Depressive Disorders Flashcards
MDE
5/9 symptoms in criterion A, for at last two weeks (depressed mood or loss of interest)
Clinically significant distress or impairment (Criterion B)
Not caused by substance or medical symptom (Criterion C)
MDE Length required
2 weeks
MDE symptoms needed (criteria A)
five or more, with at least one being:
(1) depressed mood or (2) loss of interest or pleasure.
MDE Criteria A Symptoms
- Depressed mood most of the day, nearly every day, Note: In children and adolescents, can be irritable mood.)
- Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness, nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
MDE: Depressed mood in children
irritable
MDE: important to screen for
Can’t be response to a significant loss (ex. Bereavement, financial ruin, natural disaster etc.)
Did the loss trigger MDD, or is grief compounding on top of loss use clinical judgement (read footnote)
MDD
5/9 symptoms in criterion A, for at last two weeks (depressed mood or loss of interest)
Clinically significant distress or impairment (Criterion B)
Not caused by substance (Criterion C)
^MDE, and
Not better explained by another mental health diagnosis – shizo/psychotic (D)
Never been a manic or hypomanic (E)
MDD and MDE
A-C of MDD are MDE
AKA need at least one MDE
When coding for MDD, you code for
severity/course specifier, and if single episode/recurrent episode
Coding MDD Severity: if in episode
mild, moderate, severe, with psychotic features (no real good description for severity)
Coding MDD Severity: if in remission
Remission: During past two months, no significant signs or symptoms of disturbance
Partial remission:
- Symptoms are present, but full criteria aren’t met (not full-blown symptoms)
- No significant symptoms, but less than two months
Coding MDD Remision for MDD
2 months
Coding MDD Severity: if unkown
Unspecified
Coding MDD Single episode/recurrent:
Recurrent: Must have an interval of at least 2 consecutive months between separate episodes
Can MDD have a manic or hypomanic episode
NO!
Persistent Depressive Disorder
Depressed mood almost always for 2 years for adults, 1 year for children (A)
2/6 symptoms (B)
During disturbance, never have been in remission (two months) (C)
May meet MDD criteriaa (D)
Never manic or hypomanic (E)
Not better explained by others – mostly shizo/bipolar (F)
Not from substance or medical condition (G)
Clinically significant distress (H)
PDD Length
Two years for adults, one year for kids
PPD Criteria B – Symptoms
B. Presence, while depressed, of two (or more) of the following:
- Poor appetite or overeating.
- Insomnia or hypersomnia.
- Low energy or fatigue.
- Low self-esteem.
- Poor concentration or difficulty making decisions.
- Feelings of hopelessness.
PPD Coding
only one code!
PPD Specifiers
Specify onset: early (before 21) or late (after 21)
Specify if in partial or full remission
Specify for more recent 2 years: –> criteria for MDE
- Pure dysthymic syndrome: no criteria met for MDE
- Persistent MDE: Full criteria for a major depressive episode have been met
- Intermittent MDE, with current episode: MDE currently met, but have been periods of remission (2 months)
- Intermittent MDE, without current episode: MDE not currently met, but has been met previously
PPD Specifiers: Onset age
21
PPD specifiers: MDE criteria
- Pure dysthymic syndrome: no criteria met for MDE
- Persistent MDE: Full criteria for a major depressive episode have been met
- Intermittent MDE, with current episode: MDE currently met, but have been periods of remission (2 months)
- Intermittent MDE, without current episode: MDE not currently met, but has been met previously
Dysthymia
NOT IN DSM, but mild, persistent depression
Most missed symptom in MDE
Cognitive impairment
When at most dangerous point for suicide
Right after hitting rock bottom, doing a little better (so have motivation, less cognitively impaired –> can act)
Depressed mood for children can show as
irritability!
Can have PDD and MDD?
Yes!
