depressive disorders for ncmhce study

Depressive DisordersReview of DSM5 Mental Disorders for NCMHCE Study

Kinds of Depressive Disorders1. Disruptive Mood Dysregulation

Disorder2. Major Depressive Disorder 3. Persistent Depressive Disorder

(Dysthymia)4. Premenstrual Dysphoric Disorder5. Substance/Medication-Induced Depressive

Disorder6. Depressive Disorder Due to Another

Medical Condition7. Other Specified Depressive Disorder8. Unspecified Depressive Disorder

Depressive Disorders

S2. Assessments1. BDI Beck Depression Inventory2. Hamilton Rating Scale3. SCID Structured Clinical Intervew 4. Patient Health Questionnaire-9 5. HAM-D6. Zung Self Rating Depression Scale7. Geriatric Depression Scale8. Mood Disorder Questionnaire9. MMSE10. Physical exam11. Steen Happiness Index

Depressive DisordersTreatments1. Medications

Antidepressants usually SSRI’s or SNRI’s

TCA’s (Tricyclic antidepressant)

MAOI’s (Monoamine oxidase inhibitor)

2. Therapies BAT Behavioral Activation

Therapy CBT Cognitive Behavioral

Therapy Mindfulness Therapy Electroconvulsive therapy Vagal nerve stimulation Transcranial magnetic

stimulation IPP Interpersonal

psychotherapy Social skills and

assertiveness training

Differences Among Depressive DisordersMajor Depression 5 criteria For 2 weeks Lower

functioning

Persistent Depression 3 criteria For 2 years▪ 1 year for

youth Milder, higher

functioning

Criteria Sleep

problems Disinterest Low self-

esteem Energy

problems Poor

concentration Appetite

change Agitated or

slow Suicidal

ideation

Disruptive Mood Dysregulation Disorder

Disruptive Mood Dysregulation Disorder (DMDD)

DiagnosisSevere recurrent temper outbursts, grossly out of proportion in intensity or duration Inconsistent with maturity level Verbal and/or physical rages,

against people or property Persistently irritable or angry

most of the day between outbursts

Frequent, 2-3 times weekly For 12 or more months Onset must be between ages 6-

10, until age 18

Rule Out ODD:

More severe

Differences Among Depressive & Disruptive DisordersDisruptive Mood Dysregulation 2-3 times

weekly For 12 or

more months ages 6-10,

until age 18 Persistently

irritable or angry

Verbal and/or physical rages

Oppositional Defiant Difficult

behavior for 6 months

Verbal rages Argumentative Aggressive More severe

Intermittent Explosive

3 times yearly Verbal

aggression Assaults Outbursts

causing damage

Ages 6-adult Remorseful


S1. Find Out Medical evaluation Affective functioning Cognitive functioning Symptomology

development Family history Past trauma Substance use history Work/school history Family meeting

S2. Assess & Refer


S5. TreatmentsMedications Antidepressants usually SSRI’s or SNRI’sTherapies Psychoeducation Individual psychotherapy Family therapy

Major Depressive Disorder (MDD)


Diagnosis5 or more symptoms during the same 2 week period Must

include depressed mood or loss of interest or pleasure

1. Depressed mood most of the day, most days

2. Decreased pleasure in activities

3. Weight loss or gain; loss of energy

4. Insomnia or sleeping too much5. Psychomotor agitation or

retardation 6. Feelings of worthlessness and

guilt7. Harder to think or make

decisions8. Recurrent thoughts of death

and suicide, and/or plans or attempt

9. More likely after puberty


Diagnosis IISpecifiers Mild, moderate, severe With psychotic features In partial remission, in full

remission, unspecified Anxious distress, melancholic

features Mixed features, atypical

features Mood-congruent psychotic

features, mood-incongruent features

Catatonia Peri-partum onset Seasonal pattern

Comorbidity Substance

abuse Panic

disorders OCD

Anorexia Nervosa

Bulimia Nervosa

Borderline Personality


S1. Find Out Medical evaluation Affective functioning Cognitive functioning Symptomology development Family history Past trauma Substance use history Work history Family meeting


