Session-10 The Depressive Disorders Flashcards
What are the DSM-IV-TR Depressive Disorders?
Major Depressive Disorder
- Single Episode - Recurrent
Dysthymic Disorder
Depressive Disorder NOS
What is the DSM-IV-TR: Diagnostic Criteria for Major Depressive Episode?
Presence of a Major Depressive Episode: 5 or more symptoms during the same 2-week period; at least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure (anhedonia).
- Sxs do not meet criteria for Mixed Episode.
- Clinically significant distress/impairment.
- Sxs not due to substance
- Sxs not better accounted for by Bereavement
What is the DSM-IV-TR: Major Depressive Disorder: Complete Diagnostic Criteria?
A. Presence of one or more Major Depressive Episodes (Single Episode vs. Recurrent).
B. MDE not better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or psychotic disorder NOS.
C. No history of manic, hypomanic or mixed episode(s).
What are the DSM-IV-TR: Major Depressive Disorder: Specifiers (see p. 375 and 412)?
Mild
Moderate
Severe Without Psychotic Features (review closely p. 412)
Severe With Psychotic Features (specify whether psychotic features are mood-congruent or mood-incongruent) (see p. 412)
Chronic: full criteria for MDE have been met continuously for at least 2 years
With Catatonic Features:
- Motoric immobility as evidenced by catalepsy (incl. waxy flexibility) or stupor
- Excessive motor activity (purposeless)
- Extreme negativism (resistance to instruction or rigid posture against attempts to be moved) or mutism
- Peculiarities of movement
- Echolalia (automatic/involuntaryrepetition of vocalizations/sounds/languagemade by another person) or echopraxia (the involuntary repetition or imitation of another person’s actions)
With Melancholic Features
- Loss of interest in all activities or a lack of reactivity to usually pleasurable stimuli – NOTE: almost a complete absence of the capacity for pleasure
- Depressed mood does not improve, even temporarily, when something good happens
- Also, at least 3 of the following:
Distinct quality of the depressed mood (clearly unlike bereavement) Depression worse in the morning Early morning awakening Psychomotor agitation/retardation Anorexia/weight loss Excessive or inappropriate guilt
With Atypical Features:
- Mood reactivity (capacity to be cheered up when presented with positive events)
- 2 or more of the following:
- Significant weight gain or increase in appetite
- Hypersomnia
- Leaden paralysis (feeling heavy, leaden, or weighted down, usually in the arms or legs)
- Long-standing pattern of interpersonal rejection sensitivity
With Postpartum Onset:
Onset within 4 weeks postpartum
Longitudinal Course Specifiers:
With and Without Full Interepisode Recovery
With Seasonal Pattern:
- Temporal relationship between onset of major depressive episodes and a particular time of the year
- Full remissions also occur at a characteristic time of year
- MDEs in the past two years that demonstrate above pattern
- Seasonal episodes outnumber non-seasonal episodes
What is catatonia?
Motor immobility as evidenced bycatalepsy(includingwaxy flexibility) orstupor;
Excessive motor activity (purposeless, not influenced by external stimuli);
Extreme negativism (resistance to all instructions or maintenance of a rigid posture against attempts to be moved);
Peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
What is waxy flexibility?
Apsychomotor symptomofcatatonic schizophrenia which leads to a decreased response to stimuli and a tendency to remain in an immobile posture.
For instance, if one were to move the arm of someone with waxy flexibility, they would keep their arm where one moved it until it was moved again, as if it were made from wax.
What is catatonic stupor?
A form of catatonia characterized by a marked decrease in response to the environment with a reduction in spontaneous movement. Patients with this disorder sometimes appear unaware of their environment
What are the DSM-IV-TR: Major Depressive Disorder: Recording Procedures?
Major Depressive Disorder:
-296.xx
-Fourth digit:
If single episode: 2
If recurrent episodes: 3
-Fifth digit: Indicates severity If criteria for MDE are currently met: 1 Mild Severity 2 Moderate Severity 3 Severe without Psychotic Features 4 Severe with Psychotic Features
If criteria for MDE are NOT currently met:
5 In Partial Remission (no sxs, but less than 2 months OR some sxs, but full criteria no longer met)
6 In Full Remission (no sxs for ≥ 2 months)
Additional specifiers not coded by number
What are the DSM-IV-TR: Major Depressive Disorder: Differentials?
