Post on 21-Apr-2017
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
Disruptive Mood Dysregulation Disorder (DMDD)
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
Disruptive Mood Dysregulation Disorder (DMDD)
S5. TreatmentsMedications Antidepressants usually SSRI’s or SNRI’sTherapies Psychoeducation Individual psychotherapy Family therapy
Major Depressive Disorder (MDD)
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
Major Depressive Disorder (MDD)
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
Major Depressive Disorder (MDD)
S1. Find Out Medical evaluation Affective functioning Cognitive functioning Symptomology development Family history Past trauma Substance use history Work history Family meeting
Major Depressive Disorder (MDD)
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
Major Depressive Disorder (MDD)
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
Major Depressive Disorder (MDD)
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)
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
Persistent Depressive Disorder (Dysthymia)
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)
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
Premenstrual Dysphoric Disorder (PDD)
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