ABP 03: Mood, Suicide, Eating & Sleep-wake, Physical, Sexual

• Unipolar Mood Disorder


  Individuals who suffers either depression or mania; mood remains at one "pole" of the usual depression-mania continuum
• Unipolar Depression


  Have no history of mania and return to a normal or nearly normal mood when their depression lifts
• Bipolar Disorders


  Have periods of mania that alternate with periods of depression
• Most people with Unipolar Mood Disorder develops to Depression
• Major Depressive Episode


  Most commonly diagnosed and most severe depression
• Anhedonia


  Loss of energy and inability to engage in pleasurable activity or have any "fun"
• Mania


  Extreme pleasure in every activity, becoming extraordinarily active, requires little sleep, and may develop grandiose plans, believing they can accomplish anything they desire
• Mania


  • Persistently increased goal-directed activity or energy
• Hypomania


  Less severe version of a manic episode that does not cause marked impairment in social or occupational functioning
• Bipolar I Disorder (BP1)


  Consists of at least one MANIC episode
• BP1


  • Peak age at onset between 20 and 30 years, but onset occurs throughout the lifespan
  • Children should be judged according to his or her own baseline in determining whether a particular behavior is normal or evidence of a manic episode
  • First episode is usually depressive and its symptoms are the most frequent symptoms experienced across the long-term course of BP1, and usually the individual seeks help for depression
• Factors that could be considered before diagnosing MDD:
• Bipolar I disorder, with psychotic features

  The diagnosis if the psychotic symptoms have occurred EXCLUSIVELY during manic and major depressive episodes
• Symptoms of mania in BP1


  • Occur in distinct episodes and typically begin in late adolescence or early adulthood
• When any child is being assessed for Mania, it is essential that the symptoms represent clear change from the child's typical behavior
• Symptoms of mood lability and impulsivity must represent a distinct episode of illness, or there must be a noticeable increase in these symptoms over the individual's baseline in order to justify an additional diagnosis of BP1
• Bipolar II Disorder (BP2)


  Major depressive episodes with HYPOMANIC episodes rather than full manic episodes
• BP2


  • Can begin in late adolescence and throughout adulthood, slightly later than bipolar disorder but earlier than MDD
  • Often begins with depressive episodes
  • Highly recurrent, also have seasonal variation in mood compared to those with BP1
  • The number of lifetime episodes tends to be higher for BP2 than for MDD or BP1
  • Once the hypomanic episode has occurred, it never reverts back to MDD
  • Switching from a depressive episode to a manic or hypomanic may occur, both spontaneously and during the treatment for depression
• Bipolar II disorder with psychotic features

  The diagnosis if psychotic symptoms have occurred exclusively during major depressive episodes
• The double counting of symptoms toward both ADHD and BP2 can be avoided if the clinician clarifies whether the symptoms represent a distinct episode and if the noticeable increase over baseline required for the diagnosis of BP2 is present
• Mania may be linked to low serotonin activity accompanied by high norepinephrine activity
• Among bipolar individuals, irregularities of these ions may cause neurons to fire too easily (mania) or too stubbornly resist firing (depression)
• Cyclothymic Disorder


  Milder but more chronic version of bipolar disorder
• Cyclothymic Disorder


  • Do not meet the complete criteria for depressive symptoms and hypomanic symptoms
  • Usually begins in adolescence or early adult life and is sometimes considered to reflect a temperamental predisposition to other disorders
  • Experience onset of mood symptoms before the age of 10
• Specifiers for Cyclothymic Disorder

  • With Anxious Distress
  • With Mixed Features
  • Rapid Cycling
  • With Melancholic Features
  • With Atypical Features
  • With Psychotic Features
  • With seasonal pattern
• Disruptive Mood Disorder (DMDD)

  • Onset must be before age of 10 yrs, with developmental age of younger than 6 yrs
  • The diagnosis of DMDD must be made while considering the presence or absence of multiple other conditions
  • DSMM is not episodic conditions, hence, the diagnosis cannot be assigned to a child who has ever experienced a full duration hypomanic or manic episode or who has ever had a manic or hypomanic episode lasting more than 1 day
  • Presence of severe and frequently recurrent outbursts and persistent disruption in mood between outbursts
  • Requires severe impairment in at least one setting and mild to moderate impairment to second settngs
  • Can receive comorbid diagnosis of ADHD
  • Children with DMDD may have symptoms that also meet criteria for anxiety disorder and can receive both diagnoses, but children who irritability is manifest in the context of exacerbation of an anxiety disorder diagnosis rather than DMDD
  • IED and DMDD should not be made in the same child
  • For children with outbursts and intercurrent persistent irritability, only the diagnosis of DMDD should be made
• Major Depressive Disorder (MDD)


  • May first appear at any age, but the likelihood of onset markedly with puberty
  • Chronicity of depressive symptoms substantially increases the likelihood of underlying personality, anxiety, and substance use disorders and decreases the likelihood that treatment will be followed by full symptom resolution
• Ask individuals presenting with depressive symptoms to identify the last of at least 2 months during which they were entirely free of depressive symptoms
• Depression with earlier age at onset are more familial and more likely to involve personality disturbances
• If criteria are met for both MDD and PDD, both can be diagnosed
• Irritability is confined to the major depressive episodes
• When the depressive symptoms meet full criteria for a MDE, a diagnosis of other specified depressive disorder may be made in addition to the diagnosis of psychotic disorder
• Distractibility and low frustration tolerance can occur in both ADHD and MDE; if the criteria are met for both, ADHD may be diagnosed in addition to the mood disorder
• Specifiers for MDD


  • Seasonal
  • Catatonic
  • Peripartum
  • Melancholic
• Persistent Depressive Disorder (PDD)

  • Often has an early and insidious onset and, chronic course
  • Early onset is associated with a higher likelihood for comorbid personality disorders and substance-use disorders
• If full criteria for a major depressive episode have been met at some point during the current episode of illness, a diagnosis of MDD would apply. Otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder should be given
• A separate diagnosis of PDD is not made if the symptoms occur only during the course of the psychotic disorder
• Premenstrual Dysphoric Disorder (PMDD)


  • Onset can occur at any point after menarche
  • PMS do not require a minimum of five symptoms nor mood-related symptomatology and is generally considered to be less severe than Premenstrual Dysphoric Disorder
• Double Depression


  • Suffer from both MDE and PDD with fewer symptoms
  • Few depressive symptoms develop first and then one or more MDE occur later only to revert to underlying pattern of depression once the MDE has run its course
• Specifiers for PMDD


  • Psychotic Features
  • Anxious Distress
  • Mixed Features
  • Melancholic Features
  • Peripartum Onset
  • Seasonal Pattern