Chapter 10 - depressive and bipolar disorder
Mood disorder: disturbance in mood is the central feature. Subjects suffer from extreme, persistent
or poorly regulated emotional states. DSM-5 include disruptive mood dysregulation disorder, major
depressive disorder, persistent depressive disorder and bipolar disorder.
One of the most common, chronic and disabling illnesses in young people.
- Dysphoria: state of prolonged bouts of sadness
- Anhedonia: feel little joy in anything they do and lose interest in nearly all activities
- Mania: abnormally elevated or expansive mood, increased goal-setting activity and energy
and feelings of euphoria: exaggerated sense of well-being
o BP: suffer from an ongoing combination of extreme highs and extreme lows (manic
depressive illness)
o Depressive disorder
Irritability: refers to easy annoyance and touchiness, characterized by an angry mood and temper
outbursts.
Depressive disorders:
Often have accompanying problems such as anxiety or oppositional conduct disorders. Express in
often hidden and indirect ways masked depression
Significant impairment in their daily lives. Experience recurrent bouts of depression and continued
impairments long lasting emotional suffering, heightened risks for suicide, substance use, other
mental health problems is a significant concern.
The expression is different at every age. There is no recognizable criteria under the age of 7:
- Infancy:
Sleep disturbances, loss of appetite, crying and sadness
- Preschool:
Whiny behavior around mother, fears of separation or abandonment stomachaches
- School-age:
Increased irritability, disruptive behavior, temper tantrums and combativeness, peer
problems weight loss, headaches and sleep disturbances (physical symptoms)
- Pre-teens and teens:
Increasing self-blame and expressions of low self-esteem, persistent sadness and social
inhibition, eating disturbances, loss of feelings of pleasure or interest and worsening school
performance, feelings of guilt, worthlessness and loneliness.
Presence of sad mood, diminished interest or pleasure or irritability is essential for diagnosis, must
persist over time.
Depression as a symptom: refers to feeling sad or miserable. Occur without the existence of a
serious problems, mostly temporary.
Depression as a syndrome: refers to a groups of symptoms that occur together more often than by
chance.
Depression as a disorder:
- Major depressive disorder (MDD):
Minimum duration of two weeks and is associated with depressed or irritable mood, loss of
interest or pleasure (sleep disturbances, difficulty concentrating, feelings of worthlessness)
and significant distress or impairment in functioning.
- Persistent depressive disorder (P-DD or dysthymia):
, Is associated with depressed or irritable mood, generally fewer, less severe, but longer-
lasting symptoms and significant impairment in functioning.
- Disruptive mood dysregulation disorder (DMDD):
Characterized by:
o Frequent and severe temper outbursts that are extreme overreactions to the
situation or provocation.
o Chronic, persistently irritable or angry mood that is persistent between the outbursts
Common characteristic is presence of sad, empty or irritable mood, along with the individuals
functioning. Differences is duration, timing, associated features or presumed causes.
Major depressive disorder (MDD):
Key features: sadness, loss of interest or pleasure symptoms that are present during the same two-
week period.
Diagnostic criteria MDD DSM-5:
- 5 of the following symptoms have been present during the same two-week period. One of the
symptoms is 1 or 2.
1. Depressed mood most of the day, indicated by observation or subjective report
2. Diminished interest or pleasure in all activities
3. Weightloss when not dieting or decrease or increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate or invasiveness
9. Recurrent thoughts of death, recurrent suicidal with(out) a plan
- Symptoms cause clinically significant distress of impairment in social, occupational or other
areas of functioning
- Episode is not attributable to the physiological effects of a substance or medical condition
- Occurrence of major depressive episode is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder or other psychotic disorders
- Never been a manic episode of another medical condition
Important points of diagnosing:
1. Same DSM-5 criteria for adults can be used to diagnose, school-age children and adolescents
2. Children’s disruptive behaviors attract more attention, easier observed as internal, subjective
suffering, depression in children can be overlooked easily
3. Some features are more common by children than adults
Youths with MDD recover fast, but have a higher risk for BP. Children who recover slow with MDD,
have a severe form of affective illness.
Prevalence:
Lot with adolescents may underestimate the problem.
