mood disorders - complete
TRANSCRIPT
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Group Members
0 Jacqueline Wong - Introduction, Major Depressive Episode
0 Lai Chee Gong - Manic Episode, Hypomanic Episode
0 Ho Kin Wai Mixed Episode, Major Depressive Disorder
0 Lee Chain Yiing - Dysthymic Disorder, Cyclothymic Disorder
0 Lee Chai Mei Bipolar I Disorder, Bipolar II Disorder
0 Kong Peoi Yarn Causes, Treatments
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Prevalence of Depression
Depression is a common and serious disorder
Every year there are 5% of children and 20% ofyoung adolescents experience depression.
The depression in children can be seen at the age of
as young as 3 to 5 years old (NIMH, 2011).
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0 Disturbancein a persons emotional mood
0 Can experience extreme depression (dysphoria),
extreme elation (euphoria) or combination(bipolar)
0 Occurs in episodes with specific intense symptoms
0 Episodes can be mild, moderate, severe
Mood Disorders
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0 Depression = mood is abnormally low
0 Mania = mood is abnormally high
0 Mood disorders are broadly divided into unipolardisorders and bipolar disorders.
0 Nearly all patients who have mania eventually
experience at least one period of depression as well.
0 Individual episodes in mood disorders vary in lengthbut last many months if left untreated. Some patients
have recurrent episodes throughout their lives.
Mood Disorders
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Unipolar vs. Bipolar Disorders
There are two main types of mood disorders, on the
basis of the presence or absence of manic as well
as depressive episodes
Unipolar mood disorderBipolar mood disorder
(manic depression)
patients experience depressive
episodes only
patients experience both
depressive and manic episodes
occurs from adolescence, with
prevalence peaking between 40-50
years, and a gradual decline after the
age of 60 years.
commonly presents earlier than
depression, with most patients
suffering their first manic or
hypomanic episodes by their early
20s.
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MOOD EPISODES
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Criterion (A):
0 Five (or more) of the following symptoms have beenpresent during the same 2-week period and
represent a change from previous functioning; at leastone of the symptoms is either (1) depressed moodor (2) loss of interest or pleasure.
Note: Do note include symptoms that are clearly due to ageneral medical condition, or mood-incongruentdelusions or hallucinations.
Diagnostic Criteria
Major Depressive Episode
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1. Depressed mood most of the day, nearly every day, as indicatedby either subjective report (e.g., feels sad or empty) or observationmade by others (e.g., appears tearful). Note: In children andadolescents, can be irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all,activities most of the day, nearly every day (as indicated by eithersubjective account or observation made by others)
3. Significant weight loss when not dieting or weight gain (e.g., a
change of more than 5% of body weight in a month), or decreaseor increase in appetite nearly every day. Note: In children, considerfailure to make expected weight gains.
4. Insomnia or hypersomnia nearly every day
Diagnostic Criteria
Major Depressive Episode
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5. Psychomotor agitation or retardation nearly every day (observable byothers, not merely subjective feelings of restlessness or being sloweddown)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt(whichmay be delusional) nearly every day (not merely self-reproach or guiltabout being sick)
8. Diminished ability to thinkor concentrate, or indecisiveness, nearly
every day (either by subjective account or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidalideation without a specific plan, or a suicide attempt or a specific plan forcommitting suicide
Diagnostic Criteria
Major Depressive Episode
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Criterion (B):
The symptoms do not meet criteria for a Mixed Episode.
Criterion (C):
The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Criterion (D):
The symptoms are not due to the direct physiological effects of a substance (e.g., a
drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
Criterion (E):
The symptoms are not better accounted for by Bereavement, i.e., after the loss of a
loved one, the symptoms persist for longer than 2 months or are characterized by
marked functional impairment, morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms, or psychomotor retardation.
