Depressive Disorder due to AMC + Other/Unspecified + Specifiers

Question 1

criterion A for depressive disorder due to another medical condition

Answer 1

a prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture

Question 2

criterion B for depressive disorder due to another medical condition

Answer 2

there is evidence from the history, physical examination or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition

Question 3

criterion C for depressive disorder due to another medical condition

Answer 3

the disturbance is not better explained by another mental disorder (i.e adjustment disorder, with depressed mood, in which the stressor is a serious medical condition)

Question 4

criterion D for depressive disorder due to another medical condition

Answer 4

the disturbance does not occur exclusively during the course of a delirium

Question 5

criterion E for depressive disorder due to another medical condition

Answer 5

the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning

Question 6

what are three specifiers that can be used to describe depressive disorder due to another medical condition

Answer 6

with depressive features–> full criteria are not met for an MDE

with major depressive-like episode–> full criteria are met (except criterion C) for an MDE

with mixed features–> symptoms of mania or hypomania are also present but do not predominate in the clinical picture

Question 7

list 5 neurological disorders with clear associations (and some neuroanatomical correlates) with depressive disorder due to another medical condition

Answer 7

stroke

Huntington’s disease

parkinsons disease

TBI

MS

Question 8

name 2 neuroendocrine disorders most closely associated with depressive disorder due to another medical condition

Answer 8

cushings disease

hypothyroidism

Question 9

describe the onset of depression associated with stroke

Answer 9

onset of depression appears to be quite ACUTE following stroke–> within 1 day or a few days of the CVA in the largest case series

in some cases though, can be weeks to months after the CVA

duration of the MDE after stroke was about 9-11 months

Question 10

how does depression usually appear in huntingtons or parkinsons disease

Answer 10

often early in the course of illness

often precedes the major motor impairments and cognitive impairments assoc with the conditions (more prominent for huntingtons–> depression is considered the FIRST neuropsych symptom of this disease)

Question 11

what affects the risk of developing depression after CVA

Answer 11

risk of acute onset (within days to 1 week) appears to be strongly related with LESION LOCATION

(though lesion location appears to become less important in depression associated with strokes presenting 2-6 months post stroke)

Question 12

in terms of stroke, a lesion in which location appears to confer the GREATEST risk of post-stroke depression

Answer 12

left frontal

Question 13

in terms of stroke, a lesion in which location appears to confer the LEAST risk of post-stroke depression

Answer 13

right frontal

Question 14

how does serious medical illness affect suicide risk

Answer 14

increases risk

clear association

particularly shortly after onset or diagnosis of the illness

*prudent to assume that risk of suicide for depressive disorder due to another medical condition is NO LESS than that for other forms of MDE and may be even greater

Question 15

ddx for depressive disorder due to another medical condition

Answer 15

depressive disorders NOT due to another medical condition

medication induced depressive disorder

adjustment disorders

Question 16

what are the major differentiating elements between adjustment disorders (with stressor being the diagnosed medical conditions) vs depressive disorder due to another medical condition

Answer 16

the pervasiveness of the depressive pictures and the number or quality of the depressive symptoms that the patient reports or demonstrates on the MSE

Question 17

when do you use “other specified depressive disorder” as the diagnosis

Answer 17

“This category applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class. The other specified depressive disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific depressive disorder. “

Question 18

list 3 examples of presentations that can be specified using the “other specified designation”

Answer 18

recurrent brief depression

short duration depressive episode (4-13 days)

depressive episode with insufficient symptoms

Question 19

what is recurrent brief depression

Answer 19

concurrent presence of depressed mood + 4 other symptoms at least for 2-13 days

at least ONCE PER MONTH (not assoc. with menstrual cycle)

for at least 12 CONSECUTIVE MONTHS

in someone who has never met criteria for any other depressive or bipolar illness and does not currently meet active or residual criteria for any psychotic disorder

