Depressive Disorders Flashcards
Types of depressive disorders
•Disruptive Mood Dysregulation Disorder
•Major Depressive Disorder
•Persistent Depressive Disorder
•Premenstrual Dysphoric Disorder
Used to be called dysthymia
Persistent Depressive Disorder
Symptoms in this cluster of disorders include somatic and cognitive changes which typically affect an individual’s ability to function
Distinctions: severity, duration of episodes, degree of chronicity, and presumed etiology
Depressive D/O
Major depressive disorder characterizes what two disorder
Bipolar and depressive disorders
Diagnostic criteria for specific episodes are identical, regardless of the condition in which they appear.
•Distinction made based on frequency and duration of the episodes and whether or not accompanied by manic or hypomanic episodes.
Major depressive disorder
For a dx of MDD an individual must
show 5 symptoms that include depressed mood or anhedonia and four other manifestations of depression
Symptoms of MDD may include
–Weight loss without attempting to do so
–Insomnia or hypersomnia almost every day
–Fatigue or lack of energy
–Feelings of guilt or worthlessness
–Difficulty concentrating
–Repeated suicidal ideation
Etiology of MDD
there is a genetic component although the precise characteristics of the genetic factors are not yet established.
Prognosis of MDD
Outcomes will vary; some do well, experience few recurrences and better postepisode function and others have chronic and severe courses. More positive emotion is associated with better outcome
Prognosis factors for recurrence of MDD
Severity of the episode and sever symptoms of depressed mood, intense sadness, and anorexia. Long working hours, work-family conflict, negative thinking, and co-existing social phobia
combination of the characteristics of t DSM-4 conditions: chronic major depressive disorder and dysthymic disorder
Dysthymia
Etiology, prognosis, and implications of dysthymia
Etiology: Unclear
Prognosis: relatively intractable
Implications: same as indicated for major depressive d/o
5 or more symptoms before and during menses indicating Premenstrual Dsyphoric Disorder
emotional lability, irritability, depressed mood, anxiety, decreased interest in activities, poor concentration, lethargy, changes in appetite and sllep, feelings of being overwhelmed or out of control, and physical symptoms
Etiology, prognosis, and implications of premenstrual dysphoric disorder
Etiology: Unclear
Prognosis: resolves with onset of menopause
Implications: cognitive and functional impairments; primarily emotional regulation impaired; working memory has been demonstrated to be impaired. May have higher absenteeism and lower productivity at work
What are Depressive Disorders?
They include:
•Disruptive mood dysregulation disorder
•Major depressive disorder
•Persistent depressive disorder (dysthymia)
•Premenstrual dysphoric disorder
•Substance/medication induced depressive disorder
•Depressive disorder due to another medical condition
•Other/Unspecified D.D.
Common features of depressive disorders
Sad, empty, or irritable mood accompanied by
Somatic and cognitive changes that significantly affect individual’s capacity to function
Depressive disorder in children
⦿Disruptive mood dysregulation – refers to presence of symptoms
Prevalence of depressive disorders
⦿Common among children presenting to pediatric mental health clinics
⦿Among children and adolescents – 2% – 5% range
⦿Rates expected to be higher in males and school aged children than in females and adolescents.
Development and course of depressive disorders
⦿Onset must be before age 10 and diagnosis should not be applied to children with a developmental age of less than 6.
⦿Diagnosis validity established for those aged 7 – 18 years
Risk factors of depressive disorders
⦿Temperamental
⦿Genetic and physiological factors
Predominantly male children present to clinics with DMDD (disruptive mood dysregulation diorder)
Functional consequences in depressive disorders
⦿Disruption in a child’s family and peer relationships and school performance
⦿Dangerous behavior, suicidal ideations or suicide attempts, severe aggression, and psychiatric hospitalization are common
Depressed mood most of the day, nearly every day through subjective report or observation made by others (in children—it can be irritable mood).
•Diminished interest or pleasure in almost all activities most of the day, nearly every day
Major Depressive Disorder
Risk factors of MDD
⦿Temperamental
⦿Environmental
⦿Genetic and physiological
Functional consequences of MDD
Impairment can be very mild
⦿Impairment can range from complete incapacity (unable to attend to basic self-care needs or is mute or catatonic)
⦿In general medical environments, those w/major depressive disorders have more pain and physical illness and greater decreases in physical, social, and role functioning
⦿Depressed mood for most of the day, for more days than not, for at least two years (in children and adolescents, mood can be irritable and duration must be at least 1 year)
Persistent Depressive Disorder (DYSTHYMIA)
Development of PDD
Often has an early and insidious onset (childhood, adolescence, or early adult life) and a chronic course
⦿Early onset (before 21 years) is associated with higher likelihood of comorbid personality disorders and substance use disorders
Risk factors of PDD
⦿Temperamental
•Several predictive factors (negative affect, symptom severity, poor global functioning, presence of anxiety disorders or conduct disorder)
⦿Environmental
•Parental loss or separation
⦿Genetic and physiological
•Brain regions implicated (prefrontal cortex, anterior cingulate, amygdala, hippocampus)
Most common of all psychiatric disorders
Anxiety disorders
unpleasant emotional, cognitive, behavioral, or physical experiences of stress
Anxiety
worry that propels one to act
Normal anxiety
feeling uneasy, overwhelmed, helpless and out of control
Emotional
cardiovascular, gastrointestinal, respiratory, urinary, genital, autonomic, muscular
PHYSIOLOGICAL
confusion, poor memory, loss of perspective, obsessive thoughts, poor problem solving
Cognitive
looks preoccupied, immobile, overactive, restl
Behavioral
Cardiac symptoms, trembling, shortness of breath, feeling of suffocation, chest pain, sensations of choking, nausea, dizziness, derealization, paresthesia, chills, hot flashes, fear of losing control
4 or more symptoms in 10 minutes
Panic attack
Prevalence of anxiety
Median age of onset fir anxiety disorders (11 years) younger than the age of onset for substance use (20 years) and mood disorders (30 years)
⦿GAD one of the most prevalent psych d/o documented in US
Gender differences in anxiety
⦿Women at higher risk than men for anxiety d/o
⦿Gender specific risk factors for women:
•Socioeconomic disadvantage
•Gender-based violence
•Subordinate social status
•Responsibility for the care of others
