The document discusses mood disorders including major depressive disorder, dysthymic disorder, and bipolar disorders. It provides diagnostic criteria for each disorder based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Symptoms are described for major depressive episodes, manic episodes, and hypomanic episodes. A case presentation is also included describing symptoms consistent with bipolar I disorder.

1. Mood Disorders Lucia Merino Psychopathology Class Presentation December 13 th , 2009

2. The Four Humors Melancholic moody glum (water) Choleric hot-tempered Irritable (fire) Sanguine healthy Happy (air) Phlegmatic droopy Slow (earth) Source: https://eee.uci.edu/clients/bjbecker/PlaguesandPeople/humorsb.jpg

3. The Four Personality Type based on the four humors The humors each had associated physical and mental characteristics; the result was a system that was quite subtle in its capacity for describing types of personality. Source: http://www.kheper.net/topics/typology/four_humours.html Humor Body Substance Produced by Personality Type Sanguine blood liver Amorous, happy, healthy, optimistic, irresponsible Choleric yellow bile spleen Violent, vengeful, irritable, short tempered, ambitious Phlegmatic phlegm lungs Sluggish, pallid, cowardly, droopy, slow, lazy Melancholic Black bile gall bladder Introspective, sentimental, moody, gloomy, gluttonous

4. The four humors today

5. From the four humors to Diagnostic Statistical Manual

6. Since 2000 using DSM-IV-TR

7. Mood Disorders Unipolar Disorders Major Depressive Disorder -specify: single, psychotic, post-partum Dysthymic Disorder Depressive Disorder NOS Bipolar Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Bipolar Disorder NOS Mood Disorder due to a General Medical Condition Mood Disorder Not Otherwise Specified Substance-Induced Mood Disorder

8. Mood changes Vegetative symptoms Suicidal Ideation Negative Self-Evaluation Cognitive changes Major Depressive Disorder Major Depressive Episode Symptoms: Sad/depressed mood Decreased interest in pleasurable activities Motoric changes: retardation or agitation Sleep changes: too much or too little Appetite changes: anxious eating or no eating Fatigue or loss of energy Cognitive changes: indecisiveness, lack of attention, concentration Guilt, worthlessness, hopelessness Suicidal ideation (15-20% more likely suicide)

9. Dysthymic Disorder A. Depressed mood most of the day more days than not for at least 2 yrs. B. While depressed presence of 2 of: (1) poor appetite or overeating (2) insomnia or hypersomnia (3) low energy or fatigue (4) low self-esteem (5) poor concentration or undecis (6) hopelessness C. During the illness two year period the person has never been without A & B sxs for more than 2 months No Major Depressive Episode has been present during the two years of dysthymia. There has never been a manic, hypomanic or mixed episode or cyclothymic d/o. The disturbance does not occur during the course of a chronic psychotic disorder such as schizophrenia or delusional disorder. The symptoms are not due to a medical condition or physiological effect of any Substances (alcohol, drugs or medications). They symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Photo source: http://i.ehow.com/images/GlobalPhoto/Articles/5472319/391169-main_Full.jpg

10. Depressive Disorder Not Otherwise Specified The Depressive Disorder NOS category includes disorders with depressive features that do not meet criteria for a MDD, Dysthymic , Adjustment with Depressed Mood, or Adjustment with Mixed Anxiety and Depressed Mood disorder. Sometimes depressive symptoms can present as part of an Anxiety Disorder NOS. Examples of Depressive Disorder NOS include: Premenstrual dysphoric disorder: Minor depressive disorder: Recurrent brief depressive disorder: Postpsychotic depressive disorder of Schizophrenia: A M D Episode superimposed on Delusional D/O, Psychotic NOS, or the active phase of schizophrenia. Situations in which the clinician has concluded that a depressive d/o is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced.

11. Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Bipolar Disorder NOS Bipolar Disorders

12. Manic Episode Source: http://farm4.static.flickr.com/3141/2658083689_60c2ff67a0_o.jpg

13. Symptoms of a Manic Episode Elevated Mood Inflated Self-esteem or grandiosity Decreased need for sleep Talkative, pressure to keep talking Racing thoughts, flight of ideas Distractibility Goal directed activity(social, work, sex) Psychomotor agitation Excessive pleasurable activities Poor judgment behavior Diagnostic Criteria: A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary) B) During the period of mood disturbance, three or more of the symptoms listed have persisted (four if the mood is only irritable) and have been present to a significant degree. C) The symptoms do not meet criteria for a mixed episode. D) The mood disturbance is sufficiently severe to case marked impairment in functioning. E) Not due to a medical condition, treatment or substances. Photo source: http://images.dailyradar.com/media/uploads/showhype/photos_large/2008/09/07/robinwilliams.jpg

14. Case presentation 45 year old divorced Caucasian working male sober for last 20 yrs –computer programmer. Presenting symptoms: Sleeping 3-4 hours walking up fully rested Writing 2-3 short novels per week (goal directed) Racing thoughts – rush of mental energy Promiscuous behavior including female therapist Poor judgment behavior (i.e. getting $ from ATM and giving it out to people in the street, getting on a plane to Thailand and spending several months having sex with prostitutes, ex-wife wiring $ to stay longer an finally having to bail him out of jail, having robbers and drunks as room mates at home and relapsing. Showing up in his company party on a skirt with no underwear and flirting with personnel. Finally losing job, health, properties, finances and being sent to a nursing home since his health severely deteriorated and family were not able to take care of him. His children were afraid of him being inappropriate with children, showing up drunk or being aggressive. His behavior was grandiose, he would wear lots of native American jewelry he had made, colorful beads necklaces, chains with buffalo horns pendant, many rings in his fingers and an exuberant big hat with exotic feathers. Picture retrieved from: http://www.hypomanicedge.com/reviews/nyt/nytimesarticle.jpg

15. Symptoms of a Hypomanic Episode Elevated, expansive, or irritable mood Inflated Self-esteem or grandiosity Decreased need for sleep Talkative, pressure to keep talking Racing thoughts, flight of ideas Distractibility Goal directed activity(social, work, sex) Psychomotor agitation Excessive pleasurable activities Poor judgment behavior Diagnostic Criteria: A) A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days , that is different from the usual non-depressed mood. B) During the period of mood disturbance, three or more of the symptoms listed have persisted (four if the mood is only irritable) and have been present to a significant degree. C) The episode is associated with an unequivocal uncharacteristic change in functioning. D) The disturbance in mood and the change in functioning are observable by others. E) The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization ,and there are no psychotic features. F) The symptoms not due to the physiological effects of substances or medical conditions.

16. Diagnostic Criteria Cyclothymic Disorder For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a MDE. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance. The symptoms in Criterion A are not better accounted for by Schizoaffective and are not superimposed on Schizophrenia, Schizophreniform, Delusional, or Psychotic NOS. Symptoms not due to the effects of substances, mediations or medical conditions. F. The symptoms cause clinically significant distress or impairment in functioning. Photo source: http://www.metroactive.com/papers/metro/03.30.00/gifs/bipolar2-0013.jpg

17. Bipolar Disorder NOS The Bipolar Disorder NOS category includes disorders with bipolar features that do not meet criteria for any specific Bipolar Disorders. Examples are: Very rapid alternation (over days) between manic symptoms and depressive symptoms that meet symptom threshold criteria but not minimal duration for Manic, Hypomanic, or Major Depressive Episodes. Recurrent Hypomanic Episodes without intercurrent depressive sxs. A Manic or Mixed Episode superimposed on Delusional D/O, residual Schizophrenia, or Psychotic D/O NOS. Hypomanic Episodes, along with chronic depressive symptoms, that are too infrequent to qualify for a diagnosis of Cyclothymic Disorder. Situations in which the clinical has concluded that a Bipolar Disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced. Source: DSM-IV-TR

18. Summary Graphics Retrieved from: http://journey2balance.files.wordpress.com/2009/10/bipolar_arrow.jpg

19. Summary Graphics Retrieved from: http://www.thebody.com/content/esp/art6293.html

20. Bipolar I, II, and Cyclothymic Disorders Retrieved from: http://www.psychosis-bipolar.com/information-about-psychoses-57.html

26. References Woo, S., & Keatinge, C. (2008) Schizophrenia and other psychotic Disorders (pp.469-532) in Diagnosis and Treatment of Mental Disorders Across the Life Span. Wiley: NJ American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders; Fourth edition; Text Revision; DSM-IV-TR. APA:DC