Depressive & Bipolar Disorders
Mood disorders are among the most common psychiatric conditions and are often first identified in primary care due to their frequent physical symptoms. While sadness is a normal human emotion, mood disorders involve more persistent and disruptive symptoms that require clinical care.
Sadness is a common human emotion that exists on a spectrum from the absence of depression to severe, debilitating symptoms of major depression. Cultural factors can influence how depression is expressed. Mild depression may even serve as a natural response to life stressors, helping motivate individuals to process challenges and emotions.
Sadness can be pathological if:
- It is disproportionate to events and sustained over a significant period
- It greatly hinders normal social functioning such as occupational, social, school, relational functioning.
- It greatly hinders normal somatic functioning, for example, loss of appetite, altered sleep, altered self-care activities, and altered sexual functioning.
- It is supposedly unrelated to any identifiable event or situation in a person’s life.
One of the most common psychiatric disorders; the primary unipolar affective disorder
A complex brain-based illness with a primary characteristic of a persistent disturbance in mood
Manifestations of behavioral, affective, cognitive, and somatic symptoms due to an excessive or distorted degree of sadness
Significantly interferes with daily functioning and goal attainment X Has complex genetic, biochemical, and environmental etiological factors
A disorder like MDD but with less acute symptoms; with a more protracted, chronic disease course; and without any manifestations of psychotic symptoms
Less discrete episodes of illness than MDD
Symptoms often go undetected and therefore untreated for years
Vegetative symptoms which includes sleep, appetite, weight changes are much less common in dysthymic disorder than in MD
Consist of a wide range of normal responses that can become abnormal and excessive
Involve normative emotional, cognitive, and behavioral reactions to death or loss of a significant person or object
Unlike in major depression, self-esteem is usually maintained in the grieving person
Involve nonnormative psychological responses to an identifiable stressor that can result in the development of clinically significant emotional or behavioral symptoms
Stressor encompassing elements of perceived loss
Develops within 3 months of stressor
Single event
End of relationship
Death of relative or partner
Recurring event: Living with person with terminal illness
Developmental event: Leaving home to go away to school. Getting married. Becoming a parent. Retiring from work
BIPOLAR (BP) DISORDER
A complex, brain-based condition characterized primarily by significant disturbances in mood.
These mood changes often occur at both extremes depressive episodes and expansive or manic episodes.
Several Patterns:
- Single-polarity symptoms only including mania.
- Distinct symptom patterns of alternating polarity. It includes manic symptoms alternating with depressive symptoms
- Mixed, co-occurring symptoms
- Excessive or distorted amount of sadness or elation, possibly both
- Presents with behavioral, affective, cognitive, and somatic symptoms
- May have precipitating event, situation, or concern yet often occurs without an identified
Precipitating Stressor
- Has complex genetic, biochemical, and environmental etiological factors
Period of abnormally or persistently elevated, expansive, or irritable mood, lasting for at least 1 week
Mood episode with rapid development and escalation of symptoms over a few days
Often precipitated by significant environmental stressor
Mood disturbance may result in brief psychotic symptoms may present after mood disturbance
Manic episodes may persist for days to several months
Briefer duration and concludes more abruptly than major depressive episodes
For 60% of people, a major depressive episode will immediately precede or follow the manic episode
Persistence of other suggestive symptoms: Lessened need for sleep, Feels rested after 3 hours sleep on average, Typically a discernible difference from normal baseline sleep pattern, Inflated self-esteem, Feeling of grandiosity, Increased goal-directed activities, Excessive involvement in pleasurable activities with a high potential for painful consequences, Unrestrained shopping sprees, Sexual indiscretions, Unsound business ventures, Excessive substance use or abuse, Highly recurrent depressive episodes
Major depressive episode shifting to a manic episode
Manic episode shifting to a major depressive episode
Major depressive episode shifting to a mixed episode.
CYCLOTHYMIC DISORDER
Chronic, fluctuating mood disorder with symptoms similar to but less severe than BP disorder
Expansive or elated mood symptoms known as Manic symptoms as described above
Hypomanic: Like mania but briefer in duration. Episode less severe than mania. No hospitalization required. Does not cause significant functional
Numerous periods of hypomanic and dysthymic symptoms.
Etiology is like BP disorder
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