Diagnostic Criteria
Major Depressive Episode
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Depressive vs. Manic Episodes
Depressive episodes Manic episodesDepressed mood Inflated self-esteem or grandiosity
Decreased interest or pleasure in
nearly all activities Frantic work activity andincreased talkativenessFatigue and loss of energy Decreased need for sleep
Recurrent thoughts of death Flights of ideas or racing thoughtsAppetite disturbances
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Diagnostic Criteria
Manic EpisodeCriterion (A):
A distinct period of abnormally and persistentlyelevated, expansive, or irritable mood, lasting at least 1
week(or any duration if hospitalization is necessary)
Criterion (B):
During the period of mood disturbance, three (or
more) of the following symptoms have persisted (fourif the mood is only irritable) and have been to asignificant degree:
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1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
3. More talkative than usual or pressure to keep talking4. Flight of ideas or subjective experience thatthoughts are racing
5. Distractibility (1.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
6. Increase in goal directed activity (either socially, at work or
school, or sexually) or psychomotor agitation
7. Excessive involvementin pleasurable activities that have a high
potential for painful consequences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business
investments)
Diagnostic Criteria
Manic Episode
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Criterion (C):
The symptoms do not meet criteria for a Mixed Episode.
Criterion (D):
The mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationships with others, or
to necessitate hospitalization to prevent harm to self or others, or there are
psychotic features.
Criterion (E):
The symptoms are not due to the direct physiological effects of a substance (e.g., adrug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
Note: Manic-like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count
toward a diagnosis ofBipolar I disorder.
Diagnostic Criteria
Manic Episode
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Diagnostic Criteria
Hypomanic EpisodeCriterion (A):
A distinct period of persistently elevated, expansive, or
irritable mood, lasting throughoutat least 4 days, that is
clearly different from the usual non-depressed mood.
Criterion (B):
During the period of mood disturbance, three (or more) of
the following symptoms have persisted (four if the mood isonly irritable) and have been present to a significant degree:
Symptoms are same as Manic Episode
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Criterion (C):
The episode is associated with an unequivocal change in functioning that is uncharacteristic of
the person when not symptomatic.
Criterion (D):The disturbance in mood and the change in functioning are observable by others.
Criterion (E):
The episode is not severe enough to cause marked impairment in social or occupational
functioning, or to necessitate hospitalization, an there are no psychotic features.
Criterion (F):
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition (e.g., hypothyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g.,
medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of
Bipolar II disorder.
Diagnostic Criteria
Hypomanic Episode
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Mania vs. Hypomania
0 Although both symptoms are the same, but they are different.
0 Mania0 dangerousbecause people dont just act abnormally; they typically
endanger themselves or vital parts of their lives.0 Requires hospitalization due to the damage they are doing, psychotic
problems.
0 Happens in Bipolar I (Hallucination, Paranoia)
0 Hypomania0
An unusual mood0 May cause some harm to the person or their lifestyle, butnotto the
point where they need to be hospitalized.
People in hypomania buy 5 pairs of shoes, people in a mania buy 50
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Diagnostic Criteria
Mixed EpisodeCriteria (A)
The criteria are metboth for a Manic Episode and for a Major Depressive Episode (except for
duration) nearly every day during at least a 1-week period.
Criteria (B)The mood disturbance is sufficiently severe to cause marked impairment in occupational
functioning or in usual social activities or relationships with others, or to necessitate
hospitalization to prevent harm to self or others, or there are psychotic features.
Criteria (C)
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g.,
medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of
Bipolar I disorder.
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DEPRESSIVE DISORDERS
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296.2x Major Depressive
Disorder, Single EpisodeCriteria (A)
Presence ofa single Major Depressive Episode.
Criteria (B)
The Major Depressive Episode is not better accounted for by Schizoaffective
Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
Criteria (C)
There has never been a Manic Episode, a Mixed Episode, or a Hypomanic
Episode. Note:This exclusion does not apply if all of the manic-like, mixed-like, or
hypomanic-like episodes are substance or treatment induced or are due to the direct
physiological effects of a general medical condition.
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296.3x Major Depressive
Disorder, RecurrentCriteria (A)
Presence oftwo or more Major Depressive Episodes.
Note: To be consideredseparate episodes, there must be an interval ofat least2 consecutive months in which criteria are not met for a Major DepressiveEpisode.
