Depressive Disorders

Question 1

Disruptive Mood Dysregulation Disorder

Answer 1

A: Severe recurrent temper outbursts manifested verbally and/or behaviorally
B: Temper outbursts are inconsistent with developmental level
C: Temper outbursts occur on average three or more times per week
D: The mood between temper outbursts is persistently irritable or angry mood most of the day, nearly every day
E: Criteria A-D has been met for 12+ months
F: present in two of three settings
G: cannot be made before 6 or after 18
H: age of onset is before 10

Question 2

Major Depressive Disorder

Answer 2

A. 5+ of the following present in the same 2-week period and represent a change from previous functioning; at least 1 symptom is depressed mood or loss of interest/pleasure
▪ Depressed mood most of the day, nearly everyday (may be irritable mood in children)
▪ Markedly diminished interest/pleasure in all or almost all activities most of the day, nearly everyday
▪ Significant weight loss or gain without trying
▪ Insomnia/hypersomnia nearly everyday
▪ Psychomotor agitation/retardation nearly every day
▪ Fatigue/loss of energy nearly every day
▪ Feelings of worthlessness/excessive or inappropriate guild nearly every day
▪ Diminished ability to think/concentrate, indecisiveness nearly every day
▪ Recurrent thoughts of death/recurrent suicidal ideation w/wo plan or intent
B. Clinically significant distress or impairment
C. Episode not attributable to physiological effects of substance or another medical condition
D. Occurrence of the major depressive episode is not better explained by another mental illness
E. There has never been a manic or hypomanic episode

Question 3

MDD Mild Specifier

Answer 3

few if any symptoms in excess of diagnostic criteria

Question 4

MDD Moderate Specifier

Answer 4

some symptoms in excess of diagnostic criteria

Question 5

MDD Severe Specifier

Answer 5

many symptoms in excess of diagnostic criteria

Question 6

Other MDD Specifiers

Answer 6

With psychotic features
In partial remission
In full remission

Question 7

With Anxious Distress

Answer 7

2 of the following: keyed up r tense, unusually restless, difficulty concentrating, fear that something awful will happen, feeling that the individual might lose control of self

Question 8

With Mixed Features

Answer 8

– A.) 3+ of the following: expansive mood, grandiosity, more talkative/pressured speech, flight of ideas/racing thoughts, increase in energy and goal directed activity, increase in risk taking, decreased need for sleep; B. Observable by others and are a change from usual; C.) if full criteria for hypomania met then it is bipolar ii; D. Not substance related

Question 9

With Melancholic Features

Answer 9

A.) 1+ of the following: loss of pleasure in all or most activities, lack of reactivity to pleasurable stimuli; B.) 3+ of the following: depressed mood characterized by despondency/despair/moroseness/empty mood, depression is worse in the morning, early morning awakening, marked psychomotor disturbance, significant anorexia or weight loss, excessive or inappropriate guilt

Question 10

With Atypical Features

Answer 10

A.) Mood reactivity; B.)2 of the following: significant weight gain/increase in appetite, hypersomnia, leaden paralysis, long standing pattern of interpersonal rejection sensitivity; C.) Criteria for melancholic or catatonia not met during same episode

Question 11

With Mood-Congruent Psychotic Features

Answer 11

content of delusions and hallucinations consistent with depressive themes

Question 12

With Mood InCongruent Psychotic Features

Answer 12

content of delusions does not involve depressive themes

Question 13

With Peripartum Onset

Answer 13

during pregnancy or 4 weeks following the delivery

Question 14

With seasonal pattern (recurrent episode only)

Answer 14

A.) Regular temporal relationship between onset of major depressive episodes in MDD; B.) full remissions also occur at characteristic times of the year; C.) In 2 years, major depressive episode and particular times of the year; B.) full remissions can occur
D. Seasonal major depressive episodes outnumber nonseasonal in a person’s life time

Question 15

MDD Assessment Measures

Answer 15

o Unstructured clinical interview
o MSE
o SCID-5 Mood Disorders
o BASC-3/Conners CBRS for kiddos
o Childhood Depression Inventory
o Beck Depression Inventory and Hopelessness scale
o MMPI-3
o PAI

Question 16

MDD Treatment

Answer 16

o behavioral activation
o CBT – identify problems and goals, modify the environment by increasing reinforcement/setting events, decreasing punishment, and behavioral activation, modify cognitions through thought reframing and restructuring, through addressing negative core beliefs, reducing confirmation bias, and reducing rumination of self-discrepancies.
o Medication – SSRIs, medical consult; need to monitor because a medication can pull someone out of vegetative depression and they are just energetic enough to attempt suicide
o Combination of medication and psychotherapy
o CAMS

Question 17

Persistent Depressive Disorder

Answer 17

A. Depressed mood for most of the day, for more days than not for at least 2 years (kids and adolescents can have irritable mood and it can be for 1 year)
B. Presence of 2+ of the following
▪ appetite disturbance
▪ insomnia/hypersomnia
▪ Low energy/fatigue
▪ Low self-esteem
▪ Poor concentration or difficulty making decisions
▪ Feelings of hopelessness
C. During 2(1)year period, individual has never been without symptoms for more than 2 months at a time
D. Criteria for MDD may be continually present for 2 years
E. No manic/hypomanic episode or cyclothymia
F. Not better explained by another disorder
G. Not due to a substance

Question 18

PDD Specifiers

Answer 18

Early Onset (Before 21)
Late onset (after 21)
With pure dysthymic syndrome: full criteria for major depression not met in past 2 years
With persistent MDD – full criteria for mdd have been met throughout the past 2 years
With intermittent MDD episodes, with current episodes – full criteria for major depressive episode currently met, but there have been periods in at least 8 weeks in the past 2 years with symptoms below threshold
With intermittent MDD episodes, without current episode: full criteria not currently met, but there is evidence of past episodes in the past 2 years

Question 19

Premenstrual Dsyphoric Disorder

Answer 19

Depressive symptoms that happen I the final weeks before the onset of a period and start to improve within days after