Now,these used to be called mood disorders. I've gone ahead and changed it because
I'm just going to have to make the changes with the DSM-5.
You don't need to know that term at all. You need to know these terms we're going to
talk about
underneath this, which remain the same. But what we're talking about
is marked by emotional disturbances. It used to be called mood disorders
because they all involve mood. Now they've broken them out into two different
classes where you have depressive disorders
and bipolar and related disorders.
Now, this is a pet peeve for me because
bipolar is oftentimes misdiagnosed.
It's not under diagnosed, it is quite probably over diagnosed. There are some
question as to whether dissociative identity disorder is over diagnosed because
it's our rapid spike
and diagnostic levels after
some very popular movies and books came out and became more and more subject on talk TV
and things like that and the question was whether
there was actually an increase or whether there were people who are now
being
made aware of it in clinical realms and they're being
more sensitive in diagnosing it more appropriately or whether they are now
expecting to see it and
some patients tend to fulfill the expectations through self-fulfilling
prophecy
then you get misdiagnoses. But bipolar
is a very real disorder and it affects less than two percent of the population,
right. That's not that many people. It's too many people without a doubt but it's
not
as many as you are going to see one out of every ten persons walking in to your clinic for example
might have this disorder. Its it's fairly rare and unusual.
And we'll talk about a little bit why it's oftentimes misdiagnosed.
One type that you're very aware of because you probably experienced it
yourself to some degree is depression.
Now we all have feelings of sadness at times. We don't all necessarily have feelings
of worthlessness. We all experience loneliness at times
Sometimes we have lethargy, we don't feel all energetic.
Occasionally you'll lose interest in something you thought pleasurable.
Maybe you have issues where you eat a lot more than you usually do, or you eat a lot
less than you usually do and
maybe sometimes you have problems sleeping and can't sleep as much. And
sometimes more but but not usually a lot of those things together persistently
at such a level that it impairs your ability to enjoy your life fully
or engage in daily activities functionally.
And that's what you are talking about when you are talking about clinical depression.You have to have met criteria
for a major depressive episode
to be diagnosed with major depressive disorder.
And that is a two week period were a number of symptoms
are present out of a laundry list of symptoms and what's really interesting
with these symptoms is
they're very different sometime between different people
but it manifest the same disorder. So that some people
have profound sadness but not necessarily worthlessness
and they're lonely but they haven't lost interest in everything. And if you've got
problems sleeping, so you look at these as individual manifestations of this
general disorder
and you have to be very careful that you go through these various symptoms to
make sure that people had them for the requisite criterion and amount of time
and that they are at a level that is clinically significantly impairing their
lives.
Because all of us deal with depression. Sometimes it's a natural response.
It would be weird if you weren't depressed after certain kinds of events in our
lives.
But not so pro but that would be a normal human experience not a clinical
disorder,
right. It would be a clinical disorder if it persisted way beyond what most
people
require to get over such events or to get past such events, maybe not over.
But with some people let's say eating. Some people profoundly depressed
eat a lot more. So what do you mean changes in eating
like a change of 5 percent of body weight without an attempt to do so.
Gaining five percent of one's body weight or more. But, other people can't
eat. They actually don't feel hungry
while they're depressed and they lose weight. But they're not dieting they're
not attempting to lose weight.
And so in that sense 5 percent of body weight decrease in by the way or more would be
significant and looked at.
For other people when they get really depressed they can't hardly get
out of bed.
They don't want to get out of bed and they might sleep 10-12 hours a day
or more. Other people can't sleep at all when they're depressed, right.
They have insomnia and it's very difficult to get to sleep. So here we
are
looking at opposite ends of the same behavior being symptomatic
of depression potentially. And so you need to look through those
systematically
and talk to each person individually before you make any kind of diagnostic
claim. The flip side to this is mania.
This isn't sad, this is WOOOOO,
feeling good, feeling great, feeling too good, too great
not due to a substance.
Cocaine will do that WOOO. We'll talk about that.
But that's due to a substance and you'll come back down,
very quickly. As soon as the dose wears off.
This is going up in staying up. These have to be departures from normal
experience. This isn't just somebody who is really happy and chipper,
right. This is going way beyond that. We're looking at feelings of excitement,
elation, euphoria, granduer which means
everything seems relevant to you,right and you are relevant to everybody and
everything.
Unrealistic optimism, high-energy
lack of logical thought, lack of a need for sleep.
Now, this is why it gets diagnosed oftentimes incorrectly because
racing thoughts is also a part of the symptom profile
and so somebody might go in to their doctor and complain of having issues
that are troubling them and the doctors going to naturally ask you know what
accompanies that.
And you know I cant stop thinking. I'm worried all the time. I have got all these racing
racing thoughts. That's one of the criterion and you go yeah man I can't
sleep.