Criteria (B)
The Major Depressive Episodes are not better accounted for by SchizoaffectiveDisorder and are not superimposed on Schizophrenia, SchizophreniformDisorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
Criteria (C)There has never been a Manic Episode, a Mixed Episode, or a HypomanicEpisode. Note: This exclusion does not apply if all of the manic-like, mixed-like,or hypomanic-like episodes are substance or treatment induced or are due to thedirect physiological effects of a general medical condition.
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Subtypes / Specifiers of
Major Depressive DisorderThe DSM-IV-TR recognizes five further subtypes of MajorDepressive Disorders, called specifiers, in addition to notingthe length, severity and presence of psychotic features:
0 Catatonic depression (pg 202) Motoric immobility as evidenced by cataplexy or stupor
Excessive motor activity
Extreme negativism or mutism
Peculiarities of voluntary movement as evidenced by
posturing, stereotyped movements, prominent mannerismsor prominent grimacing
Echolalia or echopraxia
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Subtypes / Specifiers of
Major Depressive Disorder0 Melancholic depression (pg 203)
Loss of pleasure in most or all activities
A failure of reactivity to pleasurable stimuli or events
Distinct quality of depressed mood
Early morning awaking
Psychomotor retardation
Significant weight loss
Excessive guilt
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Subtypes / Specifiers of
Major Depressive Disorder0 Atypical depression (pg 203)
Mood reactivity
Significant weight gain or increased appetite
Hypersomnia
Leaden paralysis
Long-standing pattern of interpersonal rejection
sensitivity that results in significant social or
occupational impairment
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Subtypes / Specifiers of
Major Depressive Disorder0Postpartum onset(pg 204)
Uncommon depressive episode that begins
within four weeks of giving birth to a child
0 Seasonal pattern (pg 207)
Occurs for 2 months during a particulartime of the year (usually winter) but they
return to normal functioning
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Challenges
Affects all aspects of a person's life
Fatigue, tired, lack of energy
Not interested in anything
Panic attacks may occur
Separation anxiety may occur in children
Substance abuse
Eat too much or too little = obese and anorexic Isolation, impair social relationship
Induce suicidal ideation
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300.4 Dysthymic Disorder
Criteria (A)
Depressed mood for most of the day, for more days than not, as indicated either by subjective
account or observation by others, for at least 2 years. Note:In children and adolescents, mood
can be irritable and duration must be at least 1 year.
Criteria (B)
Presence, while depressed, oftwo (or more) of the following:
1. Poor appetite or overeating
2. Insomnia or Hypersomnia
3. Low energy or fatigue4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
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300.4 Dysthymic Disorder
Criteria (C)
During the 2-year period (1 year for children or adolescents) of the disturbance, the
person has never been withoutthe symptoms in Criteria A and B for more than 2
months at a time.
Criteria (D)
No Major Depressive Episode has been present during the first 2 years of the
disturbance (1 year for children and adolescents); i.e., the disturbance is not better
accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In
Partial Remission.
Note: There may have been a previous Major Depressive Episode provided there was a full
remission (no significant signs or symptoms for 2 months) before development of theDysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents)
of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in
which case both diagnoses may be given when the criteria are met for a Major Depressive
Episode.
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300.4 Dysthymic Disorder
Criteria (E)
There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria
have never been met for Cyclothymic Disorder.
Criteria (F)
The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder,
such as Schizophrenia or Delusional Disorder.
Criteria (G)
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug ofabuse, a medication) or a general medical condition (e.g., hypothyroidism).
Criteria (H)
The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
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Dysthymic Disorder vs. Major
Depressive Disorder0 The levels of severity, duration and persistence are different
in both disorders.
0 Major Depression Disorder Mood disturbance occurs nearlyevery day during a period of two weeks
0 Dysthymic Disorder Mood disturbance occurs for most of the
day, for more days than not, for at least 2 years
0 Dysthymia may be reported less than major depression, as its
symptoms are less severe and easier to live with.
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Challenges0 Dysthymia is simply chronic depression which lasts for years. It does not have to
be as severe as the major depression; however people who suffer from dysthymia
do not even remember a day that they did not felt depressed.