Manic, Mixed or Hypomanic Episodes: if these mood episodes are present, will NOT meet criteria for MDD.
Mood Disorder Due to a General Medical Condition: diagnose if mood disturbance is judged to be direct physiological consequence of a specific medical condition.
Substance-Induced Mood Disorder: mood disturbance due to a substance.
Adjustment Disorder With Depressed Mood: diagnose if mood disturbance does not meet criteria for a Major Depressive Episode and symptoms are in response to a psychosocial stressor.
Dysthymic Disorder: diagnose if depressed mood present for more days than not over a period of at least 2 years; chronic, less severe depressive symptoms present for many years.
Schizoaffective Disorder: diagnose if 2 weeks of delusions or hallucinations occurring in the absence of prominent mood symptoms (vs. MDD, With Psychotic Features).
What is diagnostic criteria for
DSM-IV-TR: Dysthymic Disorder?
A. Depressed mood for most of the day, more days than not, for at least 2 years
B. Presence, while depressed, of 2 or more of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
C. During the 2-year period, person has not been without symptoms for more than 2 months at a time
D. No MDE during first 2 years of disturbance
E. No h/o manic, hypomanic, mixed episode; person does not meet criteria for cyclothymic disorder
F. Episode not exclusively in the context of psychotic disorder Specifiers: -Early onset: before age 21 -Late Onset: age 21 or older -With Atypical Features
What are DSM-IV-TR Dysthmic Disorder: Differentials?
MDD: diagnose if one or more Major Depressive Episodes are present that is different from person’s usual functioning.
Psychotic Disorder (Schizoaffective, Schizophrenia, Delusional Disorder): diagnose if mood symptoms occur only during the course of the Psychotic Disorder.
Mood Disorder Due to a General Medical Condition:
Personality Disturbance: diagnose if pervasive ongoing pattern of mood disturbance; diagnose both Dysthymic and PD if criteria are met.
What are the DSM-5 “Depressive Disorders”?
- Disruptive Mood Dysregulation Disorder
- Major Depressive Disorder
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
- Substance/Medication Induced Depressive Disorder
- Depressive Disorder Due to Another Medical Condition
- Other Specified Depressive Disorder
- Unspecified Depressive Disorder
What are the DSM-5 “Depressive Disorders”: Huge List of Specifiers?
see pp. 184-188
What is diagnostic criteria for
DSM-5 Disruptive Mood Dysregulation Disorder?
A. severe recurrent temper outbursts manifested either verbally or behaviorally that is grossly out of proportion to intensity or duration to provocation.
B. temper outbursts inconsistent with developmental level
C. temper outbursts three or more times a week
D. mood between temper outbursts is irritable or angry predominantly and is observable by others.
E. A-D lasting through 12 months or more without asymptomatic period (three or more consecutive months)
F. A-D present in two of three settings (e.g. home, school peers) and severe in one of these situations
G. dx. Should not be made before age 6 or after 18 for the first time.
H. Onset of A-E before 10 years
I. No manic or hypomanic episode
J. Beh. not exclusively during MDD andnot explained by another mental disorder
Note: cannot co-exist with ODD, intermittent explosive disorder, or bipolar. If ODD and disruptive mood dysregulation disorder then disruptive mood dyreg. Disorder supersedes.. If manic or hypomania and disruptive mood dysregulation disorder, then bipolar etc supersesdes.
K. Not due to substance, GMC or neurobiological condition.
What is diagnostic criteria for
DSM-5 Persistent Depressive Disorder(Dysthymia)?
This disorder is a consolidation of chronic major depressive disorder (ongoing MDEs) and dysthmic disorder.
A. depressed mood for at least two years
(Note: in children and adolescents, mood can be irritable and last at least one year)
B. Presence, while depressed, of two or more:
1. poor appetire or overeating
2. insomnia or hypersomnia
3. fatigue
4. low-esteem
5. poor concentration or indecisive
6. hopelessness
