PSY240H1 Lecture Notes - Lecture 4: Premenstrual Dysphoric Disorder, Psychomotor Agitation, Major Depressive Episode
Week 4 – Wednesday February 3rd, 2016
Symptoms of Depression
• Cognitive
o Poor concentration and attention
• Not due to some underlying attention deficit
o Indecisiveness
• Hard time deciding what to eat or what to wear
o Poor self-esteem
• Negative self-schema
• Think that they're worthless
o Hopelessness
• Doubting that things will ever get better
o Suicidal ideation
• Don't have to actually commit suicide, just thinking about it is enough
o Delusions and hallucinations
• Can show features of psychosis
• Physiological and Behavioural
o Sleep disturbances
• Trouble falling asleep, staying asleep, waking up
o Appetite disturbances
• No appetite
▪ Lose a lot of weight
• Big appetite
▪ Gain a lot of weight
• Crave starchy foods
o Psychomotor retardation/agitation
• Very fidgety / pacing or very slow
• Might want verification from external sources
o Catatonia
• Complete lack of reaction to external forces
• Very rare in depression
• Example: Completely unreactive to somebody talking to them, etc.
o Fatigue
• Low energy regardless of how much sleep they get
• Emotional
o Depressed mood
• Extreme and persistent sadness
o Anhedonia
• Don't get pleasure from things that you used
• Example: Quit hobbies, stop socializing, etc. because it's "just not fun anymore"
o Irritability*
• Doesn't happen for everybody
• Not recognized as a symptom of depression for everybody
Major Depressive Episode
• Not a disorder
o Kind of like panic attacks for panic disorder
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• 5+ symptoms for 2 weeks (one must be depressed mood or anhedonia)
o Depressed mood*
• In children (and adolescents), it can be expressed as irritability
o Anhedonia
o Decreased / increased appetite / weight
o Insomnia / hypersomnia
o Psychomotor agitation / retardation
o Fatigue
o Worthlessness / inappropriate guilt
o Diminished ability to concentrate / indecisiveness
o Suicidal ideation / behaviour
• 1+ MDE (single episode vs. recurrent)
• Not accounted for by psychotic disorder
o If they're experiencing psychotic symptoms only when they're depressed, then we
would say it's a major depressive disorder with psychotic features
o If it happened at other times too, then it's a psychotic disorder
• No hypo/manic, or mixed episodes
o If they have had a hypo or manic episode, they would not be diagnosed with
major depressive disorder
• Not better accounted for by:
o A general medical condition
• Example: Thyroid issues
o The effects of a substance
o Bereavement (2 months or less)***
• Normal grief response (e.g. losing a loved one)
• Bereavement Exclusion
o DSM-IV
• An "expectable response" to the death of a loved one
• A "culturally sanctioned response" to the event
• Certain symptoms are less common
▪ Wouldn't have symptoms anhedonia, psychomotor agitation /
retardation, etc.
o DSM-5
• Omitted from DSM-5, because:
▪ Removes implication that bereavement lasts 2 months or less
▪ Bereavement is a severe stressor that can precipitate a MDE
▪ Bereavement-related depression typically occurs in individuals with history
of MDEs
▪ Responds to same treatments
o Removal in DSM-5 is controversial!
• Associated with lower risk of subsequent MDEs
▪ Risk of having MDEs increases exponentially if you've already had one
▪ Opposite for bereavement
• Less associated with treatment-seeking
• Less associated with substantial functional impairment
• Associated with lower neuroticism and guilt
• Prevalence and Prognosis
o 8.2 - 12.2% lifetime prevalence (Canada)
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o 15 - 24 years old most likely to have a current MDE
o More common in females (2:1)
• Many factors can contribute to this
• Perhaps males are more likely to hide disorder?
o 50% or more have a comorbid condition
• Example: Anxiety
Depression in Youth
• Children < adults
• Girls = boys (until adolescence)
• ~15% of Canadian preschoolers
• 4.8% of youth (not clinically depressed) report suicidal ideation
New to DSM-5
• DSM-IV Mood Disorders Chapter
o DSM-5 Depressive Disorders Chapter
o DSM-5 Bipolar and Related Disorder Chapter
• Added:
o Premenstrual dysphoric disorder
• 5+ symptoms of major depression episode in the final week before the onset of
menses, that improve within a few days of onset
• Affective symptoms
▪ Marked affective lability
▪ Marked irritability or anger
▪ Marked depressed mood
▪ Marked anxiety
• At least one cognitive / physical symptom of depression
▪ Example: Anhedonia, sleeping problems, fatigue, etc.
o Persistent depressive disorder
• Includes:
▪ DSM-IV Dysthymic disorder (3+ symptoms, 2+ years)
• Low-grade
▪ Chronic major depressive disorder (5+ symptoms)
• Symptoms for 2+ years
▪ No periods longer than 2 months without symptoms
• Uninterrupted
o Disruptive mood dysregulation disorder
• Severe temper outbursts
▪ Out of proportion to the situation
▪ Inconsistent with developmental level
• Acting in a more immature way than expected
▪ 2 - 3 times / week
• Fairly regular and consistent
• Mood is otherwise irritable / angry
▪ When they're not having outbursts
• 12+ months of irritability / anger / outbursts
• Diagnosed between 6 - 18 years
• Addresses the over-diagnosis of bipolar disorder in childhood
find more resources at oneclass.com
find more resources at oneclass.com
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Document Summary
Symptoms of depression: cognitive, poor concentration and attention, not due to some underlying attention deficit. Indecisiveness: hard time deciding what to eat or what to wear, poor self-esteem, negative self-schema. Irritability: doesn"t happen for everybody, not recognized as a symptom of depression for everybody. Major depressive episode: not a disorder, kind of like panic attacks for panic disorder, 5+ symptoms for 2 weeks (one must be depressed mood or anhedonia, depressed mood* In children (and adolescents), it can be expressed as irritability: anhedonia, decreased / increased appetite / weight. Insomnia / hypersomnia: psychomotor agitation / retardation, fatigue, worthlessness / inappropriate guilt, diminished ability to concentrate / indecisiveness, suicidal ideation / behaviour, 1+ mde (single episode vs. recurrent, not accounted for by psychotic disorder. If they"re experiencing psychotic symptoms only when they"re depressed, then we would say it"s a major depressive disorder with psychotic features.