0 In adults, dysthymia has a big risk to turn into major depressive disorder.
0 In children, there is a risk of having hyperactivity disorder, learning disorders
and mental retardation.
0 Adolescents have bad school performance,low self esteem and poor social
interaction.
0 Although dysthymia was traditionally considered less severe than major
depression, the consequences of dysthymia are increasingly recognized as grave
and include severe functional impairment, increased morbidity from
physical disease, and increased risk of suicide.
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BIPOLAR DISORDERS
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301.13 Cyclothymic DisorderCriteria (A)
For atleast 2 years, the presence of numerous periods with hypomanic symptoms and
numerous periods with depressive symptoms thatdo not meet criteria for a Major
Depressive Episode.Note: In children and adolescents, the duration must be at least 1 year.
Criteria (B)
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.
Criteria (C)
No Major Depressive Episode, Manic Episode, or Mixed Episode has been presentduring thefirst 2 years of the disturbance
Note:After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there
may be superimposed Manic or Mixed Episodes (in which case both Bipolar I disorder and
Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar
II Disorder and Cyclothymic Disorder may be diagnosed)
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301.13 Cyclothymic Disorder
Criteria (D)
The symptoms in Criterion are not better accounted for by Schizoaffective
Disorder and is not superimposed on Schizophrenia, Schizophreniform
Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
Criteria (E)
The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
hyperthyroidism).
Criteria (F)
The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
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Cyclothymic Disorder vs.
Bipolar Disorder0 Cyclothymic is usually considered to be a type of bipolar disorder, albeit
on a lesser scale.
0 The reasons for Cyclothymic may be genetic, but with predominantly
environmental roots. A bipolar disorder is mainly genetic and is caused bychemical imbalances in the brain
0 The symptoms for the two conditions are similar. However, in the case of a
bipolar disorder, they are more long standing.
0 Treatment for Cyclothymic will mainly rely on self help or mild
medications. However, a patient with bipolar disorder is usually put on
stronger medications or even hospitalized.
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Challenges
0 Left untreated, cyclothymic can result in significant
emotional problems thataffect every area of life.
0 In addition, cyclothymic significantly increases risk
of developing bipolar disorder.
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296.0x Bipolar I Disorder,
Single Manic EpisodeCriteria (A)
Presence ofonly one Manic Episode and no pastMajor Depressive Episodes.
Criteria (B)
The Manic episode is not better accounted for bySchizoaffective Disorder and is not superimposed on
Schizophrenia, Schizophreniform Disorder, DelusionalDisorder, or Psychotic Disorder Not OtherwiseSpecified.
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296.40 Bipolar I Disorder, Most
Recent Episode HypomanicCriteria (A)
Currently (or most recently) in a Hypomanic Episode
Criteria (B)
There has previously been at least one Manic Episode or Mixed Episode
Criteria (C)
The mood symptoms cause clinically significant distress or impairment insocial, occupational or other important areas of functioning.
Criteria (D)
The mood episodes in criteria A and B are not better accounted for bySchizoaffective Disorder and are not superimposed on Schizophrenia,Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NotOtherwise Specified.
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296.4x Bipolar I Disorder,
Most Recent Episode ManicCriteria (A)
Currently (or most recently) in a Manic Episode
Criteria (B)There has previously been at least one Major DepressiveEpisode, Manic Episode or Mixed Episode.
Criteria (C)
The mood episodes in criteria A and B are not better accounted forby Schizoaffective Disorder and are not superimposed onSchizophrenia, Schizophreniform Disorder, Delusional Disorder, orPsychotic Disorder Not Otherwise Specified.
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296.6x Bipolar I Disorder,
Most Recent Episode MixedCriteria (A)
Currently (or most recently) in a Mixed Episode
Criteria (B)There has previously been at least one Major DepressiveEpisode, Manic Episode or Mixed Episode.
Criteria (C)
The mood episodes in criteria A and B are not better accounted forby Schizoaffective Disorder and are not superimposed onSchizophrenia, Schizophreniform Disorder, Delusional Disorder, orPsychotic Disorder Not Otherwise Specified.
