abno

• Mood disorders


  Profound disturbance in emotion
• Two major types of depressive disorders


  • Major Depressive Disorder (MDD)
  • Persistent Depressive Disorder (PDD)
• Other depressive disorders

  • Premenstrual dysphoric disorder (PMDD)
  • Disruptive mood dysregulation disorder (DMDD)
• Manic symptoms


  Experienced by those with bipolar disorders
• Most who experience mania will also experience depression
• Depression is not a requirement for bipolar I but is required for bipolar II
• Subtypes of bipolar disorders

  • Bipolar I
  • Bipolar II
  • Cyclothymia
• Treatments for bipolar disorders


  • Cognitive Therapy
  • Family-focused Therapy (FFT)
  • Mood stabilizing medications (e.g. Lithium)
  • Anticonvulsants
  • Antipsychotics
  • Antidepressants (if with depression)
• Suicide prevention and treatment


  • Talk about suicide in an open manner
  • Cognitive Behavioral Therapy (CBT)
  • Dialectical Behavior Therapy (DBT)
  • Collaborative Management of Suicidality (CAMS)
  • Means Restriction
• Conditions for further study


  • Attenuated Psychosis Syndrome
  • Depressive Episodes with Short-Duration Hypomania
  • Suicidal Behavior Disorder
  • Non-Suicidal Self-Injury (NSSI)
• Major Depressive Disorder (MDD)

  Basis of at least 5 symptoms, lasting at least 2 weeks
• Persistent Depressive Disorder (PDD)


  At least 2 symptoms, must be present for 2 years (1 year for children and adolescents)
• Major Depressive Disorder (MDD)


  • Cardinal symptoms: Profound sadness and/or Anhedonia (The inability to experience pleasure)
  • Experiences at least five symptoms, including profound sad mood and anhedonia
  • Episodic, and recurrence is common
  • Symptoms are present nearly every day, most of the day, for at least 2 weeks
  • Symptoms are distinct from and more severe than normative response to loss
• MDD Symptoms


  • Thoughts about suicide when feeling completely dejected and hopeless
  • Attentional exhaustion and difficulty in absorbing what they hear or read
  • Initiative may disappear
  • Social withdrawal
  • Neglecting their appearance
• Physical symptoms of MDD


  • Fatigue and low energy
  • Physical aches and pains
  • Psychomotor retardation or agitation
  • Loss of appetite or an increase in appetite
  • Sexual interest disappears
• Even in cases when there is no obvious physical explanation for the symptoms, symptoms can be severe enough to persuade those who are experiencing them that they must have a significant medical disease
• Symptoms of depression are varied, and most people who struggle with depression experience only some of these symptoms, not all of them
• People with a depressive disorder may reverberate with self-recriminations in their head
• Persistent Depressive Disorder (PDD)


  • Symptoms must have lasted for at least 2 years for adults; 1 year for children and adolescents
  • Chronically depressed for most of the day or more than half of the time for at least 2 years
  • Characterized by low levels of symptoms
• PDD Symptoms


  • Sleeping too much or too little
  • Poor appetite or overeating
  • Low energy
  • Poor self-esteem
  • Trouble concentrating or making decisions
  • Feelings of hopelessness
• Symptoms do not clear for more than 2 months at a time in PDD
• Bipolar disorders are not present in PDD
• Premenstrual dysphoric disorder (PMDD) symptoms


  • Marked affective lability (e.g. mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
  • Marked irritability or anger or increased interpersonal conflicts
  • Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
  • Marked anxiety, tension, or feeling on edge
  • Decreased interest in usual activities
  • Subjective difficulty in concentration
  • Lethargy, easy fatigability, or marked lack of energy
  • Marked change in appetite (overeating or specific cravings)
  • Hypersomia or insomnia
  • A sense of being overwhelmed or out of control
  • Physical symptoms (e.g. Breast tenderness, swelling, joint/muscle pains, bloating, or weight gain)
• Disruptive mood dysregulation disorder (DMDD)


