2 Depressive Disorders Includes: 1. Disruptive mood dysregulation disorder2. Major depressive disorder3. Persistent depressive disorder4. Premenstrual dysphoric disorder5. Substance-induced depressive disorder6. Depressive disorder due to another medical condition7. Other specified depressive disorder
3 How Do People Feel? Sad Empty Irritable Cognitive changes Somatic changesAll of these significantly affect the individual’s ability to function
4 1. Disruptive Mood Dysregulation Disorder For children up to 12 years oldChildren were being over-diagnosed with bipolar disorderOccurs in approx. 2-5% of the child populationHigher in males and school-age children than females and adolescents
5 DMDD symptoms Severe irritability Have lots of outbursts Disruption of family and friend relationshipsAffects school performanceLow frustration toleranceDangerous behaviorsSuicidal ideationSevere 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 provocationThe outbursts must be inconsistent with the developmental level
7 DMDD Diagnostic Criteria cont’d The outbursts must occur 3 or more times per weekThe mood between the outbursts must be irritable and mostly angryEveryone needs to observe it (teachers, parents, friends, etc.)Must be observed across a variety of settingsMust have been going on for a minimum of 12 monthsMust be diagnosed between 6 and 10 years oldThe 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 DisorderADHDAutism Spectrum Disorder
9 2. Major Depressive Disorder At least 2 weeks durationCarefully have to look at normal sadness and grief and bereavement before diagnosingMDD is usually EPISODIC and SEVEREFigure 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 DYSTHYMIACan be diagnosed when the mood disturbance continues for at least 2 years in adults or 1 year in childrenNot episodic, but CHRONICLess severe than Major Depressive DisorderAffects 0.5% of the population
12 PDD Risk and Prognosis More likely to get PDD when You are younger Have higher neuroticismHave a poor GAF score (axis 5)Have anxiety disordersHave parental loss or separation as a childHave 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 yearsPresence, while depressed, of at least 2 or more of the following:Poor appetite or overeatingInsomnia or hypersomniaLow energy or fatigueLow self-esteemPoor concentration or making decisionsFeelings of hoplessness
14 PDD Diagnostic Criteria cont’d The criteria for Major Depressive Disorder may be present for the 2 yearsThere has never been a “manic” episodeThe disturbance is not related to any schizophrenic or psychotic disorderThe disturbance is not due to substance or medication use, or another medical conditionThe 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 disorderPsychotic disordersDepressive disorders related to other medical conditionsSubstance-induced depressionPersonality 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 womenSymptoms worsen as they approach menopauseOral contraceptives help reduce symptoms
17 5. Substance/Medication-Induced Depressive Disorder The symptoms followed with the onset of the substance (drug) or medicationThe symptoms persist for at least 1 month even after use has stoppedThe disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioningCan not be explained better by another depressive disorderCan be divided into mild, moderate, or severePrevalence is 0.26% in the USAWhat 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:StrokesHuntingtons’s diseaseParkinson’s disease