Mood, Anxiety and Psychotic Disorders
Summary
Week 1
Lecture 1
Mood and anxiety are about Internalizing disorders or Emotional disorders. They have high
comorbidity. Patients respond to the same treatments and there are many transdiagnostic
processes. There is a lot of overlap
between the symptoms of the
disorders. There is also a lot of
comorbidity between many
disorders.
Schizophrenia is very comorbid
with emotional disorders.
Schizophrenia and Bipolar disorder
partly share a common genetic
cause.
Psychotic disorders share a genetic
vulnerability and exist on a
continuum. Transdiagnostic refers to
looking into more than one disorder
at once, focusing on co-present
symptoms. Anxiety has a much
earlier onset compared to depression
and the combination of anxiety and
depression. Remission is recovery without treatment. Relapse is a second episode that happens
,after remission or
recovery, but it is the
same as the first episode.
Recurrence is the
re-emerging of the
disorder.
sadness/bereavement and
depression share some
common ground. One
big difference is that
sadness is an adaptive
response to loss but depression is seen as dysfunctional. Anxiety and fear can be adaptive on
certain levels since it protects us from threats and dangers. For something to be called a disorder,
it should be causing personal distress, it should violate social norms, cause disability and
dysfunction, continue for a long period of time and there is no other explanation.
DSM-5 Depressive Disorders
Major Depressive Disorder (MDD)
A. Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning; at least one of the symptoms is
either (1) depressed mood or (2) loss of interest or pleasure.
a. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad, empty, hopeless) or observation made by others
(e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
b. Markedly diminished interest or pleasure in all, or almost all, activities most of
the day, nearly every day (as indicated by either subjective account or
observation).
, c. Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly
every day. (Note: In children, consider failure to make expected weight gain.)
d. Insomnia or hypersomnia nearly every day.
e. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down).
f. Fatigue or loss of energy nearly every day.
g. Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
h. Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others).
i. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide.
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 the physiological effects of a substance or another
medical condition.
D. The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified
and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
Differential Diagnosis
- Manic episodes with irritable mood or mixed episodes
This distinction requires a careful clinical evaluation of the presence of manic symptoms.
- Mood disorder due to another medical condition
individual history, physical examination, and laboratory findings must be considered.
- Substance/medication-induced depressive or bipolar disorder
Etiological relation to a substance is required
- Attention-deficit/hyperactivity disorder
, Disturbance in mood must be caused by sadness or loss of interest instead of irritability to
diagnose MDD
- Adjustment disorder with depressed mood
the full criteria for a major depressive episode are not met in adjustment disorder.
- Sadness
The criteria must be met for severity, duration and clinically significant distress or impairment.
Persistent Depressive Disorder (Dysthymia) (PDD)
A. Depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least 2 years.
B. Presence, while depressed, of two (or more) of the following:
a. Poor appetite or overeating.
b. Insomnia or hypersomnia.
c. Low energy or fatigue.
d. Low self-esteem.
e. Poor concentration or difficulty making decisions.
f. Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the
individual has never been without the symptoms in Criteria A and B for more than 2
months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never
been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication) or another medical condition (e.g. , hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
Differential Diagnosis
Summary
Week 1
Lecture 1
Mood and anxiety are about Internalizing disorders or Emotional disorders. They have high
comorbidity. Patients respond to the same treatments and there are many transdiagnostic
processes. There is a lot of overlap
between the symptoms of the
disorders. There is also a lot of
comorbidity between many
disorders.
Schizophrenia is very comorbid
with emotional disorders.
Schizophrenia and Bipolar disorder
partly share a common genetic
cause.
Psychotic disorders share a genetic
vulnerability and exist on a
continuum. Transdiagnostic refers to
looking into more than one disorder
at once, focusing on co-present
symptoms. Anxiety has a much
earlier onset compared to depression
and the combination of anxiety and
depression. Remission is recovery without treatment. Relapse is a second episode that happens
,after remission or
recovery, but it is the
same as the first episode.
Recurrence is the
re-emerging of the
disorder.
sadness/bereavement and
depression share some
common ground. One
big difference is that
sadness is an adaptive
response to loss but depression is seen as dysfunctional. Anxiety and fear can be adaptive on
certain levels since it protects us from threats and dangers. For something to be called a disorder,
it should be causing personal distress, it should violate social norms, cause disability and
dysfunction, continue for a long period of time and there is no other explanation.
DSM-5 Depressive Disorders
Major Depressive Disorder (MDD)
A. Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning; at least one of the symptoms is
either (1) depressed mood or (2) loss of interest or pleasure.
a. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad, empty, hopeless) or observation made by others
(e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
b. Markedly diminished interest or pleasure in all, or almost all, activities most of
the day, nearly every day (as indicated by either subjective account or
observation).
, c. Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly
every day. (Note: In children, consider failure to make expected weight gain.)
d. Insomnia or hypersomnia nearly every day.
e. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down).
f. Fatigue or loss of energy nearly every day.
g. Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
h. Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others).
i. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide.
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 the physiological effects of a substance or another
medical condition.
D. The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified
and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
Differential Diagnosis
- Manic episodes with irritable mood or mixed episodes
This distinction requires a careful clinical evaluation of the presence of manic symptoms.
- Mood disorder due to another medical condition
individual history, physical examination, and laboratory findings must be considered.
- Substance/medication-induced depressive or bipolar disorder
Etiological relation to a substance is required
- Attention-deficit/hyperactivity disorder
, Disturbance in mood must be caused by sadness or loss of interest instead of irritability to
diagnose MDD
- Adjustment disorder with depressed mood
the full criteria for a major depressive episode are not met in adjustment disorder.
- Sadness
The criteria must be met for severity, duration and clinically significant distress or impairment.
Persistent Depressive Disorder (Dysthymia) (PDD)
A. Depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least 2 years.
B. Presence, while depressed, of two (or more) of the following:
a. Poor appetite or overeating.
b. Insomnia or hypersomnia.
c. Low energy or fatigue.
d. Low self-esteem.
e. Poor concentration or difficulty making decisions.
f. Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the
individual has never been without the symptoms in Criteria A and B for more than 2
months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never
been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication) or another medical condition (e.g. , hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
Differential Diagnosis