- DSM-5 diagnosis of MDD might be lower than the self-reported symptoms of depression
- Barely fail for diagnoses, still show significant impairments in their social competence, coping
skills, cognitive attributions, family relations and experience of stress higher risk for
developing future depression
Comorbidity:
Mood disorder: disturbance in mood is the central feature. Subjects suffer from extreme, persistent
or poorly regulated emotional states. DSM-5 include disruptive mood dysregulation disorder, major
depressive disorder, persistent depressive disorder and bipolar disorder.
One of the most common, chronic and disabling illnesses in young people.
- Dysphoria: state of prolonged bouts of sadness
- Anhedonia: feel little joy in anything they do and lose interest in nearly all activities
- Mania: abnormally elevated or expansive mood, increased goal-setting activity and energy
and feelings of euphoria: exaggerated sense of well-being
o BP: suffer from an ongoing combination of extreme highs and extreme lows (manic
depressive illness)
o Depressive disorder
Irritability: refers to easy annoyance and touchiness, characterized by an angry mood and temper
outbursts.
Depressive disorders:
Often have accompanying problems such as anxiety or oppositional conduct disorders. Express in
often hidden and indirect ways masked depression
Significant impairment in their daily lives. Experience recurrent bouts of depression and continued
impairments long lasting emotional suffering, heightened risks for suicide, substance use, other
mental health problems is a significant concern.
The expression is different at every age. There is no recognizable criteria under the age of 7:
- Infancy:
Sleep disturbances, loss of appetite, crying and sadness
- Preschool:
Whiny behavior around mother, fears of separation or abandonment stomachaches
- School-age:
Increased irritability, disruptive behavior, temper tantrums and combativeness, peer
problems weight loss, headaches and sleep disturbances (physical symptoms)
- Pre-teens and teens:
Increasing self-blame and expressions of low self-esteem, persistent sadness and social
inhibition, eating disturbances, loss of feelings of pleasure or interest and worsening school
performance, feelings of guilt, worthlessness and loneliness.
Presence of sad mood, diminished interest or pleasure or irritability is essential for diagnosis, must
persist over time.
Depression as a symptom: refers to feeling sad or miserable. Occur without the existence of a
serious problems, mostly temporary.
Depression as a syndrome: refers to a groups of symptoms that occur together more often than by
chance.
Depression as a disorder:
- Major depressive disorder (MDD):
Minimum duration of two weeks and is associated with depressed or irritable mood, loss of
interest or pleasure (sleep disturbances, difficulty concentrating, feelings of worthlessness)
and significant distress or impairment in functioning.
- Persistent depressive disorder (P-DD or dysthymia):
, Is associated with depressed or irritable mood, generally fewer, less severe, but longer-
lasting symptoms and significant impairment in functioning.
- Disruptive mood dysregulation disorder (DMDD):
Characterized by:
o Frequent and severe temper outbursts that are extreme overreactions to the
situation or provocation.
o Chronic, persistently irritable or angry mood that is persistent between the outbursts
Common characteristic is presence of sad, empty or irritable mood, along with the individuals
functioning. Differences is duration, timing, associated features or presumed causes.
Major depressive disorder (MDD):
Key features: sadness, loss of interest or pleasure symptoms that are present during the same two-
week period.
Diagnostic criteria MDD DSM-5:
- 5 of the following symptoms have been present during the same two-week period. One of the
symptoms is 1 or 2.
1. Depressed mood most of the day, indicated by observation or subjective report
2. Diminished interest or pleasure in all activities
3. Weightloss when not dieting or decrease or increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate or invasiveness
9. Recurrent thoughts of death, recurrent suicidal with(out) a plan
- Symptoms cause clinically significant distress of impairment in social, occupational or other
areas of functioning
- Episode is not attributable to the physiological effects of a substance or medical condition
- Occurrence of major depressive episode is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder or other psychotic disorders
- Never been a manic episode of another medical condition
Important points of diagnosing:
1. Same DSM-5 criteria for adults can be used to diagnose, school-age children and adolescents
2. Children’s disruptive behaviors attract more attention, easier observed as internal, subjective
suffering, depression in children can be overlooked easily
3. Some features are more common by children than adults
Youths with MDD recover fast, but have a higher risk for BP. Children who recover slow with MDD,
have a severe form of affective illness.
Prevalence:
Lot with adolescents may underestimate the problem.
- DSM-5 diagnosis of MDD might be lower than the self-reported symptoms of depression
- Barely fail for diagnoses, still show significant impairments in their social competence, coping
skills, cognitive attributions, family relations and experience of stress higher risk for
developing future depression
Comorbidity:
