6. Specific Disorders - Depressive Disorders Flashcards Preview

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Flashcards in 6. Specific Disorders - Depressive Disorders Deck (32):
1

What is the difference between mood and affect?

Mood: More pervasive or sustained emotion, colors experiences and perceptions of the world.

Affect: Reflects the fluctuating changes in emotion from moment to moment. It is a pattern of observable behaviors.

Affect is to weather as mood is to climate.

2

Explain introjective and anaclitic depression.

Include citations.

Introjective: denotes achievement concerns, and is characterized by a tendency towards self-criticism and self-evaluation (Freud, 1917).

Anaclitic: excessive interpersonal concerns, including feelings of loneliness, weakness, helplessness and abandonment fears (Spitz, 1945).

3

Provide some cultural examples of depression in different cultures.

▪ Nerves and headaches in Latino culture
▪ Weakness, tiredness, or imbalance in Asian cultures
▪ Problems of the heart in Middle Eastern cultures
▪ Western culture tends to value positive emotions
and feelings, feeling good about oneself, autonomy,
and independence

4

What criteria need to be met for a Major Depressive Episode?

A. 5 or more of the following list in the same 2 week period, One of the symptoms MUST be depressed mood or loss of interest or pleasure:
I’M SAD (WEPT)
Inadequate Self-Esteem
Depressed Mood
Sleep - insomnia or hypersomnia
Anhedonia - diminished interest or pleasure
Death
Weight - gain or loss (children – can be failure to
make weight gains)
Energy Loss or Fatigue
Psychomotor – agitation or retardation
Thoughts – Diminished concentration;
indecisiveness (observed by others)

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

C. The episode is not attributable to the physiological effects of a substance or another medical condition.

To be diagnosed:
▪ Must not be a mixed episode
▪ Not due to bereavement

5

For Major Depressive Disorder to be diagnosed, you must have __________.

The presence of a depressive episode.

6

What makes MDD recurrent?

If two or more major depressive episodes occur with two or more months between them.

7

What is the suicide risk for someone with MDD?

Up to 15%

Females are more likely to attempt suicide, but males are more likely to be successful.

Increased completed suicide risk occurs in individuals who are male, living alone, and having prominent feelings of hopelessness. Having BPD increases risk for future suicide attempts.

8

What is the prevalence rate of MDD?

Total: 7% for 12 months

Note: 3x higher in 18-29 yo than in 60+, and females are 1.5 - 3x higher than males beginning in early adolescence.

APA, 2000
▪ 10% to 25% for women and from 5% to 12% for men
▪ Average onset is mid-20’s

9

In addition to criteria A-C for a major depressive episode, to be diagnosed with MDD you must also meet criteria:

D: The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

E. A manic or hypomanic episode (unless they are substance induced or due to another medical condition.

10

When is the average onset of MDD?

mid-20's

11

What is the likelihood of experiencing another episode after first, second, and third episodes?

First - 60%

Second - 70%

Third - 90%

12

For someone who has a first degree relative with depression, how much more likely are they to have MDD?

1.5 - 3x more likely

People whose second degree relatives are also more likely

13

After a major depressive episode, how long can symptoms linger?

Full or partial symptoms can linger even after a year.

14

What are the specifiers for MDD?

Severity/course: Mild, Moderate, Severe, w/ psychotic features, in partial remission, in full remission, and unspecified

Codes for current episode:
With anxious distress
With mixed features
With melancholic features
With atypical features
With mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset
With seasonal pattern

15

What is important to rule out for differential diagnosis of MDD?

1. Manic episodes with irritable mood or mixed episodes
2. Mood disorder due to another medical condition
3. Substance/medication induced depressive or bipolar disorder
4. ADHD
5. Adjustment disorder with depressed mood - full criteria for major depressive episode not met
6. Sadness

16

What are the diagnostic criteria for Persistent Depressive Disorder (Dysthymia)?

A. Depressed mood for most of the day for at least 2 years

B. Presence, while depressed, of two or more of the following (ASH ICE)
Appetite
Sleep
Hopelessness
Inadequate self-esteem
Concentration
Energy - low or fatigue

C. During the 2-year period (1 for children/adolescents) the individual was never without the symptoms in criterion A or B for more than two months at a time.

D. Criteria for MDD may be continuously present for 2 years.

E. No manic or hypomanic episodes, and criteria not met for cyclothymic disorder.

F. Not better explained by szhioaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum or psychotic disorder.

G. Not due to a substance or other medical condition.

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

17

PDD is early onset if it occurs......

PDD is late onset if it occurs......

...... before the age of 21 years.

...... at age 21 years or older.

18

What is known about the comorbidity of MDD and other disorders?

Frequently occurs with: substance related disorders, panic disorder, OCD, anorexia nervosa, bulimia nervosa, and borderline personality disorder

19

What is known about the comorbidity of Persistent Depressive Disorder/Dysthymia and other disorders?

Compared to those with MDD, those with persistent depressive disorder are at higher risk for psychiatric comorbidity in general, and for anxiety disorders and substance use disorders in particular.

Early-onset PDD is strongly associated with DSM-IV Cluster B and C personality disorders.