S2. Assessments1. Beck Depression Inventory2. Hamilton Rating Scale3. SCID4. Patient Health Questionnaire-9 5. HAM-D6. Zung Self Rating Depression Scale7. Geriatric Depression Scale8. Mood Disorder Questionnaire9. MMSE10. Physical exam


S5. TreatmentsMedications Antidepressants

usually SSRI’s or SNRI’s

TCA’s (Tricyclic antidepressant)

MAOI’s (Monoamine oxidase inhibitor)

Therapies Behavioral Activation

Therapy BAT Cognitive Behavioral

Therapy Mindfulness Therapy Exercise Electroconvulsive

therapy Vagal nerve stimulation Transcranial magnetic

stimulation


S5. Monitoring Medication

compliance Interactions with

family Use of leisure time Weight gain or loss Sleep quality Social activities

S6. Termination Medication Support group

Persistent Depressive Disorder (Dysthymia)


Diagnosis IDepressed mood, most of the day, most days For at least 2 years (or 1 year for

youth) During this period, symptoms

ceased for less than 2 monthsWhile depressed, 2 or more symptoms: Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self esteem Poor concentration and indecisive Feelings of hopelessness

No manic or hypomanic episodes

Milder and higher functioning than MDD

Comorbidity Anxiety Substance

abuse

Persistent Depressive Disorder (Dysthymia)S1. Find Out Medical evaluation Affective functioning Cognitive functioning Symptomology

development Family history Past trauma Substance use history Work/school history Family meeting

S2. Assess & ReferPsych testing

Beck Depression Inventory (BDI)

Steen Happiness Index


S5. TreatmentsMedications Antidepressants usually SSRI’s or SNRI’s TCA’s (Tricyclic antidepressant) MAOI’s (Monoamine oxidase inhibitor)Therapies CBT Cognitive Behavioral Therapy IPP Interpersonal psychotherapy Social skills and assertiveness training Decisionmaking training

Premenstrual Dysphoric Disorder (PDD)


S1. DiagnosisAt least 5 symptoms in the final week before onset of menses With improvement

a few days after the onset

Minimal or absent in the week after menses

Same symptoms in most menstrual cycles in the past year

2 months of symptoms

1 or more of these: Mood swings Irritability, anger, or

increased interpersonal conflicts

In addition, 1 or more symptoms to make 5 total Decreased interest in

activities Difficulty concentrating Lethargy Changes in appetite; Hypersomnia/insomnia Feeling overwhelmed or

out of control Bloating or weight gain


S1. Find Out Medical evaluation Affective functioning Cognitive functioning Symptomology

development Family history Past trauma Substance use history Work history Family meeting

S2. Assess & ReferPsych testing

Beck Depression Inventory (BDI)

Patient Health Questionnaire-9

Depressive Disorder with Peripartum Onset

Depressive Disorder with Peripartum Onset (Postpartum Depression)

Diagnosis1. Symptoms

start anytime during pregnancy or up to 12 months following delivery

2. Five of the following nine symptoms, within a two week period: Feelings of sadness, emptiness, or

hopelessness, nearly every day, for most of the day

Loss of interest or pleasure in activities

Weight loss or decreased appetite Changes in sleep patterns Feelings of restlessness Loss of energy Feelings of worthlessness or guilt Loss of concentration or increased

indecisiveness Recurrent thoughts of death

Other Depressive Disorders

Substance/Medication-Induced Depressive Disorder

DiagnosisDepressive symptoms associated with the ingestion, injection or inhalation of a substance Persist beyond the anticipated length of

physiological effects, intoxication or withdrawal period

Depression Due to Another Medical Condition (DDAMC)DiagnosisDepressive symptoms directly related to the start or progression of disease Not delirium Not psychological

response to the condition

No other stressor or evidence of tendency towards depression

Conditions causing depression1. Thyroid dysfunction2. Cancer3. Poorly-controlled diabetes4. Chemotherapy5. Endocrine problems6. Post-partum7. Parkinson’s disease

depressive disorders for ncmhce study

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