The document discusses various mood disorders including major depressive disorder, dysthymia, bipolar disorder, and cyclothymia. It defines the diagnostic criteria for each disorder, compares their symptoms, and outlines treatment options including self-care, medication, and suicide prevention strategies.

1. WHAT IS A MOOD DISORDER? A disturbance of mood

2. BACKGROUND All respond to treatment Treatments vary on type of depression Multiple occurrences Physical Examination Myths

3. COGNITIVE TRIAD How one views themselves How one views their experiences How one views their future

4. DEPRESSION DSM-IV CRITERIA Major Depressive Disorder – Single Episode Major Depressive Disorder – Recurrent Major Depressive Episode Depressed mood most of the day nearly every day Diminished interest in activities Weight loss/gain Insomnia/hypersomnia nearly every day Psychomotor agitation/retardation Fatigue/loss of energy Feelings of worthlessness/inappropriate guilt Difficulty concentrating Recurrent thoughts of death

5. Most Common Physiological Symptoms Sleep disturbance Appetite Sexual

6. Self-Help Strategies Set Realistic Goals Break Large Tasks into Smaller Ones Don’t Isolate Participate in Activities Gradual Improvement Postpone Major Decisions

7. DYSTHYMIA “Mild Depression” Long-term and chronic but does not disable Many experience Major Depression at some point

8. DYSTHYMIA DSM-IV Criteria 1) Depressed mood most days, more days than not, at least 2 years 2) Presence of: A) Increased/Decreased appetite B) Insomnia/Hypersomnia C) Low Energy/Fatigue D) Low Self-Esteem E) Poor Concentration, Difficulty making decisions F) Hopelessness 3) During two Years, never symptom free for more than two months 4) No Major Depressive Episode 5) No Manic/Mixed/Hypomanic episodes 6) No Psychosis 7) No Substance Abuse 8) Clinically significant distress

9. DYSTHYMIA Symptoms 1) Critical/Irritable/Complaining 2) Prone to worry 3) Feelings of worthlessness, inferiority, Lack of self-confidence 4) Excessive guilt/Self-critical 5) Low stress tolerance, easily overwhelmed 6) Overly cautious 7) Difficulty being assertive

10. BIPOLAR DISORDER Bipolar I – “Classic Bipolar” Long bouts of Depression + Long bouts of Mania or Mixed episodes DSM-IV Criteria – Six separate 1) Single Manic Episode 2) Most recent episode Hypomanic 3) Most recent episode Manic 4) Most recent episode Mixed 5) Most recent episode Depressed 6) Most recent episode unspecified

11. BIPOLAR DISORDER Bipolar Disorder II – hypomanic episodes + depressive episodes One or more MD episodes At least one Hypomanic episode Never had a Manic Episode

12. BIPOLAR DISORDER Don’t recognize how it affects their life or others Typically begins in adolescence/early adult Sometimes dramatic – most often gradual

13. SYMPTOMS SUBJECTIVE REPORTS OF BD Lack of motivation vs increased productivity Dulling of thinking process vs clarity of thought Low self-esteem vs inflated ego/over confidence Pessimistic brooding/worry vs carefree

14. SYMPTOMS UNSTABLE MOOD CHARACTERISTICS Easily bored Difficulty holding enthusiasm Easily irritated if don’t get their way Impulse control problems Reckless behavior Stormy relationships Multiple relationships/marriages Frequent moves Multiple job/career changes

15. SYMPTOMS MANIC PHASE Euphoria, optimism, inflated self-esteem Rapid speech, racing thoughts,increased physical activity Poor judgement and recklessness Easily distracted Inability to concentrate/Flight of ideas Extreme instability Restlessness Goal-directed activity Decreased need for sleep Increased sexual desire Inappropriate social behavior

16. SYMPTOMS DEPRESSIVE PHASE Persistent sadness, anxiety, guilt, hopelessness Sleep/appetite disturbance Anhedonia Difficulty concentrating Recurring thoughts od suicide Chronic pain not caused by physical problems Restlessness, irritability, agitation Decreased energy

17. TREATMENT SELF-CARE Bipolar Disorder is NOT an illness one can treat on their own Med compliance Warning signs Avoid drugs and alcohol Check for interaction before taking other meds Find enjoyable activities Enhance friendships and relationships

18. CYCLOTHYMIA Everything is pretty much o.k. Irregular, short cycles of depression and hypomania DSM IV Criteria For two or more years hypomanic symptoms and depressive symptoms that don’t meet criteria for MD During 2 year period, not without symptoms for more than 2 months No Major Depressive Episode, Manic Episode, nor Mixed Episode No Psychotic Disorder No physiological problem Causes significant distress or impairment

19. SUICIDE Suicide assessment is critical MYTH – talking about suicide will put the idea in their head Consider: Method contemplated Access to method Environmental resources Assistance if attempt is made

20. SUICIDE Assessment Newspaper reporter Ideation, Plans, Attempts/Intent Clues Secretive Making a will suddenly Verbal Statements

21. SUICIDE Motives To die Based on reality Influence others Tipping the scale against suicide Play for time No-Harm Contract Elicit reasons to live and die

22. SUICIDE Dealing with Hopelessness Problem solving Stress inoculation Training people to think differently Increases in suicidality