MOOD DISORDERS

(Depressive Disorders, Bipolar

and Other Related Disorders)
Abnormal Psychology
Depressive Disorders (DSM-V)
 Disruptive Mood Dysregulation Disorder
 Major Depressive Disorder
 Persistent Depressive Disorder (Dysthymia)
 Premenstrual Dysphoric Disorder
 Substance/Medication Induced Depressive

Disorder
 Other specified Depressive Disorder
 Unspecified Depressive Disorders
Common Features
 The presence of sad, empty, irritable mood
accompanied by somatic and cognitive
changes that significantly affect the
individual’s capacity to function.
 What differs among them are issues of

duration, timing or presumed etiology.

 MAJOR DEPRESSIVE DISORDER
A. 5 (or more) of the following symptoms have been
present during a 2-week period & represent a
change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2)
loss of interest or pleasure
1. Depressed mood most of the day, nearly everyday
as indicated by subjective reports (feels sad,
empty, hopeless) or observations by others
(appears tearful)
(*In children/adolescents – can be irritable mood )
MAJOR DEPRESSIVE DISORDER
2. Markedly diminished pleasure in all, or
almost all activities most of the day, nearly
everyday
3. Significant weight loss when not dieting or
weight gain / decrease or increase in appetite
nearly everyday
4. Insomnia / hypersomnia nearly everyday
5. Psychomotor agitation / retardation nearly
everyday (observed by others)
6. Fatigue or loss of energy, nearly everyday
MAJOR DEPRESSIVE DISORDER
7. Feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional)
nearly everyday.
8. Diminished ability to think or concentrate or
indecisiveness, nearly everyday (either
subjective or observed by others)
9. Recurrent thoughts of death (not just fear of
dying), recurrent suicidal ideation without a
specific plan, OR suicide attempt OR a
specific plan for committing suicide
MAJOR DEPRESSIVE DISORDER
B. The symptoms cause clinically significant
distress or impairment in social, occupational
or other important areas of functioning.
C. The episode is not attributable to
physiological effects of a substance or to
another medical condition
D. The occurrence is not better explained by
another clinical disorder
E. There has never been a manic episode or
hypomanic episode.
Prevalence of MDD
 7% - one year prevalence of MDD in the US
 Prevalence in individuals 18-29 is 3x more

than the prevalence among people 60 years

and older.
 Females experience 1.5 to 3x higher rates of

MDD than males beginning early adolescence

Co-morbidity
 MDD usually co-occurs among individuals
with:
 Substance related disorders
 Panic disorder
 OC disorder
 Anorexia nervosa
 Bulimia nervosa
 Borderline PD
 Persistent Depressive Disorder
(Dysthymia)
A. Depressed mood for most of the day, for more
days than not, indicated by subjective reports or
observations by others, for at least 2 years
B. Presence of 2 or more of the following:
1. Poor appetite / over-eating
2. Insomnia / hypersomnia
3. Low energy / fatigue
4. low self esteem

(Note: In children / adolescence, can be irritable

mood, & duration at least 1 year)
Persistent Depressive Disorder
(Dysthymia)
5. Poor concentration / difficulty making
decisions
6. Feelings of hopelessness

C. During the 2 year period, the individual has

never been without the symptoms in Criteria
A & B for more than 2 months at a time
D. Criteria for MDD may be continuously
present for 2 years
 Persistent Depressive Disorder
(Dysthymia)
E. There has never been a manic / hypomanic
episode & criteria not met for cyclothymic disorder
F. Disturbance is not better explained by other
psychotic disorders (schizoaffective /
schizophrenia, delusional disorder etc.)
G. The episode is not attributable to physiological
effects of a substance or to another medical
condition (hypothyroidism)
H. The symptoms cause clinically significant distress
or impairment in social, occupational or other
important areas of functioning.
Prevalence of PDD (Dysthymia)
 Persistent depressive disorder is effectively
an amalgam of DSM-IV’s dysthymic disorder
& chronic major depressive episode.
 The 12-month prevalence in the US is 0.5%

for PDD and 1.5% for chronic major

depressive disorder
Co-morbidity of PDD
 Compared to people with MDD, those with
pervasive depressive disorder are at a higher
risk for psychiatric co-morbidity in general ,
and for anxiety & substance use disorder
 Early onset PDD is strongly associated with

DSM-IV’s Cluster B & C personality disorders

BIPOLAR & RELATED
DISORDERS
 BIPOLAR & RELATED DISORDERS
 Bipolar I
 Bipolar II
 Cyclothymic
 Substance/Medication Induced

bipolar & related disorders

 Bipolar & related disorders due

to another medical condition

 Other Specified Bipolar
 Unspecified Bipolar & related

disorder
BIPOLAR I DISORDER
 For a diagnosis of Bipolar I disorder, it is
necessary to meet the criteria for a MANIC
episode.
 The manic episode may have been preceded

