Depressive Disorders (Midterm) Flashcards
(11 cards)
Depressive disorders - disruptive mood dysregulation disorder
This is a chronic, severe, persistent, irritability and frequent episodes of extreme behavioral dyscontrol for children up to 12 years of age.
The onset of symptoms must be before age 10, and a DMDD diagnosis should not be made for the first time before age 6 or after age 18.
Children with this symptom pattern typically develop unipolar depressive disorders or anxiety disorders, rather than bipolar disorders
It has 2 clinical manifestations
a. Frequent temper outbursts: these occur in
response to frustration and can be verbal or behavioral. These must occur frequently—3 or more times per week
a. Chronic, persistently irritable or angry mood that is present between the severe temper outbursts. This must be characteristic of the child, being present most of the day, nearly every day, and noticeable by others.
The behavior persists for 12 months or more without a period of at least 3 months free of symptoms.
Differential Diagnosis for disruptive mood dysregulation disorder
Differential diagnosis: oppositional defiant behavior, bipolar disorders, major depressive disorder, anxiety disorder, intermittent explosive disorder, ADHD.
Major depressive disorder
Major depressive disorder is diagnostic when five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning.
* One of the symptoms must be either depressed mood or loss of interest or pleasure.
Depressed mood most of the day, or nearly every day.
b. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, or nearly every day.
c. Significant weight loss without dieting or weight gain, or decreased or increase appetite nearly every day.
d. Insomnia or hypersomnia nearly every day.
e. Psychomotor agitation or retardation nearly every day.
f. Fatigue or loss of energy nearly every day.
g. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
h. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
i. Recurrent thoughts of death, recurrent suicidal ideation without specific plans, or suicidal attempts.
Persistent Depressive Disorder (Dysthymia)
Persistent depressive disorder (dysthymia) is characterized by a depressed mood that occurs for most of the day, for more days than not, for at least 2 years, or at least 1 year for children and adolescents.
Present while depressed will be two or more of the following:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue Low self-esteem
Poor concentration or
difficulty making
decision
Feeling of hopelessness
Symptoms become part of their day to day life
Major depression may precede persistent depressive disorder, and major depressive episodes may occur during persistent depressive disorder.
Premenstrual Dysphoric Disorder
This is the expression of mood lability irritability, dysphoria, and anxiety symptoms that occur repeatedly during the pre- menstrual phase of the cycle and remit around the onset of menses or shortly thereafter.
Diagnostic criteria
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post- menses.
B. One or more of the following symptoms must be present:
Marked affective lability (e.g. mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).
Marked irritability or anger or increased interpersonal conflicts.
Marked depressed mood, feelings of hopelessness, or self- deprecating thoughts.
Marked anxiety, tension, and or feelings of being keyed up or on the edge.
C. One or more of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from criterion B above.
Decreased interest in usual activities
Subjective difficulty in concentration
Lethargy, easy fatigability, or marked lack of energy
Hypersomnia or insomnia
A sense of being overwhelmed or out of control
Physical symptoms such as breast tenderness or swelling,
joint or muscle pain, a sensation of “bloating” or weight gain.
Delusions and hallucinations have been described in the late luteal phase of the menstruation cycle but are rare.
The premenstrual phase has been considered by some to be a risk period for suicide.
The diagnosis of premenstrual Dysphoric disorder is appropriately confirmed by 2 months of prospective symptom ratings.
Differential Diagnosis for Premenstrual Sysphoric Disorder
Differential diagnosis
Delusions and hallucinations have been described in the late luteal phase of the menstruation cycle but are rare.
The premenstrual phase has been considered by some to be a risk period for suicide.
The diagnosis of premenstrual Dysphoric disorder is appropriately confirmed by 2 months of prospective symptom ratings.
Premenstrual syndrome—premenstrual syndrome does not require a minimum of five symptoms and there is no stipulation for affective symptoms.
Dysmenorrheal—this is a syndrome of painful menses, with symptoms beginning with the onset of menses not before as in premenstrual Dysphoric disorder.
Bipolar disorder, major depressive disorder, persistent depressive disorder (dysthymia).
Substance/Medical Induced Depressive Disorder
This is a prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all activities; however, the depressive symptoms are associated with the ingestion, injection, or inhalation or a substance (e.g. drug of abuse, toxin, psychotropic medication, or other medications).
There are different ICD codes for intoxication due to alcohol, phencyclidine, other hallucinogens, inhalants, opioids, sedatives, amphetamines, and cocaine.
Depressive Disorder due to medical condition
- This is a prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all activities; however, the depressive symptoms are thought to be related to the direct physiological effects of another medical condition.
Other specified depressive disorder
This category applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders
The “other specified” disorders include:
a. Recurrent brief depression: concurrent presence of depressed mood and at least four other symptoms of depression for 1-13 days at least once per month but not associated with the menstrual cycle.
b. Short-duration depressive episode (4-13 days): depressed affect and at least four of the other eight symptoms of a major depressive episode that persist for more than 4 days, but less than 14 days without meeting the criteria of other depressive or bipolar disorder.
C. Depressive episode with insufficient symptoms: depressed affect and at least one of the other 8 symptoms of a major depressive episode associated with clinically significant distress or impairment that persist for at least 2 weeks in an individual whose presentation has never met the criteria for any other depressive or bipolar disorder.
Unspecified Depressive Disorder
This category applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class.
This class is used in situations where the clinician chooses not to specify the reason that the criteria are not met for a specific depressive disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis e.g. in an emergency room setting.