20

List all DSM-5 Depressive Disorders (p. 155)

1. Disruptive Mood Dysregulation Disorder (156)
2. Major Depressive Disorder (160)
3. Persistent Depressive Disorder (Dysthymia; 168)
4. Premenstrual Dysphoric Disorder (171)
5. Substance/Medication-Induced Depressive Disorder (175)
6. Depressive Disorder Due to Another Medical Condition (180)
7. Other Specified Depressive Disorder (183)
8. Unspecified Depressive Disorder (184)

21

What is the core feature of Disruptive Mood Dysregulation Disorder?

Chronic, severe persistent irritability that has two clinical manifestations, 1) frequent temper outbursts, and 2) chronic, persistently irritable mood that is characteristic of the child and present between the outbursts.

22

List the diagnostic criteria for Disruptive Mood Dysregulation Disorder.

A. Severe recurrent temper outbursts manifested verbally and/or behaviorally that are out of proportion to the situation
B. Outbursts are inconsistent with developmental level
C. Occur, on average, 3 or more times per week
D. Mood between outbursts is persistently irritable or angry most of the day, every day, and observable by others (parents, teachers, peers)
E. A-D present 12+ months (and no breaks in symptoms for more than 3 months at a time)
F. A and D present in at least 2/3 settings (home, school, peers) and are severe in at least one setting
G. Dx should not be made for the first time before age 6, or after age 18
H. Onset before 10 years old
I. No period of more than 1 day of a manic or hypomanic episode
J. Sx not only present during MDD or another disorder
K. Not attributable to physiological effects of a substance or another medical/neurological condition

23

What is the prevalence of disruptive mood dysregulation disorder among children and adolescents?

2-5% range, but higher in males and school age children vs. adolescents.

24

To diagnose with disruptive mood dysregulation disorder...

Onset must be before the age of 10, and the diagnosis shouldn't be given to a child with a developmental age of less than 6 years.

25

What is known about the comorbidity of disruptive mood dysregulation disorder and other disorders?

Comorbidity is extremely high, as it is rare that symptoms meet criteria for this disorder alone. It most often overlaps with Oppositional Defiant Disorder.

26

What should be known about differential diagnosis of Disruptive Mood Dysregulation Disorder?

It is especially important to properly differentiate it from bipolar disorder and oppositional defiant disorder.
Central feature differentiating disruptive mood dysregulation disorder and bipolar disorders in children is the longitudinal course of the core symptoms. In this disorder, the irritability is present and NOT episodic as it is in bipolar disorders. Also, the presence of expansive mood and grandiosity is characteristic of bipolar disorders and not mania.

It is also important to differentiate it from ADHD, major depression, anxiety disorders, autism spectrum, and from intermittent explosive disorder (159).

27

What are risk factors for MDD?

Temperamental - Neuroticism (negative affectivity) is a well established risk factor

Environmental - Adverse childhood experiences

Genetic/Physiological - 1st degree family members of individuals with major depressive disorder have 2-4x higher risk for MDD, and risks are higher for early-onset and recurrent forms. Heritability is approximately 40% and neuroticism accounts for a substantial portion of that genetic liability

Course modifiers - Substance use, anxiety, borderline personality disorders, chronic illness (esp. morbid obesity, diabetes, and cardiovascular disease)

28

What are some culture-related diagnostic issues for MDD?

In most countries cases of depression go unrecognized in primary care settings, and in many cultures somatic symptoms are likely to constitute the presenting complaint - in particular insomnia and loss of energy.

29

What is the current 12-month prevalence in the U.S. of persistent depressive disorder?

Of chronic major depressive disorder?

.5%

1.5%

30

List some risk and prognostic factors for persistent depressive disorder (dysthymia).

Temperamental - Neuroticism, greater symptom severity, poorer global functioning, and presence of anxiety disorders or conduct disorder

Environmental - Parental loss of separation

Genetic/Physiological - Likely that individuals with persistent depressive disorder will have a higher proportion of first-degree relatives than do individuals with MDD and other depressive disorders in general. Some brain regions (PFC, anterior cingulate, amygdala, hippocampus) have been implicated, and it's possible there are polysomnographic abnormalities also.

31

What is important to know for differential diagnosis of persistent depressive disorder and other disorders?

1. Major Depressive Disorder - The diagnosis depends on the two year duration, which distinguishes it from episodes of depression that don't last two years
2. Psychotic Disorders - Don't diagnose if symptoms only occur during the course of a psychotic disorder, including the residual phases
3. Depressive or bipolar and related disorder due to another medical condition
4. Substance/medication-induced depressive or bipolar disorder
5. Personality disorders - if an individual's presentation meets criteria for both, then both diagnoses can be given

32

What is important to know about differential diagnosis of premenstrual dysphoric disorder and other disorders?

It should be distinguished from:
1. Premenstrual syndrome
2. Dysmenorrhea - painful menses, but distinct from one with affective changes. It also occurs at the onset of menses
3. Bipolar disorder, major depressive disorder, and persistent depressive disorder (dysthymia) - women with these diagnoses will often mis-attribute their symptoms to their cycle and being cycle specific
4. Use of hormonal treatments