I really can't sleep. Lack of asleep,
that sounds like mania. But you've got to be careful.
Differential diagnosis is important because
racing thoughts can be indicative of an anxiety disorder, like
generalized anxiety disorder. Lack of sleep could be caused by racing thoughts
one can't stop thinking about things that worry one, they can't relax enough to
go to sleep,
or it might just be primary insomnia.Might just be
trouble sleeping. In mania it's lack of a need for sleep.
These people stay up and they don't feel like they're tired.
It's like they're on amphetamines. And if you know anything about amphetamines
and abuse of amphetamines,
you see that people don't sleep sometimes for days on end. Well, they're not
necessarily abusing any drugs although the impulsive behavior might include
drug use
it might include dangerous reckless, behavior,
it might include indiscriminate sexual activity, it might include
spending money one doesn't have,
running credit cards up or gambling debts up and things like that
because in this period, distinct period of major elevation of mood,
people start doing things without regard to consequences.
And the longer they stay up there's an interesting parallel between amphetamine
abuse
and mania. You become more and more
toward the psychotic end of the spectrum of reality and become less and less
reality-based.
People on amphetamines become very paranoid and the longer you stay up
eventually you'll have what they call sleep deprivation psychos. You'll start
seeing little
flickering things in the peripheral vision and you might even hallucinate.
And eventually
you'll micro sleep because if it's just about, you'll fall asleep. But
they're not falling asleep and the longer they stay up the more departure you get
from reality.
And it's dangerous. And so where depression requires
a two-week period of distinct change from normal mood
that meet full criteria for the episode,
mania only requires one week unless hospitalization is needed earlier.
Because if somebody's doing behaviors that can be putting themselves in danger
or other people in danger,
that becomes very problematic. There's also bipolar 1 and bipolar 2,
that's a distinction. We'll talk about it.
Major depressive disorder then is what I said
you have to have the excessive despair or excessive sadness that has to be there.
You have to have a lost of interest in previously pleasurable activities
and a whole other set of symptoms to go with that. Those are fundamental
but you need additional symptoms for at least two weeks. Having had that
episode diagnosed you could then be did diagnosed with major depressive disorder.
It's about a 50-50 shot as to whether you'll have another episode of depression.
Interestingly enough, when we talk about treatment,
about 85 percent of all depressions will remit on their own, go away on
their own if you do nothing
within six months. But who should suffer for six months if we have treatments
that will
bring relief quicker than that. And we do have treatments but medical
and psychological treatments that can bring much quicker relief.
And so in this sense having these core symptoms
departing from one's normal mood to a level that is
clinically significant and causing functional problems
or suffering for the person bringing them in for treatment can be very, very, very
helpful,
right. And that criteria whatever that treatment might be, but we'll talk about to read more
extensively
in the next part of this section of material.
The greatest risk is suicide and we are going to talk a little bit about suicide in a minute.
Not something beyond...this is what you want to know for your test.
that of these disorders we're talking about, the greatest risk here is for
suicide.
Now there's a suicide risk that's elevated for schizophrenia
and for bipolar because it also includes depression.
There's also the suicide risk for all kinds of other things like substance
abuse and
and other disorders but depression
leads oftentimes to a despair that is so profound
that people wish themselves not to be alive.
And if they make that attempt it can be devastating.
If they make that attempt a completion
that's awful because you could treat this.
You could almost always treat this if you can get them to the resources they need
to get to.
Bipolar disorder used to be called manic depression.
Manic-depression is a frustrating message if you familiar with Jimi Hendrix.
So the old school term was manic depression.
Well that's what it is. That's a pretty descriptive term.
Bipolar is between mania
and depression so now you have to actually
have met criteria for depressive episode
and criteria for full-blown manic episode
and if you meet criteria for a full-blown manic episode and
major depressive episode then you're bipolar 1,
right. There's another kind of mania
that's like less intense but is still an elevation in mood
that is going to include things like excitement, elation, euphoria,
not so much the grandeur necessarily, lots of optimism but not necessarily
unrealistic optimism
high energy, not lack of sleep totally or no need for sleep but less need for sleep,
it's a highly productive feeling. And, and that's kind of cool.
For the people experiencing it they're like why would I want to not feel this way
because it feels great.
The problem in bipolar 2 is the hypomania. You can get a lot done because
you're focused, you're not unrealistic, you're not doing
things that are highly risky and stuff like that. You're oftentimes highly
productive.
But it comes with the crash. It comes with the depression.
So the treatment is critical. Treatment is to prevent
the depression. You oftentimes will lose
the mania that at lower levels may not be, it's called hypomania,
may not be so bad in of itself but losing the depression
can be a lifesaver, literally.