Depressive Disorders Flashcards
Learn criteria, specifiers, and rule outs for Depressive Disorders
The common feature of this classification of disorders is sad, empty, or irritable mood, accompanied by related changes that significantly affect the individual’s capacity to function.
Depressive Disorders
Depressive Disorders
Diagnosable between the ages of 6 & 18 with onset before age 10; featuring frequent, out of proportion temper outbursts inconsistent with developmental level & chronic, persistently irritable or angry mood between temper outbursts; present for 12 or more months; present in at least 2 settings.
Disruptive Mood Dysregulation Disorder
Depressive Disorders
The full symptom criteria for ____________________ or ________________ ____________________, lasting more than 1 day, are inconsistent with a diagnosis of Disruptive Mood Dysregulation Disorder (F34.81).
manic or
hypomanic episodes
Depressive Disorders
A diagnosis of Disruptive Mood Dysregulation Disorder cannot coexist with:
1.
2.
3.
- Oppositional Defiant Disorder
- Intermittent Explosive Disorder
- Bipolar Disorders
Depressive Disorders
If an individual’s symptoms meet criteria for both Oppositional Defiant Disorder or Intermittent Explosive Disorder AND Disruptive Mood Dysregulation Disorder, which diagnosis should be given?
Disruptive Mood Dysregulation Disorder
Depressive Disorders
Disruptive Mood Dysregulation Disorder can be comorbid with other disorders, including:
1.
2.
3.
4.
- Major Depressive Disorder
- Attention Deficit/Hyperactivity Disorder
- Conduct Disorder
- Substance Use Disorder
Depressive Disorders
True or False: If a child with Autism Spectrum Disorders exhibits symptoms of Disruptive Mood Dysregulation Disorder, the diagnosis of Disruptive Mood Dysregulation Disorder should be given?
False.
Temper outbursts are considered secondary to Autism Spectrum Disorders and the diagnosis of Disruptive Mood Dysregulation Disorder should not be given.
Depressive Disorders
A. 5 (or more) symptoms present during 2-week period; change from previous functioning; at least 1 symptom is (1) or (2):
1. depressed mood
2. diminished interest or pleasure
3. significant weight loss or gain or change in appetite
4. insomnia or hyposomnia
5. psychomotor agitation or retardation
6. fatigue or loss of energy
7. feeling worthless or excessive guilt
8. diminished ability to concentrate
9. suicidal ideation, attempt, or plan
B. Clinically significant distress or impairment.
C. Not attributable to substance or medication.
D. Not better explained by other disorders.
E. No manic or hypomanic episode.
Major Depressive Disorder
Criteria A-C represent a major depressive episode.
Note: symptoms concurrent with significant loss should be carefully considered relative to the loss, the individual’s history, and cultural norms.
Depressive Disorders
The diagnostic code for Major Depressive Disorder is dependent on:
Single or recurrent episodes
Recurrent, > 2 consecutive months between separate episodes.
Depressive Disorders
What are the 3 severity and 4 course specifiers for MDD?
- Mild
- Moderate
- Severe
- With psychotic features
- In partial remission
- In full remission
- Unspecified
Depressive Disorders
MDD Differential Diagnosis
If mood is prominently irritable, criteria for ____________ symptoms should be carefully considered.
manic
Manic episodes with irritable mood or mixed features may present as MDD with prominent irritable mood. The threshold for manic criteria cannot be met for diagnosis of MDD.
Depressive Disorders
MDD Differential Diagnosis
Major depressive episodes with a history of a _______________ or __________________ episode precludes the diagnosis of MDD.
manic or hypomanic
Bipolar I, Bipolar II, or other specified bipolar and related disorders should be considered if manic or hypomanic symptoms are present.
Depressive Disorders
MDD Differential Diagnosis
What disorder is characterized by at least 2 years of depressed mood and can be concurrent with MDD?
Persistent Depressive Disorder
Depressive Disorders
MDD Differential Diagnosis
Episodes of MDD are not temporally connected to the menstrual cycle, but mood disturbances may be connected to:
Premenstrual Dysphoric Disorder
Depressive Disorders
MDD Differential Diagnosis
Persistent irritability or emotional lability and severe temper outbursts may be more indicative of this diagnosis:
Disruptive Mood Dysregulation Disorder
Depressive Disorders
MDD Differential Diagnosis
MDD with psychotic features differs from this disorder because psychotic features persist for more than 2 weeks in the absence of a major depressive episode.
