Depressive Disorder due to AMC + Other/Unspecified + Specifiers Flashcards
criterion A for depressive disorder due to another medical condition
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
criterion B for depressive disorder due to another medical condition
there is evidence from the history, physical examination or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition
criterion C for depressive disorder due to another medical condition
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)
criterion D for depressive disorder due to another medical condition
the disturbance does not occur exclusively during the course of a delirium
criterion E for depressive disorder due to another medical condition
the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
what are three specifiers that can be used to describe depressive disorder due to another medical condition
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
list 5 neurological disorders with clear associations (and some neuroanatomical correlates) with depressive disorder due to another medical condition
stroke
Huntington’s disease
parkinsons disease
TBI
MS
name 2 neuroendocrine disorders most closely associated with depressive disorder due to another medical condition
cushings disease
hypothyroidism
describe the onset of depression associated with stroke
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
how does depression usually appear in huntingtons or parkinsons disease
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)
what affects the risk of developing depression after CVA
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)
in terms of stroke, a lesion in which location appears to confer the GREATEST risk of post-stroke depression
left frontal
in terms of stroke, a lesion in which location appears to confer the LEAST risk of post-stroke depression
right frontal
how does serious medical illness affect suicide risk
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
ddx for depressive disorder due to another medical condition
depressive disorders NOT due to another medical condition
medication induced depressive disorder
adjustment disorders
what are the major differentiating elements between adjustment disorders (with stressor being the diagnosed medical conditions) vs depressive disorder due to another medical condition
the pervasiveness of the depressive pictures and the number or quality of the depressive symptoms that the patient reports or demonstrates on the MSE
when do you use “other specified depressive disorder” as the diagnosis
“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. “
list 3 examples of presentations that can be specified using the “other specified designation”
recurrent brief depression
short duration depressive episode (4-13 days)
depressive episode with insufficient symptoms
what is recurrent brief depression
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
what is short duration depressive episode
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
what is depressive episode with insufficient symptoms
basically meets time criteria but not number of symptoms for MDE
also cannot meet criteria for basically any other mood or psychotic disorder
when do you use the diagnosis for unspecified depressive disorder
“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).”
list specifiers for depressive disorders
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
what are the 5 symptoms associated with the specifier “with anxious distress”
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
how many symptoms of the 5 possible must someone have to meet criteria for “with anxious distress”
at least 2 (mild)
(and severe is having 4-5 with motor agitation)
(must be present the majority of days of the MDE)
why is it worthwhile noting whether someone meets criteria for “with anxious distress”
because high levels of anxiety have been associated with:
higher suicide risk
longer duration of illness
greater likelihood of treatment nonresponse
list the 7 symptoms considered under the “with mixed features” specifier for depression
- elevated, expansive mood
- inflated self esteem or grandiosity
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- increase in energy or goal directed activity
- increase or excessive involvement in activities that have high potential for painful consequences
- decrease need for sleep
how many symptoms within the 7 associated with the “with mixed features” specifier must be present to use this specifier for depression
at least 3
why do we care about noting whether someone has just depression or depression “with mixed features”
because mixed features associated with an MDE have been found to be a SIGNIFICANT RISK FACTOR for the development of BIPOLAR I/II disorders
one of two features MUST be present to consider the “with melancholic features” specifier for depression. what are those two features
loss of pleasure in all, or almost all, activities
and/or
lack of reactivity to usually pleasurable stimuli
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?
at least THREE of the following 6:
- a distinct quality of depressed mood characterized by profound despondency, despair and/or moroseness or by so called empty mood
- depression that is regularly worse in the MORNING
- early morning awakening (ie at least two hours before usual awakening)
- marked psychomotor agitation or retardation
- significant anorexia or weight loss
- excessive or inappropriate guilt
do melancholic features tend to reappear across episodes in the same individual
only a modest tendency to do this
what are the features associated with the specifier “with atypical features” with regard to depression
- mood reactivity (must have this)
- 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
how long does the sensation of leaden paralysis usually last
generally present for at least an hour per day but often lasts for hours at a time
what % of women will experience onset of a MDE during pregnancy or in the weeks postpartum
likely between 3-6%
a depressive episode is considered “peripartum” if it occurs when
during pregnancy or within 4 weeks of delivery
