Depressive Disorders

1. Depressive Disorders

2. Depressive Disorders Includes: 1. Disruptive mood dysregulation disorder 2. Major depressive disorder 3. Persistent depressive disorder 4. Premenstrual dysphoric disorder 5. Substance-induced depressive disorder 6. Depressive disorder due to another medical condition 7. Other specified depressive disorder

3. How Do People Feel? • Sad • Empty • Irritable • Cognitive changes • Somatic changes • All of these significantly affect the individual’s ability to function

4. 1. Disruptive Mood Dysregulation Disorder For children up to 12 years old Children were being over-diagnosed with bipolar disorder Occurs in approx. 2-5% of the child population Higher in males and school-age children than females and adolescents

5. DMDD symptoms • Severe irritability • Have lots of outbursts • Disruption of family and friend relationships • Affects school performance • Low frustration tolerance • Dangerous behaviors • Suicidal ideation • Severe aggression

6. DMDD Diagnostic Criteria • Diagnostic Criteria Include: • Severe recurrent temper outbursts manifested verbally (ex. rages), and/or behaviorally (ex. physical aggression) that are out-of-proportion to the situation or provocation • The outbursts must be inconsistent with the developmental level

7. DMDD Diagnostic Criteria cont’d • The outbursts must occur 3 or more times per week • The mood between the outbursts must be irritable and mostly angry • Everyone needs to observe it (teachers, parents, friends, etc.) • Must be observed across a variety of settings • Must have been going on for a minimum of 12 months • Must be diagnosed between 6 and 10 years old • The behaviors can not be explained by substances, medication, other mental illnesses, or other medical or neurological conditions

8. Differential Diagnosis • You must be careful when diagnosing Disruptive Mood Dysregulation Disorder because it has similar symptoms to: • Oppositional Defiance Disorder (ODD) • Bipolar Disorder • ADHD • Autism Spectrum Disorder

9. 2. Major Depressive Disorder At least 2 weeks duration Carefully have to look at normal sadness and grief and bereavement before diagnosing MDD is usually EPISODIC and SEVERE Figure the rest out on your own!

10. Major Depressive Disorder cont’d • Read the case about major depression and answer the following: • What are the symptoms? • What are the diagnostic criteria for MDD? • What are the risk factors? • What are the “categories” or “specifiers” in MDD? • What can it often be confused with? • What other disorders, if any, is it comorbid with? • What are some treatment options for those diagnosed? • What is the prevalence? Who does it affect most?

11. 3.Persistent Depressive Disorder Also known as DYSTHYMIA Can be diagnosed when the mood disturbance continues for at least 2 years in adults or 1 year in children Not episodic, but CHRONIC Less severe than Major Depressive Disorder Affects 0.5% of the population

12. PDD Risk and Prognosis • More likely to get PDD when • You are younger • Have higher neuroticism • Have a poor GAF score (axis 5) • Have anxiety disorders • Have parental loss or separation as a child • Have it in your family

13. PDD Diagnostic Criteria • Diagnostic Criteria Include: • Depressed mood for most of the day for a period of at least 2 years • Presence, while depressed, of at least 2 or more of the following: • Poor appetite or overeating • Insomnia or hypersomnia • Low energy or fatigue • Low self-esteem • Poor concentration or making decisions • Feelings of hoplessness

14. PDD Diagnostic Criteria cont’d • The criteria for Major Depressive Disorder may be present for the 2 years • There has never been a “manic” episode • The disturbance is not related to any schizophrenic or psychotic disorder • The disturbance is not due to substance or medication use, or another medical condition • The symptoms causes significant distress or impairment in social, occupational, and other important areas of functioning.

15. Differential Diagnosis • You must be careful when diagnosing Persistent Depressive Disorder because it has similar symptoms to: • Major depressive disorder • Psychotic disorders • Depressive disorders related to other medical conditions • Substance-induced depression • Personality disorders

16. 4. Premenstrual Dysphoric Disorder Used to be in the DSM-IV for “further study” It is now recognized as a formal diagnosis (after 20 years of research!) Occurs in 1.8%-5.8% of menstruating women Symptoms worsen as they approach menopause Oral contraceptives help reduce symptoms

17. 5. Substance/Medication-Induced Depressive Disorder The symptoms followed with the onset of the substance (drug) or medication The symptoms persist for at least 1 month even after use has stopped The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning Can not be explained better by another depressive disorder Can be divided into mild, moderate, or severe Prevalence is 0.26% in the USA What do you think the risk factors are?

18. 6. Depressive Disorder Due To Another Medical Condition • Brain damage can definitely lead to depression! • Be careful not to confuse it with a medication-induced depression or with an adjustment disorder (imagine having to adjust to having a medical condition ) • Most common in those who experience: • Strokes • Huntingtons’s disease • Parkinson’s disease