Schizoaffective Disorder
Depressive Disorders
MDD Differential Diagnosis
Irritability caused by low frustration tolerance is characteristic of this disorder and caution should be used to not overdiagnose MDD in children with this disorder.
Attention-deficit/hyperactivity disorder
Depressive Disorders
MDD Differential Diagnosis
The full criteria for a major depressive episode are not fully met in response to a psychosocial stressor. This diagnosis may be given instead.
Adjustment Disorder with Depressed Mood
Depressive Disorders
MDD is frequently comorbid with:
1.
2.
3.
4.
5.
6.
7.
8.
- Substance-related disorders,
- Panic disorders
- Generalized Anxiety Disorder
- PTSD
- OCD
- Anorexia Nervosa
- Bulimia Nervosa
- Borderline Personality Disorder
Depressive Disorders
A. Depressed mood, more days than not, for at least 2 years (1 year in children or adolescents, mood can be irritable).
B. While depressed, 2 or more of the following:
1. poor appetite or overeating
2. insomnia or hyposomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficulty making decisions
6. feelings of hopelessness
C. Never been without symptoms in A & B for more than 2 months.
D. Criteria for MDD continuously present for 2 years.
E. No manic or hypomanic episode.
F. Not better explained by other disorders.
G. Not attributable to substance use or medical condition.
H. Clinically significant distress or impairment.
Persistent Depressive Disorder
Depressive Disorders
True or False: Diagnosis of Persistent Depressive Disorder and Major Depressive Disorder can be given concurrently.
True
If criteria for a major depressive episode are sufficient during the 2-year period, MDD diagnosis should be made along with PDD diagnosis with relevant specifiers.
Depressive Disorders
Differential diagnosis for PDD is similar to differential diagnosis for MDD but also includes consideration of _________________ disorders that are characterized by enduring patterns of inner experience and behavior, with onset by adolescence or early adulthood. PDD and these types of disorders can co-occur.
Personality Disorders
Early-onset PDD is strongly associated with Cluster B and C personality disorders.
Depressive Disorders
The symptoms for this disorder occur in conjunction with the majority of menstrual cycles for the preceding year.
Premenstrual Dysphoric Disorder
Depressive Disorders
A depressed mood or marked decrease in interest or pleasure in all, or almost all, activities predominates the clinical picture during or soon after substance intoxication or withdrawal, or after exposure to or withdrawal from medication, where the substance or medication is capable of producing the mood disturbance.
Substance/Medication-Induced Depressive Disorder
Depressive Disorders
A depressed mood or marked decrease in interest or pleasure in all, or almost all, activities predominates the clinical picture and there is evidence that the disturbance is the direct pathophysiological consequence of a medical condition.
Depressive Disorder Due to Another Medical Condition
Depressive Disorders
Symptoms are characteristic of depressive disorders and cause significant distress or impairment but do not meet the full criteria for disorders in the depressive disorders diagnostic class or adjustment disorders with depressed mood. The clinician should communicate the specific reason the presentation does not meet the criteria for any specific depressive disorder.
Other Specified Depressive Disorder
1. Recurrent brief depression
2. Short-term depressive episode (4-13 days)
3. Depressive episode with insufficient symptoms
4. Major depressive episode superimposed on schizophrenia spectrum disorders (other than schizoaffective disorder)
Depressive Disorders
Symptoms are characteristic of a depressive disorders and cause significant distress or impairment but do not meet the full criteria for disorders in the depressive disorders diagnostic class or adjustment disorders with depressed mood. This category is used when the clinician does not choose to specify the unmet criteria–there is insufficient information to make a more specific diagnosis (emergency department).
Unspecified Depressive Disorder
Depressive Disorders
Symptoms characteristic of a mood disturbance that cause significant distress or impairment but do not at the time of evaluation meet the full criteria for any of the disorders in either the bipolar or depressive disorders diagnostic classes and it is difficult to make the distinction.
Unspecified Mood Disorder
Depressive Disorders
Specifiers for Depressive Disorders:
1.
2.
3.
4.
5.
6.
7.
8.
- with anxious distress (mild to severe)
- with mixed features (manic/hypomanic symptoms)
- with melancholic features (near-complete absence of the capacity for pleasure)
- with atypical features (mood reactivity, weight gain, hypersomnia, leaden paralysis, interpersonal rejection sensitivity)
- with psychotic features (mood-congruent or mood-incongruent)
- with catatonia
- with peripartum onset (onset occurs during pregnancy or in 4 weeks following delivery)
- with seasonal patterns
