Week Three - Mood Disorders Flashcards
Major Depressive Disorder (MDD)?
Clinically significant sadness associated with cognitive and somatic changes.
Episodic disorder: periods of normal mood in between periods of depression
If you have one depressive disorder, likely to have another
DSM-5 criteria for MDD (A)
A. Five or more of the following within the same 2 week period for most/all of the day
- depressed mood OR markedly diminished interest or pleasure in most/all activities
- sig weight loss/gain
- insomnia or hypersomnia
- psychomotor agitation/retardation
- fatigue or loss of energy
- worthlessness/guilt
- diminished ability to think/concentrate
- thoughts of death, suicide
B. Symptoms must cause clinical distress/impairment
C. Not attributable to the physiological effects of substance/other medical condition
D. Symptoms not better explained by another disorder
E. No manic or hypomanic episode
Anhedonia?
Not caring anymore, or the person may complain of loss of interest but family/friends observe them neglecting activities and being withdrawn
MDD defined generally?
5 or more of the following experienced in 2 weeks for most of day if not all
- sig weight loss/gain
- insomnia or hypersomnia
- psychomotor agitation/retardation
- fatigue or loss of energy
- worthlessness/guilt
- diminished ability to think/concentrate
- thoughts of death, suicide
Must never have been manic/hypomanic, not explained by another disorder, substance or med condition and causes distress/impairment
Clinical features of MDD
Prevalence: 14.4%
Onset: 30.5 years (decreasing)
Gender: higher rates in women
Relapse: risk is high but lowered when CBT and medication
Suicide ideation?
Thoughts about ending life - common in depression
Non-suicidal self-injury?
Aims to cause harm but not die
When you have someone with MDD what must you always do?
Assess for a history of mania/hypomania as it will exclude them from being diagnosed with MDD
Dysthymia DSM-5 criteria (A)
A. depressed mood most of the day/more days than not (subjective or observation) for at least 2 years
B. 2 or more of the following while depressed:
- poor appetite/overeating
- insomnia/hypersomnia
- low energy or fatigue
- low self-esteem
- poor concentration
- feelings of hopelessness
C. Has not been without symptoms A or B for more than 2 months at a time (within 2 year period)
D. Criteria for MDD may be present for more than 2 years
E. Never been manic or hypomanic
F. Not better explained by another mental disorder
G. Symptoms are not due to substance use or medical condition
H. Symptoms cause clinically significant distress and impairment
Dysthymia defined generally?
depressed mood which has lasted most days for at least 2 years with 2 of these without more than 2 months of going away:
- poor appetite/overeating
- insomnia/hypersomnia
- low energy or fatigue
- low self-esteem
- poor concentration
- feelings of hopelessness
Must never have been manic/hypomanic, not explained by another disorder, substance or med condition and causes distress/impairment
MDD and PDD often experience ??
Anxiety disorders
substance use disorders
personality disorders
Specifiers?
Some disorders in DSM have specifiers - an ‘add-on’ to the primary diagnosis which describes the individual presentation with more clarity
MDD and PDD can be made with the following specifiers?
With anxious distress •With mixed features •With melancholic features •With atypical features •With mood-congruent psychotic features •With mood-incongruent
MDD only specifiers?
Catatonia
Seasonal pattern
Specifiers?
mixed features melancholic features psychotic features (delusions/hallucinations) atypical features catatonia peripartum onset seasonal pattern
Which specifier is most well researched/validated?
Seasonal pattern
Disruptive Mood Dysregulation Disorder (DMDD)
New diagnosis in DSM-5
Children aged 6-18
- addresses excessive bipolar diagnosis
Persistent irritability and frequent episodes out of control behaviour
- highly contentious due to lack of rigor
DSM-5 DMDD criteria (A)?
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviourally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation
B. The temper outbursts are inconsistent with developmental level
C. The temper outbursts occur, on average, 3 or more times per week
D. The mood between temper outbursts is persistently
irritable or angry most of the day, nearly every day, and is
observable by others
E. Symptoms A-D have been present for more than 12
months. Throughout that time, the individual has not had
a period lasting 3 or more consecutive months without
symptoms A-D
F. Criteria A and D are present in at least two settings (i.e., at home, at school , with peers) and are severe in at least
one of these.
G. The diagnosis should not be made for the first time in
children <6 or when aged >18.
H. The age of onset for criteria A-E is <10
I. There has never been a distinct period lasting >1 day
where the person has met criteria for manic or hypomanic
episode
J. The behaviours do not occur exclusively within an episode of MDD and are not better explained by another mental disorder
K. The symptoms are not attributable to the physiological
effects of a substance or other medical or neurological
condition.
DMDD defined generally?
People who are seen by others as angry/poor mood most days with severe outbursts of anger and violence 3 or more times a week in 2 or more setting (home, school etc) that are unproportionate to situation and inconsistent with developmental level, occurring for more than 12 months without being ‘normal’ for more than 3 months in that period. Person is older than 6 but younger than 18, no manic/hypomanic episodes behaviour do not occur within MDD or another MH/medical condition or substance
