This course is designed for healthcare professionals wishing to learn more about the mood disorders. The emphasis is on the symptoms and the experience of mood disorders, rather than on causes or treatment strategies. Much of the course is geared toward diagnosis, using the formal manual criteria to evaluate client behavior and reported symptoms in the clinical setting.
Course participants receive a 30-page set of notes in pdf format that review the content of all lectures.
The lectures include:
The Floating Diamond Model - A strategy for parsing the depressive experience into physiological, cognitive, emotional, and behavioral aspects. This is useful conceptually for clinicians, patients/clients, and family/friends/supporters.
Major Depressive Episode - Separated into lectures on a) the critical mood-related criteria, and b) the remaining criteria.
Diagnosis of Major Depressive Disorder.
Nondiagnostic experiential aspects of the depression experience; and an examination of the manner in which symptoms self-perpetuate and magnify one another ("snowballs and reverberations").
Minor depression and dysthymia, or persistent depressive disorder - Including diagnostic criteria for the latter.
Bipolar disorders - Including strategies for diagnosis of manic and hypomanic episodes, bipolar 1 and 2 disorder, and cyclothymia.
Other mood disorders - Including premenstrual dysphoric disorder and the array of "miscellaneous" categories for individuals who do not meet criteria for the primary syndromes.
Epidemiology - A brief consideration of issues such as gender ratio, age of onset, cost of mood disorders to society, and the possibility that mood disorders are increasing in prevalence.
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An introduction to the topics covered in this course. Plus a query: Why do we bother with diagnosis? It is intended to guide treatment, but in the case of depression its guidance may be limited. Nevertheless, it is advantageous to understand the experience of our patients/clients, and the diagnostic criteria are useful in this pursuit. The course notes and other documents are appended as supplements to this lecture.
This document provides the course notes for all of the lectures, so that you can follow along as you go.
To get us started, here's a model to help tease apart the cognitive, behavioral, emotional, and physiological symptoms of depression. Although collectively called "mood disorders," in fact these problems affect every aspect of a person. The Floating Diamond is useful for clinicians, and even more useful for clients and their families when trying to understand the variety of symptoms these disorders can produce.
There are nine criteria for MDE, of which a person must cross the threshold for five. But they must have at least one of the first two criteria: Low mood and anhedonia. In this lecture we explore the presentations of these two, and how to assess their severity.
In this lecture we consider the remaining seven criteria for Major Depressive Episode: Weight/appetite, sleep, activity, fatigue, guilt/worthlessness, concentration, and suicidality. What do they look like in the clinical setting? How much is enough to cross the threshold?
A history of major depressive episodes is only one of the criteria for Major Depressive Disorder. In this lecture we review the remaining criteria and the various specifiers and numerical codes to elaborate on the diagnosis. We also consider the controversy about the bereavement exclusion, removed in DSM-5.
The diagnostic criteria are not the only symptoms of depression. Using the Floating Diamond model, let's enumerate additional aspects of the depressive experience in the realms of physiology, behavior, thought, and emotion.
If clinical depression is "Major," might there be a disorder called "Minor Depression"? In a sense, yes, and it's a normal part of human experience. But we don't really think of it as a disorder.
What if a "Minor Depression" goes on and on and on? If it lasts for more than 2 years, we call it Dysthymia, or Persistent Depressive Disorder. Long-lasting depression brings special challenges, because the person's lifestyle and thinking may begin to be shaped to the mood problem, rather than supporting recovery.
In addition to suffering depressive episodes, some individuals experience periods of unusual mood elevation or expansiveness. In this lecture we review the diagnostic criteria for Manic Episode, and how these are actually evaluated in the clinical setting.
Once we know that a person has had at least one manic episode, we are most of the way toward a diagnosis of Bipolar 1 Disorder. But there are a few more criteria designed to rule out other possibilities. In this lecture we also consider whether an episode triggered by medication counts (it can, in DSM-5, but there are some caveats).
If mood episodes don't go to quite the extremes that we might call mania, they might count as hypomanic episodes. Bipolar 2 Disorder involves a history of both depressive and hypomanic episodes, and can be somewhat more difficult to diagnose correctly than Bipolar 1 Disorder. The ambiguities in the diagnosis - combined with sloppy practice - may have led in recent years to significant overdiagnosis of this problem.
What if a person has frequent and significant upswings and downdrafts of mood, but they do not meet the criteria for Bipolar 1 or 2? If the problem is chronic enough, cyclothymia may be the answer. But, as we shall see, the criteria are based on the NON-severity of the episodes, making this the very definition of a hard-to-diagnose disorder.
If mood episodes in women follow a monthly cycle, they may indicate the presence of Premenstrual Dysphoric Disorder. But the criteria are more complicated than that. In this brief talk we discuss the additional signs and symptoms necessary.
We seem to have a terror of being unable to diagnose people with mental disorders. Consequently, there is a set of disorders designed to classify individuals who do not, for one reason or another, meet the criteria of one of the larger problems. Given that these disorders provide minimal guidance for treatment, however, we might question their significance.
How common are the mood disorders? Who gets them? Are they becoming more common with time? And what is their financial impact on a society? Although epidemiology is not our primary focus in this brief course, let's take a look at these and related questions.
Randy Paterson is a psychologist and author in Vancouver Canada. His most recent book is the popular How to be Miserable: 40 Strategies You Already Use. He is the Director of Changeways Clinic and writes a blog called PsychologySalon. His work emphasizes the treatment of problems related to stress, anxiety, depression, and significant life change. His previous books include The Assertiveness Workbook, Private Practice Made Simple, and Your Depression Map, as well as a variety of resources and protocols for mental health practitioners. He conducts workshops on mental health issues for the public and for mental health professionals within Canada and internationally.