by and may be followed by a HYPOMANIC or

MAJOR DEPRESSIVE episode
 Manic Episode
A. A distinct period of abnormally and persistently
elevated, expansive or irritable mood & increased
goal-directed activity or energy, lasting at least 1
week, & present most of the day, nearly everyday
(or any duration, if hospitalization is necessarry)
B. During the period of mood disturbance &
increased energy / activity, 3 or more of the
following symptoms are present to a significant
degree & represent a noticeable change from the
usual behavior:
(*4 if the mood is only irritable)
Manic Episode
1. Inflated self esteem / Grandiosity
2. Decreased need for sleep (feels rested after only
3 hours)
3. More talkative than usual
4. Flight of ideas / subjective experience that
thoughts are racing
5. Distractibility
6. Increased goal directed activity or psychomotor
agitation / restlessness
7. Excessive involvement in activities that have high
potential for painful consequences
Manic Episode
C. The mood disturbance is sufficiently severe
to cause marked impairment in social,
occupational functioning or to necessitate
hospitalization to prevent harm to self and
others, or there are psychotic features
D. The episode is not attributable to
physiological effects of a substance or to
another medical condition
 Hypomanic Episode
A. A distinct period of abnormally and persistently
elevated, expansive or irritable mood & increased
goal-directed activity or energy, lasting at least
4 consecutive days, & present most of the day, nearly
everyday (or any duration, if hospitalization is
necessary)
B. During the period of mood disturbance & increased
energy / activity, 3 or more of the following
symptoms are present to a significant degree &
represent a noticeable change from the usual
behavior:
(*4 if the mood is only irritable)
Hypomanic Episode
1. Inflated self esteem / grandiosity
2. Decreased need for sleep (feels rested after only
3 hours)
3. More talkative than usual
4. Flight of ideas / subjective experience that
thoughts are racing
5. Distractibility
6. Increased goal directed activity or psychomotor
agitation / restlessness
7. Excessive involvement in activities that have high
potential for painful consequences
Hypomanic Episode
C. The episode is associated with an unequivocal
change in functioning that is uncharacteristic
of the person when not symptomatic
D. The disturbance in mood & functioning is
observable by others
E. The episode is not severe enough to cause
marked impairment in functioning, necessitate
hospitalization & NO PSYCHOTIC FEATURES
F. The episode is not attributable to the
physiological effects of a substance (abused
drug, medication or other treatment)
Major Depressive Episode
 A. 5 (or more) of the following symptoms
have been present during a 2-week period &
represent a change from previous
functioning; at least one of the symptoms is
either (1) depressed mood or (2) loss of
interest or pleasure
5 or more of the following
symptoms
S – sleep disturbance (insomnia/hypersomnia)
A – anhedonia
D – depressed mood
C – concentration problems
W – weight changes (weight loss / gain)
E – energy loss /fatigue
E – excessive guilt / feelings or worthlessness
P – psychomotor retardation / agitation
S – suicide (thoughts/ ideas, plans or attempt)
Major Depressive Episode
B. The symptoms cause clinically significant
distress or impairment in social, occupational
or other important areas of functioning.
C. The episode is not attributable to
physiological effects of a substance or to
another medical condition
BIPOLAR I DISORDER
A. Criteria have been met (A.-D.) for at least
one MANIC EPISODE
B. The occurrence of the manic and major
depressive episode(s) is not better explained
by schizoaffective disorder, schizophrenia,
schizophreniform, delusional disorder or
other specified or unspecified psychotic
disorder
*NOTE: Hypomanic and Major Depressive episodes
are common but not required to make a
diagnosis of Bipolar I disorder
Prevalence of Bipolar I disorder
 12 month prevalence in US is 0.6%
 Across 11 sampled countries is 0.0-0.6%
 Lifetime male to female prevalence ratio is

1.1:1
 Lifetime risk of suicide is 15X more that the

general population
Co-morbidity
 Anxiety disorders (panic attacks, social
phobia / social anxiety disorder, specific
phobia )
 ADHD, and other disruptive, impulse control,

conduct disorder
 Substance use disorder
BIPOLAR II DISORDER
A. Criteria have been met for at least one
HYPOMANIC episode (Criteria A.-F. ) and at
least 1 MAJOR DEPRESSIVE episode.
B. There has never been a MANIC episode
C. The occurrence of the hypomanic and major
depressive episode(s) is not better
explained by schizoaffective disorder,
schizophrenia, schizophreniform, delusional
disorder or other specified or unspecified
psychotic disorder
BIPOLAR II DISORDER
D. The symptoms of depression and the
unpredictability caused by frequent
alternation between periods of depression
and hypomania causes clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning
Prevalence of Bipolar II
 The 12 month prevalence of Bipolar II is 0.3%
(internationally) & 0.8% in the US
 The prevalence rate for combined pediatric

Bipolar I, Bipolar II and bipolar NOS yield a

combined prevalence rate of 1.8% in US and
non-US community samples and 2.7% in
youth age 12 years and older.
Comorbidity
 Approximately 60% of people with Bipolar II
disorder have 3 or more co-occurring mental
disorders.
 75% have an anxiety disorder
 37% have substance use disorder
 Approximately 14% of those with Bipolar II

have at least one episode of an eating

disorder (common is binge eating disorder)
CYCLOTHYMIC DISORDER
A. For at least 2 years (or 1 year in children &
adolescents), there have been numerous
periods with hypomanic symptoms that do
not meet the criteria for a hypomanic
episode and numerous periods with
depressive symptoms that do not meet the
criteria for a major depressive episode
B. The hypomanic & depressive episode have
been present for at least half the time & the
person has not been without symptoms for
more than 2 months at a time
CYCLOTHYMIC DISORDER
C. Criteria for major depressive, manic or
hypomanic episode have never been met
D. The symptoms in criterion A are not better
explained by schizoaffective disorder,
schizophrenia, schizophreniform, delusional
disorder or other specified or unspecified
psychotic disorder
CYCLOTHYMIC DISORDER
E. The symptoms are not attributable to the
physiological effects of a substance or
another medical condition
F. The symptoms cause clinically significant
distress or impairment in social, occupational
or other important areas of functioning
Prevalence of Cyclothymic Disorder
 The lifetime prevalence is 0.4% to 1%
 In the general population, it is apparently

equally common in males and females

 In clinical setting, females are more likely to

seek treatment than males

Comorbidity
 Substance related disorders & sleep disorders
 In children, often co-morbid with ADHD