MAPD lecture 3 Flashcards
(41 cards)
What is the current diagnostic approach to depression in the ICD-11?
The ICD-11 conceptualizes depression as a syndrome consisting of clinically recognizable symptoms and observed behaviors causing distress and functional impairment. A diagnosis requires at least five of ten symptoms to be present most of the day, nearly every day, for at least two weeks. Either depressed mood or loss of interest/pleasure must be one of the symptoms.
what is the only symptom included in the ICD-11 but not in the DSMs?
“Hopelessness about the future”. it is shown to differentiate those without depression to those with.
what other symptom should probably be added to the lists?
“diminished drive”, outperformed almost all those that are currently listed, and should probably be added to the list.
why is the number of symptoms required for diagnosis in both the DSM and the ICD controversial?
studies reported that subthreshold depressions (presence of less than five symptoms) didn’t differ from diagnosable depression with respect to risk for future depressive episodes, family history of mental illness, psychiatric and physical comorbidity, functional impairment, and predictions of response to treatment.
what are the nuclear depressive syndrome and the melancholic subtype of depression?
nuclear depressive syndrome resembles the melancholic subtype of depression. it has more common vegetative symptoms, higher frequency of suicide attempts, and higher risk for depression in siblings.
what is the debate regarding melancholia?
it is whether melancholia represents a distinct disease entity or corresponds to the most severe manifestation of depression. several people with recurrent depression experience some episodes which are melancholic and some others which are not so this argues in favour of the latter.
continuous vs categorical depression?
continuous: there isn’t a clear-cut line separating “normal sadness” from “clinical depression”—instead, there’s a gradual spectrum from mild to severe distress.
categorical: it is a distinct mental illness separate from ordinary sadness.
Why is defining a threshold for depression diagnosis problematic?
If the threshold is too low, normal sadness may be medicalized, leading to unnecessary treatment. If too high, people with real depression may fail to seek help.
What criteria have been proposed for diagnosing subsyndromal depression?
One common approach requires at least one core depressive symptom (depressed mood or loss of interest) most of the time for at least two weeks. Another alternative is having any two depressive symptoms for at least two weeks, along with social dysfunction.
How do the DSM and ICD define mild, moderate, and severe depression?
Based on the number and intensity of symptoms and functional impairment, but these definitions lack empirical validation and are rarely used in clinical practice.
What is the PHQ-9, and how is it used?
The PHQ-9 is a widely used 9-item self-report questionnaire based on DSM criteria, assessing depression severity on a 4-point scale. A cutoff score of 10 or more maximizes sensitivity (0.88) and specificity (0.85) in detecting depression. Using only the first two items (low mood and anhedonia) initially and proceeding with the full questionnaire if either is endorsed yields similar diagnostic accuracy.
What is the “network perspective” on depression? (hehe)
It views depression as a complex network of interacting symptoms rather than a simple sum of symptoms.
Why might the traditional sum-score approach to depression severity be flawed?
Different symptoms may carry different weights in determining severity; “depression sum-scores don’t add up.”
What distinguishes complicated depression from uncomplicated depression?
Complicated depression includes at least one of the following: psychomotor retardation, psychotic symptoms, suicidal ideation, or a strong sense of worthlessness/guilt.
Why is distinguishing between complicated and uncomplicated depression important?
Complicated depression predicts severity better than the standard number-of-symptoms approach and may guide treatment choices.
How can the nature of depressive symptoms influence treatment selection?
Symptoms like psychotic features or severe suicidality might warrant pharmacotherapy, while milder cases could respond better to cognitive-behavioral therapy (CBT).
What concern do some researchers have about the current operational definitions of depression?
They argue that defining depression in operational terms might oversimplify its psychopathology, failing to capture the subjective experience of those affected.
How do subjective experiences of depression differ from normal negative moods like sadness or despair?
Studies suggest that people with depression describe their experiences differently, often noting physical symptoms (aches, pains, fatigue) and a sense of detachment that aren’t emphasized in diagnostic criteria.
Do somatic symptoms play a role in depression?
Yes, a review found that headaches, general aches and pains, and heart-related symptoms (palpitations, heavy heart, heart pain) are frequently reported across populations.
How does the network approach view somatic symptoms in depression?
It suggests that sympathetic arousal (palpitations, tremors, blurred vision, sweating) is central to the depression network and strongly linked to other somatic complaints like limb heaviness and pain.
What are some common specifiers used in depression diagnosis?
Melancholic, atypical, psychotic features, peripartum onset, and seasonal pattern.
How might depression present differently in some men?
In some cases, depression in men may be part of an externalizing spectrum, including anger attacks, aggression, substance abuse, and risk-taking behaviors.
What qualifies a depressive episode as having psychotic symptoms in ICD-11?
Presence of delusions or hallucinations during the episode.
Q: How does DSM-5 define atypical depression, and how does it differ from melancholic depression?
Atypical depression includes increased appetite, weight gain, and excessive sleep, whereas melancholic depression involves loss of appetite and insomnia.
