as MDD, but less severe
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