T7: Mood Disorders and Suicide

• The most commonly diagnosed and most severe depression is called a major depressive episode. It is an extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms (such as feelings of worthlessness and indecisiveness) and disturbed physical functions (such as altered sleeping patterns, significant changes in appetite and weight, or a notable loss of energy) to the point that even the slightest activity or movement requires an overwhelming effort.
• The most central indicators of major depressive episode are the physical changes (sometimes called somatic or vegetative symptoms)
• Anhedonia is a loss of energy and inability to engage in pleasurable activities or have any “fun”.
• The duration of a major depressive episode, if untreated, is approximately 4 to 9 months.
• Manic Episode is an abnormally exaggerated elation, joy, or euphoria. In mania, individuals find extreme pleasure in every activity; some patients compare their daily experience of mania with a continuous sexual orgasm. They become extraordinarily active (hyperactive), require little sleep, and may develop grandiose plans, believing they can accomplish anything they desire.
• DSM-5 criteria for a manic episode require a duration of only 1 week.
• The duration of an untreated manic episode is typically 3 to 4 months.
• Hypomanic episode is a less severe version of a manic episode that does not cause marked impairment in social or occupational functioning and need last only 4 days rather than a full week.
• Individuals who experience either depression or mania are said to suffer from a unipolar mood disorder, because their mood remains at one “pole” of the usual depression-mania continuum.
• Someone who alternates between depression and mania is said to have a bipolar mood disorder traveling from one “pole” of the depression-elation continuum to the other and back again.
• An individual can experience manic symptoms but feel somewhat depressed or anxious at the same time; or be depressed with a few symptoms of mania. This episode is characterized as having “mixed features”.
• Persistent Depressive Disorder/Dysthymia shares many of the symptoms of major depressive disorder but differs in its course. It is depressed mood that continues at least 2 years, during which the patient cannot be symptom free for more than 2 months at a time even though they may not experience all of the symptoms of a major depressive episode. It may last sometimes for 20 or 30 years or more.
• These individuals who suffer from both major depressive episodes and persistent depression with fewer symptoms are said to have double depression.
• Clinicians use eight basic specifiers to describe depressive disorders:

  1. with psychotic features
  2. anxious distress
  3. mixed features
  4. melancholic features
  5. peripartum onset
  6. atypical features
  7. catatonic features
  8. seasonal pattern
• Hallucinations is a psychotic feature in which an individual is seeing or hearing things that aren’t there.
• Delusions is a psychotic feature in which an individual strongly held but inaccurate beliefs.
• Somatic (physical) delusion is a psychotic feature in which an individual is believing, for example, that their bodies are rotting internally and deteriorating into nothingness.
• Auditory hallucination is a psychotic feature in which an individual is hearing voices, life for example, telling them how evil and sinful they are.
• Such hallucinations and delusions are called mood congruent because they seem directly related to the depression.
• Delusions of grandeur is a psychotic feature in an individual is believing, for example, they are supernatural or supremely gifted.
• Comorbid anxiety disorders in which anxiety symptoms meeting the full criteria for an anxiety disorder.
• Depressive episodes that have several (at least three) symptoms of mania as described above would meet "mixed feature" specifier, which applies to major depressive episodes both within major depressive disorder and persistent depressive disorder.
• Melancholic specifier is one of the basic specifiers of depressive disorder in which includes severe somatic (physical) symptoms, such as early morning awakenings, weight loss, loss of libido (sex drive), excessive or inappropriate guilt, and anhedonia (diminished interest or pleasure in activities).
• Catatonic is a serious condition involves an absence of movement (a stuporous state) or catalepsy, in which the muscles are waxy and semi-rigid, so a patient’s arms or legs remain in any position in which they are placed. It also involves excessive but random or purposeless movement.
• Atypical feature is a specifier where individuals consistently oversleep and overeat during their depression and therefore gain weight, leading to a higher incidence of diabetes. Unlike on most people with depression who sleep less and lose their appetite.
• Peripartum period is during pregnancy and the 6-month period immediately following the childbirth.
• Baby blues are feelings of sadness that you experience after giving birth. It usually occurs between 1 and 5 days after delivery.
• Peripartum depression is a difficulty of a new mother who just gave birth of understanding why she is depressed, because they assume this is a joyous time.
• If two or more major depressive episodes occurred and were separated by at least 2 months during which the individual was not depressed, it will be considered as recurrent major depressive disorder.
• Seasonal Affective Disorder is a type of condition in which individuals may become depressed during the winter and manic during the summer, it could also happen to bipolar disorder. These episodes must have occurred for at least two years with no evidence of non-seasonal major depressive episodes occurring during that period of time.
• Light therapy is a promising treatment for seasonal affective disorder in which patients are exposed to 2 hours of bright light immediately on awakening.
• Melatonin is hormone secreted by the pineal gland.
• Premenstrual Dysphoric Disorder (PMDD) is a severe and sometimes incapacitating emotional reactions during the premenstrual period with a combination of physical symptoms, severe mood swings and anxiety.
• Disruptive Mood Dysregulation Disorder (DMDD) is the intense negative effect that seems to be driving the irritability and marked inability to regulate the mood. These children show no evidence of elevated mood (mania).
• Disruptive Mood Dysregulation Disorder (DMDD) has an age range of up to 12 years of age that can suffer the disorder.
• The key-identifying feature of bipolar disorders is the tendency of manic episodes to alternate with major depressive episodes in an unending roller-coaster ride from the peaks of elation to the depths of despair.
• Bipolar II disorder, in which major depressive episodes alternate with hypomanic episodes rather than full manic episodes.
• For the manic episodes to be considered separate, there must be a symptom-free period of at least 2 months between them.
• There is one specifier that is unique to bipolar I and II disorders which is the rapid-cycling specifier. It happened when an individual with bipolar disorder experiences at least four manic or depressive episodes within a year.
• Rapid mood switching is a term of direct transition from one mood state to another. It is a particularly treatment-resistant form of disorder.