Overview
This lecture covers psychiatric mood disorders along a spectrum from low to high mood, including their diagnostic criteria, differences, and treatment approaches.
Mood Spectrum Overview
- Mood disorders range from low mood (depression) to high mood (mania) with neutral in the center.
- Disorders can be placed along this spectrum based on their core symptoms.
Major Depressive Disorder (MDD)
- MDD diagnosis requires at least 5 symptoms from the SIGECAPS mnemonic, including depressed mood or anhedonia, lasting ≥2 weeks.
- SIGECAPS symptoms: Sleep changes, Interest loss (anhedonia), Guilt, Energy loss, Concentration problems, Appetite changes, Psychomotor changes, Suicidal ideation.
- Symptoms must not be due to substances or medical illnesses; examples include Wilson's disease, hypothyroidism, or substance abuse.
- Treatments: Psychotherapy, SSRIs, SNRIs, MAO inhibitors, TCAs, and ECT for refractory cases.
Mania and Hypomania
- Mania features ≥3 DIGFAST symptoms for ≥1 week, causing significant social/occupational impairment.
- DIGFAST symptoms: Distractibility, Irresponsibility/Impulsivity, Grandiosity, Flight of ideas, Activity increase, Sleep decrease, Talkativeness.
- Hypomania: Similar symptoms for ≥4 days but without significant impairment.
- Both mania and hypomania must not be due to substances or medical illness.
Bipolar Disorders
- Bipolar I: Requires at least one manic episode (may also include hypomania or depression).
- Bipolar II: Requires at least one hypomanic episode and one major depressive episode.
- Treatments: Mood stabilizers (lithium, valproic acid), lamotrigine, quetiapine, antipsychotics for acute mania.
Cyclothymic Disorder
- Alternating symptoms of hypomania and depression that do not meet full criteria for either.
- Symptoms persist for ≥2 years.
- Treated with cognitive behavioral therapy, lithium, and antipsychotics.
Persistent Depressive Disorder (Dysthymia)
- Chronic depressed mood with some but not all symptoms of MDD, lasting ≥2 years.
- Patients can still enjoy some activities and experience occasional happiness.
- Treated with cognitive behavioral therapy; SSRIs or antidepressants considered in some cases.
Adjustment Disorder
- Develops within 3 months of a major life stressor, with depressive and/or anxiety symptoms not meeting criteria for MDD or anxiety disorder.
- Symptoms usually resolve within 6 months after the stressor ends.
- Treated with supportive therapy and symptom-specific medications as needed.
Key Terms & Definitions
- Anhedonia — Loss of interest or pleasure in activities.
- SIGECAPS — Mnemonic for depression symptoms: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal thoughts.
- DIGFAST — Mnemonic for mania symptoms: Distractibility, Irresponsibility, Grandiosity, Flight of ideas, Activity, Sleep, Talkativeness.
- Mania — Abnormally elevated mood and energy with impairment.
- Hypomania — Similar to mania but less severe and without marked impairment.
- Mood stabilizer — Medication that reduces mood swings (e.g., lithium).
- Cyclothymic Disorder — Chronic fluctuating low-level mood disturbance involving periods of hypomanic and depressive symptoms.
Action Items / Next Steps
- Review the SIGECAPS and DIGFAST mnemonics.
- Learn major diagnostic criteria for mood disorders.
- Prepare for discussion on antidepressant medications in the next lecture.