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296.5x Bipolar I Disorder, Most
Recent Episode DepressedCriteria (A)
Currently (or most recently) in a Major Depressive Episode
Criteria (B)There has previously been at least one Manic Episode or MixedEpisode.
Criteria (C)
The mood episodes in criteria A and B are not better accounted forby Schizoaffective Disorder and are not superimposed onSchizophrenia, Schizophreniform Disorder, Delusional Disorder, orPsychotic Disorder Not Otherwise Specified.
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296.7 Bipolar I Disorder, Most
Recent Episode UnspecifiedCriteria (A)Criteria, except for duration, are currently (or most recently) met for a Manic, a Hypomanic, a
Mixed or a Major Depressive Episode
Criteria (B)
There has previously been at least one Manic Episode or Mixed Episode.
Criteria (C)
The mood symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
Criteria (D)
The mood episodes in criteria A and B are not better accounted for by Schizoaffective Disorder
and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or
Psychotic Disorder Not Otherwise Specified.
Criteria (E)
The mood episodes in criteria A and B are not due to the direct physiological effects of
substance or a general medical condition
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Summary
Major
Depressive
Episode
Manic EpisodeHypomanic
EpisodeMixed Episode
Single Manic
Episode- Only this - -
Most RecentEpisode
Hypomanic
- Previously Recently Previously
Most Recent
Episode ManicPreviously
Recently
Previously
-Previously
Most Recent
Episode MixedPreviously Previously -
Recently
Previously
Most Recent
Episode
Depressed
Recently Previously - Previously
Most Recent
Episode
Unspecified
RecentlyRecently
PreviouslyRecently
Recently
Previously
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296.89 Bipolar II Disorder
Criteria (A)
Presence (or history) ofone or more Major Depressive Episodes.
Criteria (B)
Presence (or history) ofat least one Hypomanic Episode.
Criteria (C)
There has never been a Manic Episode or Mixed Episode.
Criteria (D)
The mood episodes in criteria A and B are not better accounted for by Schizoaffective Disorder
and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or
Psychotic Disorder Not Otherwise Specified.
Criteria (E)
The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
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Challenges of Bipolar
Disorder0 Not recognize that they are ill and resist treatment
0 Engage in bizarre activities, dramatic style, travel
impulsively
0 Gambling and antisocial behaviour
0 Hostile, and threaten to others
0 Suicidal
0 Substance Abuse0 Law or financial problems due to manic behavior
0 Might shift from manic to depressive
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CAUSES AND TREATMENTS
FOR MOOD DISORDERS
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Biological Dimensions
0 Inherited vulnerability
High risk if relatives have mood disorder
0 Neurotransmitters and endocrine systems
Low levels of norepinephrine, serotonin
High levels of stress hormones
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Psychological Dimensions
0 Stressful life events
Traumatic events
Life stressors (eg. Examination, works, financial, death)
0 Cognitive styles
Negative views on everything cyclical process
Cognitive distortion illogical rules, overgeneralization
0 Behavioral Lack of positive reinforcement
Learned helplessness
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Social and Cultural
Dimensions0 Inequality and oppression
Women and minority higher risk
0 Lack of social support
Isolated
0
Relationship problems Divorce
Argument
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Medication
0 Antidepressant
Lithium for bipolar disorder
Tricyclics
Monamine oxidase inhibitors (MAOIs) Selective serotonergic reuptake inhibitors (SSRIs)
0 To control symptoms and restore neurotransmitterfunctioning
0 Can have side effects, thus dosage must be carefullyregulated
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Cognitive Behavioral Therapy
(CBT)0 Help people to:
Learn to replace negative depressive thoughts and
attributions with more positive cues
Develop more effective coping behavior and skills
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Interpersonal Psychotherapy
0 Help people to:
Focus on social and interpersonal triggers for their
depression (eg. Loss of the love one)
Develop skills to resolve interpersonal conflicts and
build new relationship
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Others
0 Light Therapy
For seasonal affective disorder
0 Electroconvulsive Therapy (ECT)
For severe depression, when other treatments are
ineffective
May have temporary side effects, such as memory loss
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