Major Depressive Disorder

Question 1

Diagnostic Criteria for MDD (DSM)
- Part A

Answer 1

5 (or more) of the following symptoms have been present during the same 2wk period & represent a change from previous functioning; at least 1 of the symptoms is either depressed mood or loss of interest or pleasure (anhedonia):
NOTE: doesn’t include symptoms that are clearly attributable to another medical condition.

• S = sleep: insomnia or hypersomnia nearly every day.
• I = interest decreased/diminised (anhedonia) in all or almost all activities most of the day, nearly every day (indicated by subjective account or observation).
• G = guilt; feelings of worthlessness or inappropriate guilt (which may be delusional) nearly every day (not merely self-reporach or guilt about being sick).
• E = energy decreased; fatigue nearly every day.
• D = depressed moost 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: can be irritable mood in children & adolescents.
• C = concentration decreased; diminshed ability to think or concentrate, or indecisiveness, nearly every day.
• A = appetitie is increased or decreased causing either significant weight loss when not dieting or weight gain.
• P = psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) e.g. slowed speech, decrease motivation.
• S = suicide; 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.

Question 2

Diagnostic Criteria for MDD (DSM)
- Part B

Answer 2

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 3

Diagnostic Criteria for MDD (DSM)
- Part C

Answer 3

The epidsode isn’t attributable to the physiological effects of a substance or to another medical condition.

Question 4

Criteria A - C represent a ____________.

Answer 4

major depressive disorder episode

Question 5

Diagnostic Criteria for MDD (DSM)
- Part D

Answer 5

The occurrence of the major depressive episode isn’t better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or
other specified and unspecified schizophrenia spectrum & other psychotic disorders.

Question 6

Diagnostic Criteria for MDD (DSM)
- Part E

Answer 6

There has never been a manic or hypomanic episode before.

Question 7

Grief vs Major Depressive Episode (MDE)

Answer 7

• Grief
• predominant affect is feelings of emptiness & loss. - the dysphoria in grief is likely to decrease in intensity over days to wks & occurs in waves, the so-called pangs of grief. These waves tend to be associated with thoughts or reminders of the deceased.
• self-esteem is generally preserved.

*MDE
- persistent depressed mood & inability to anticipate happiness or pleasure.
- the persistent depressed moost isn’t tied to specific thoughts or preoccupations.

Question 8

Depressed mood

Answer 8

• must be present for most of the day, in addition to being present nearly every day.
• often described as depressed, sad, hopeless, discourage, or “down in the dumps”.
• presence of depressed mood can be inferred from the person’s facial expression & demeanor.
• many individuals report or exhibit increased irritability (e.g. persistent anger, a tendency to respond to events with angry outbursts or blaming others)
• in children & adolescents = irritable or cranky mood.

Question 9

Loss of interest or pleasure / Anhedonia

Answer 9

• nearly always present, at least to some degree.
• feeling less interested in hobbies, “not caring anymore”, or not feeling any enjoyment in activities that were previously considered pleasurable.
• family members often notic social withdrawal or neglect of pleasurable avocations.
• in some individuals, there is a significant reduction from previous levels of sexual interest or desire.

Question 10

Appetite change - either increased or decreased

Answer 10

• some depressed individuals report that they have to force themselves to eat.
• others may eat more & may crave specific foods (e.g. sweets or other carbohydrates)
• severe appetite changes causes either significant loss or gain in weight.
• in children, a failure to make expected weight gains may be noted.

Question 11

Sleep disturbance - insomnia/hypersomnia

Answer 11

• insomnia (difficulty sleeping) = takes the form of middle insomnia (i.e. waking too early & being unable to return to sleep) or terminal insomnia (i.e. waking too early & being unable to return to sleep) & initial insomnia (difficulty falling asleep).
• hypersomnia (oversleeping) = experience prolonged sleep episodes at night or increased daytime sleep.

Question 12

Psychomotor changes - agitation or retardation

Answer 12

• includes:
• Agitation = inability to sit still, pacing, hand-wringing; or pulling or rubbing of the skin, clothing, or other objects.
• Retardation = slowed speech, speech that is decreased in volume, inflection, amount, or varitey of content, or muteness; slowed thinking, & body movements; increased pauses before answering.

Question 13

Energy decreased

Answer 13

• tiredness & fatigue are common
• a person may report sustained fatigue without physical exertion.
• even the smallest tasks seem to require substantial effort.
• efficiency with which tasks are accomplished may be reduced.
• e.g. an individual may complain that washing & dressing in the morning are exhausting & take 2x as long as usual.

Question 14

Guilt - sense of worthlessness

Answer 14

• ## includes unrealistic negative evaluations of one’s worth or guilty preoccupations or ruminations over minor past failings.