  Symptoms usually begin before the age of 10, and symptoms persist for at least 1 year
• DMDD Symptoms


  • Irritable or angry mood most of the day, almost every day
  • Severe temper outbursts (verbal or behavioral)
  • Issues with daily functioning due to irritability in more than one environment
• Epidemiology of Depressive Disorders


  • MDD is one of the most common psychological disorders, with approximately 16.2% of people experiencing it during their lifetime
  • About 5% of people report experiencing depressive episodes that persisted more than 2 years
  • MDD is twice as common among women as among men
  • MDD is three times as common among people who are impoverished compared to those who are not
• Gender Differences in Depression


  • Women are twice as likely to experience MDD and Persistent depressive disorder
  • Biological influences: Gonadal hormone fluctuation (puberty, premenstrual, postpartum, menopause)
  • Social influences: Twice as many girls are sexually abused during childhood, women are more likely to be exposed to poverty and caretaker responsibilities, women provide more support to others who are stressed
  • Stress reactivity: Adolescent girls worry more about body image, Hypothalamic-pituitary-adrenal (HPA) axis could be altered, focus on gaining approval and closeness within interpersonal relationships, emotion-focused coping on women can extend sad moods
• Seasonal Affective Disorder


  Depressive episodes occur during the fall or winter
• Causes of mood disorders


  • Genetic contribution
  • Neurotransmitter dysfunction
  • Changes in activation of regions in the brain in response to emotional stimuli
  • Activation of striatum in response to reward
  • Cortisol awakening response
  • Childhood adversity (parental death, physical abuse, sexual abuse)
  • Stressful life events
  • Interpersonal difficulties (lack of social support, family problems)
• Cognitive Theories of Depression


  • Pessimistic thoughts
  • Self-critical thoughts
  • Negative triad (negative view of the self, the world, and the future)
  • Hopelessness (stable vs unstable causes, global vs specific causes)
  • Rumination (repetitively dwelling on sad experiences and thoughts)
• Psychological Treatments for Depressive Disorders


  • Interpersonal Therapy
  • Cognitive Therapy (CT)
  • Mindfulness-based Cognitive Therapy (MBCT)
  • Behavioral Activation (BA) Therapy
  • Behavioral Couples Therapy
• Biological Treatments for Depressive Disorders


  • Medications (Monoamine oxidase inhibitors, Tricyclic Antidepressants, Selective serotonin reuptake inhibitors, Serotonin-norepinephrine reuptake inhibitors, Spravato)
  • Electroconvulsive Therapy
  • Repetitive Transcranial Magnetic Stimulation
• List of Antidepressants


  • Monoamine oxidase inhibitors (MAOIs)
  • Tricyclic Antidepressants
  • Selective serotonin reuptake inhibitors (SSRI)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Spravato (esketamine)
• SSRI


  • Produces fewer side effects
• SNRI


  • Produces fewer side effects
• Spravato (esketamine)


  For more severe depressive episodes but effects are short lived
• Electroconvulsive Therapy


  1. Treatment for MDD that does not respond to medication (last resort)

  2. Deliberately induces a momentary seizure by placing an electrode on the non-dominant side of the forehead

  3. Patient is given a muscle relaxant prior to the procedure

  4. 6-12 treatments, spaced several days apart

  5. Drastic results

  6. Used when psychotic symptoms are present or if patient is an elderly
• Electroconvulsive Therapy


  • Risk of short-term confusion and memory loss
• Repetitive Transcranial Magnetic Stimulation


  1. Administered on adults who have failed to respond to antidepressant treatment during the current episode

  2. Electromagnetic coil is placed against the scalp

  3. Intermittent pulses of magnetic energy are used to increase activity in the left dorsolateral prefrontal cortex

  4. Lasts 30-60 minutes with daily doses delivered for 10-30 days
• Hypomania


  Milder version of mania, typically lasting for a shorter period