Mood Disorders
· Disturbances of mood – intense and maladaptive.
· Two key moods :
o
Mania
– intense unrealistic feelings of excitement and euphoria
o
Depression
– involve feelings of extreme sadness and dejection
· Mixed Episodes – rapidly alternating
moods – sadness, irritability and euphoria.
· Unipolar disorders – person experiences
only depressive episodes.
· Bipolar disorders – Both manic and
depressive episodes.
· Differs in terms of
o
Severity
– number of dysfunctions experienced – relative degree of impairment seen in
those areas
o
Duration
– acute, chronic or intermittent
Depressions That Aren’t
Mood Disorders
· Postpartum Blues
o
New
mothers – symptoms in 10 days of birth
o
Emotional
liability, crying and irritability
o
Happy
feelings are mixed too
o
Symptoms
go away on their own
o
Causal
Factors :
§ Hormonal readjustment
§ Lack of social support
§ Difficulty adjusting to new identity
& responsibilities
§ Personal or family history of
depression.
· Loss and grieving process :
o
Numbing
and disbelief – few hours to a week – intense distress, panic or anger
o
Yearning
and searching for dead person – weeks to months – insomnia, restlessness and
anger with the dead person
o
Disorganization
and despair – accepts the loss – try to establish new identity
o
Reorganization
– begin to rebuild – zest for life returns
Unipolar Disorders
· Mainly two kinds – Dysthymic
Disorder and Major Depressive Disorder
· Dysthymic Disorder :
o
Mild
to moderate
o
Hallmark
– Chronicity
o
Depressed
mood for most of the day, more days than not, for 2 years.
· Major Depressive Disorder :
§ Symptoms :
· Depressed Mood
· Loss of interest, pleasure
· Significant weight loss or gain (without
dieting)
· Insomnia or Hypersomnia
· Fatigue or loss of energy
· Recurrent thoughts / plans / attempts
of suicide or death
·
Cognitive
– Worthlessness or guilt & thoughts of suicide
·
Behavioral
– Fatigue or physical agitation
·
Physical
– Change in appetite & sleep
patterns
o
Major
Depressive Single Episode :
§ Never been mixed or manic episode
§ Presence of single episode
§ Not better accounted for by any
other disorder
o
Major
Depressive – Melancholic features :
§ Loss interest and pleasure in
activities
§ Person must experience at least 3 of
these :
· Early morning awakenings (involuntary)
· Mornings – worse depression
· Agitation / Psychomotor Retardation
· Loss of appetite and weight
§ Higher genetic basis than others.
§ Depressed mood is qualitatively
different.
o
Severe
Major Depressive Disorder – Psychotic Features
§ Loss of contact with reality
§ Delusions
§ Hallucinations
§ Worthlessness
§ Guilt
§ Poorer long term prognosis
o
Major
Depressive Disorder – Atypical Features
§ Mood reactivity
§ 2 or more of the following :
· Weight gain / increase in appetite
· Hypersomnia
· Leaden Paralyses
· Long standing pattern – very sensitive
to interpersonal rejection
· Sometimes coexists with dysthymia – known as double depression.
o
Moderately
depressed – chronic basis
o
Time
to time – problem increases – Major Depressive Episode
o
Chronic
Major Depressive Disorder :
§ Does not remit for two years
o
Seasonal
Affective Disorder :
§ Seasonal pattern in recurrent
episodes
§ At least 2 episodes of depression
- in 2 years – same time of the year
§ Remission also occurred at same time
§ No other non-seasonal depressive
episodes
Bipolar Disorders
· It has two episodes – Manic and
Depressive or Hypomanic.
· Manic Episode :
o
Distinct
period of abnormally and persistently elevated, expansive, irritable mood –
lasting for at least a week.
o
Inflated
self esteem or grandiosity.
o
More
talkative than usual.
o
Racing
thoughts.
o
Distracted.
o
Increased
goal oriented activity
·
Hypomanic
:
o Abnormally elevated, expansive, or
irritable mood for at least 4 days.
o Have at least 3 of the symptoms :
§ inflated self- esteem
§ Decreased need for sleep
§ Flights of ideas
§ Pressured speech
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