Depressive Disorders Flashcards
Criterion A for MDD?
A. Five (or more) of the following symptoms have been present during the same 2 week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad, empty, hopeless) or observation made by others (e.g. appears tearful. (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month), or decrease in appetite nearly every day. (Note: In children consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Acronym for Criterion A for MDD
DPWIPFWCD
one of two symptoms are needed for Criterion A for MDD? what are they
- depressed mood
or - loss of interest/pleasure in activities
What do we have to exclude to meet MDD criteria?
Criterion C: any other medical condition or substance
Criterion D: exclude bipolar I and II, schizoaffective, schizophrenia, schizophreniform, delusional disorder, or any other unspecified schizophrenia spectrum or psychotic disorders.
Criterion E: Never having been a hypomanic or manic episode.
What are the specifiers for MDD
Severity
Remission status
Psychotic Features
descriptors - seasonal pattern, post partum onset, atypical features, mood congruent/incongruent psychotic features catatonia, etc.
What does the course of MDD usually look like
- long prodromal phase
- most severe is the first episode/symptom
- ## second and subsequent ones are less severe due to treatment
symptoms of persistent depressive disorder?
Depressed mood
and
2+ of
- Poor appetite or overeating.
- Insomnia or hypersomnia.
- Low energy or fatigue.
- Low self-esteem.
- Poor concentration or difficulty making decisions.
- Feelings of hopelessness.
persistent depressive disorder?
A. Depressive mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2 year period of the disturbance, the individual has never been without the symptoms of Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders.
G. The symptoms are not attributable to the physiological effects of a substance or another medical condition.
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Difference between MDD and PDD
- no suicidal ideation
- no psychomotor agitation
- 2 years vs 2 weeks
How long can PDD people be without symptoms for
2 months in 2 years
Depression vs. dementia?
Elderly people complaining of memory difficulties may be experiencing a Major Depressive Episode (pseudodementia).
Needtoassess:onsetandsequenceofbothcognitive and depressive symptoms, family history, treatment response.
In MDE cognitive state is usually normal until onset of depressive symptoms. Dementia usually presents with history of decline in cognitive functions.
two types of factitious disorders?
Factitious disorder Imposed on Self
Factitious disorder Imposed on Others (= ‘FD by proxy’)
Factitious disorder?
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
B. The individual presents himself or herself to others as ill, impaired, or injured.
C. The deceptive behaviour is evident even in the absence of obvious external rewards.
D. The behaviour is not better explained by another disorder, such as delusional disorder or another psychotic disorder.
Factitious vs malingering?
NO MOTIVE OR BENEFIT in factitious
