Depressive Mood disorders Flashcards
Major Depressive Disorder (MDD)
RF
Heritability 40%
First degree relative 2- 4x higher
Concurrent diabetes, obesity and CVD
Poor interpersonal relationships (divorce, isolated)
NO change with socioeconomic status
Major Depressive Disorder (MDD)
Prognosis
Course of MDD is variable as some individuals may never go into remission (absence of symptoms for 2 months)
Recovery begins within 3 months of onset in 40% of individuals and in 1-year in 80% of individuals
Lower recovery rates are seen with features including current episode duration, psychotic features, prominent anxiety, personality disorders, and symptom severity
Episodes can last 6-12 months without tx and 3-6 months with tx
Almost 25% relapse within 6 months, 30-50% within 2 years, 50-75% within 5 years
Major Depressive Disorder (MDD)
Criteria
Time frame
2+ weeks duration
Depressed mood or anhedonia (not enjoying things) PLUS 5+ SIGECAPS sxs
Causes significant distress
Not better explained by another disorder or substance
No history of mania or hypomanic episode
Major Depressive Disorder (MDD)
SIGECAPS
Sleep disturbance- too much or too little
Interest decrease
Guilt and feelings of worthlessness
Energy decrease
Concentration decrease
Appetite changes
Psychomotor agitation or retardation
Suicide
Major Depressive Disorder (MDD)
Major Depressive Disorder (MDD)
Major Depressive Disorder (MDD)
Major Depressive Disorder (MDD)
PHQ-9
Majro depressive disorder
DDx
Bipolar I/Bipolar II
Due to medical condition
Due to substance
Persistent depressive disorder
Premenstrual dysphoric disorder
DMDD
ADHD
Schizophrenia spectrum
Grief
Borderline personality disorder
Normalcy
MDD- Specifiers for depressive disorders
With anxious distress
At least two of the following symptoms for the majority of days of a major depressive episode
Feeling keyed up or tense
Feeling unusually restless
Difficulty concentrating because of worry
Fear that something awful may happen
Feeling that the individual might lose control of himself or herself
Severity
Mild – 2 symptoms
Moderate – 3 symptoms
Moderate-severe – 4-5 symptoms
Severe – 4-5 symptoms with motor agitation
MDD- Specifiers for depressive disorders
With mixed features
At least three of the following
- manic/hypomanic symptoms present nearly every day during most days of a major depressive episode
- Mixed symptoms are observable by others and represent a change from a person’s usual behavior
- If individuals meet criteria for either mania or hypomania diagnosis should be bipolar one and bipolar two disorder (4+ more plus enhanced mood)
- Mixed symptoms are not attributable to a substance or medical condition
MDD- Mixed
Mania Symptoms
Elevated, expansive mood
Inflated self-esteem or grandiosity
Pressure talking or more talkative than usual
Flight of ideas or racing thoughts
Increase energy or goal directed activity
Increase or excessive involvement in activities that have a high potential for painful consequences (i.e. buying sprees, sexual indiscretion, gambling, foolish business investments)
Decreased need for sleep
MDD-
With melancholic features
One of following present during most severe period of episode
- Lost of pleasure in all, or almost all, activities
- Lack of reactivity to usually pleasurable stimuli
Three or more of the following:
1. Distinct quality of depressed mood characterized by profound despondency, despair, empty mood
2. Depression that is typically worse in the morning
3. Early-morning awakening (at least 2 hours earlier than usual)
4. Marked psychomotor agitation or retardation
5. Significant anorexia or weight loss
Excessive or inappropriate guilt
MDD- Specifiers for depressive disorders
With atypical features
This specifier is applied when these features predominate during majority of days of the current episode
- Mood reactivity (mood brightens in response to actual potential positive events)
- Two or more of the following
Significant weight gain or increase in appetite
Hypersomnia
Leaden paralysis
Long-standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment - Criteria not met for with melancholic features or with catatonia
MDD
psychotic features
Psychotic features
Delusions and/or hallucinations are present
With mood-congruent psychotic features
The content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment
With mood-incongruent psychotic features
The concept of delusions or hallucinations does not involve typical depressive things of personal inadequacy, guilt, disease, death, nihilism, or deserve punishment, or the concept is a mixture of mood-incongruent to mood-congruent themes