Question 20

what is short duration depressive episode

Answer 20

basically someone who meets criteria for MDE except for the time criteria

must have symptoms for 4-13 days

has never met criteria for other depressive or bipolar illness

does not meet critieria for brief recurrent depression

no psychosis

Question 21

what is depressive episode with insufficient symptoms

Answer 21

basically meets time criteria but not number of symptoms for MDE

also cannot meet criteria for basically any other mood or psychotic disorder

Question 22

when do you use the diagnosis for unspecified depressive disorder

Answer 22

“This category applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class. The unspecified depressive disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific depressive disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis (e.g., in ER settings).”

Question 23

list specifiers for depressive disorders

Answer 23

with anxious distress

with mixed features

with melancholic features

with atypical features

with psychotic features

with catatonia

with peripartum onset

with seasonal pattern

+ severity

+ if in partial or full remission

Question 24

what are the 5 symptoms associated with the specifier “with anxious distress”

Answer 24

feeling keyed up or tense

feeling unusually restless

difficulty concentrating because of worry

fear that something awful will happen

feeling that the individual might lose control of themselves

Question 25

how many symptoms of the 5 possible must someone have to meet criteria for “with anxious distress”

Answer 25

at least 2 (mild)

(and severe is having 4-5 with motor agitation)

(must be present the majority of days of the MDE)

Question 26

why is it worthwhile noting whether someone meets criteria for “with anxious distress”

Answer 26

because high levels of anxiety have been associated with:

higher suicide risk

longer duration of illness

greater likelihood of treatment nonresponse

Question 27

list the 7 symptoms considered under the “with mixed features” specifier for depression

Answer 27

1. elevated, expansive mood
2. inflated self esteem or grandiosity
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. increase in energy or goal directed activity
6. increase or excessive involvement in activities that have high potential for painful consequences
7. decrease need for sleep

Question 28

how many symptoms within the 7 associated with the “with mixed features” specifier must be present to use this specifier for depression

Answer 28

at least 3

Question 29

why do we care about noting whether someone has just depression or depression “with mixed features”

Answer 29

because mixed features associated with an MDE have been found to be a SIGNIFICANT RISK FACTOR for the development of BIPOLAR I/II disorders

Question 30

one of two features MUST be present to consider the “with melancholic features” specifier for depression. what are those two features

Answer 30

loss of pleasure in all, or almost all, activities

and/or

lack of reactivity to usually pleasurable stimuli

Question 31

in addition to having one of the required two features (loss of pleasure/lack of reactivity) to consider “with melancholic features” specifier, how many other symptoms must be present? what are they?

Answer 31

at least THREE of the following 6:

1. a distinct quality of depressed mood characterized by profound despondency, despair and/or moroseness or by so called empty mood
2. depression that is regularly worse in the MORNING
3. early morning awakening (ie at least two hours before usual awakening)
4. marked psychomotor agitation or retardation
5. significant anorexia or weight loss
6. excessive or inappropriate guilt

Question 32

do melancholic features tend to reappear across episodes in the same individual

Answer 32

only a modest tendency to do this

Question 33

what are the features associated with the specifier “with atypical features” with regard to depression

Answer 33

1. mood reactivity (must have this)
2. 2+ of the following:
   –significant weight gain or increase in appetite
   –hypersomnia
   –leaden paralysis
   –longstanding pattern of interpersonal rejection sensitivity not limited to episodes of mood disturbance that results in significant social/occupational impairment

–> cannot have met criteria for “with melancholic features” or “with cataonia” in same episode

Question 34

how long does the sensation of leaden paralysis usually last

Answer 34

generally present for at least an hour per day but often lasts for hours at a time

Question 35

what % of women will experience onset of a MDE during pregnancy or in the weeks postpartum

Answer 35

likely between 3-6%

Question 36

a depressive episode is considered “peripartum” if it occurs when

Answer 36

during pregnancy or within 4 weeks of delivery