1. Lab 9: Depression Lab 9: Depression

2. Video #1 Dysthymic Disorder What criteria for Dysthymic Disorder does Susan meet? What criteria for Dysthymic Disorder does Susan meet? Why does she not meet the criteria for major depression? Why does she not meet the criteria for major depression? How/would would you ask about any suicidal thoughts and behaviours? How/would would you ask about any suicidal thoughts and behaviours? How would her symptoms impact on her life? How would her symptoms impact on her life?

3. DSM IV Criteria Dysthymic Disorder Depressed mood for most of the day, for more days than not, for at least 2 yrs Depressed mood for most of the day, for more days than not, for at least 2 yrs Presence while depressed of 2 or more of the following Presence while depressed of 2 or more of the following  Poor appetite or overeating  Insomnia or hyposomnia  Low energy or fatigue  Low self-esteem  Poor concentration or difficulty making decisions  Feelings of hopelessness

4. Criteria Dysthymic Disorder cont During the 2 yr period of the disturbance the person has never been without the symptoms in above criteria for more than 2 months at a time During the 2 yr period of the disturbance the person has never been without the symptoms in above criteria for more than 2 months at a time No Major Depressive Episode has been present during the first 2 yrs of the disturbance No Major Depressive Episode has been present during the first 2 yrs of the disturbance Symptoms cause clinically significant distress or impairments Symptoms cause clinically significant distress or impairments

5. Video #2 Major Depressive Disorder - Recurrent Is Max in a depressive episode at the time of the interview? Is Max in a depressive episode at the time of the interview? What is the difference between Max’s depressive symptoms and Susan’s symptoms? What is the difference between Max’s depressive symptoms and Susan’s symptoms? What further information would be important to find out about? What further information would be important to find out about? What impact do you think Max’s symptoms are having on his life? What impact do you think Max’s symptoms are having on his life?

6. DSM IV Criteria Major Depressive Disorder Recurrent Presence of 2 or more major depressive episodes (MDE) Presence of 2 or more major depressive episodes (MDE) MDE’s not better accounted for by psychotic disorder MDE’s not better accounted for by psychotic disorder No mania No mania Specify (for the most current episode) Specify (for the most current episode)  Severity  Psychotic elements  Remission specifiers  Chronic  Catatonic features  Melancholic features  Atypical features  Postpartum onset

7. MDD recurrent criteria cont Specify Specify  Longitudinal course specifiers (with and without interepisodic recovery)  Seasonal pattern

8. Major Depressive Episode DSM IV Criteria Presence of 5 of the following symptoms for at least two weeks Presence of 5 of the following symptoms for at least two weeks  Either depressed mood or loss of interest in pleasure must be one of the 5 symptoms Sad depressed mood, most of the day, nearly every day Loss of interest and pleasure in usual activities Sleep disturbance Shift in activity level Appetite disturbance, weight loss or gain Loss of energy, fatigue Negative self-concept, feelings of worthlessness and guilt Difficulty concentrating slowed thinking Reccurrent thoughts of death or suicide

9. Depression Case 1 Depression Case 1 Ralph is a 45 year old male of European descent who has been living by himself in a flat since his divorce 3 years ago. His wife initiated the divorce after years of dissatisfaction over her Ralph’s low mood, lack of energy, and the absence of any sense of happiness in their relationship. She and their two children continue to live in the family home, and although she supports Ralph staying involved with the children, he seldom seeks contact with them. He reports feeling empty most of the time, with little energy or interest in things. He used to enjoy fishing and tramping, but now says these things no longer excite him. Ralph is a 45 year old male of European descent who has been living by himself in a flat since his divorce 3 years ago. His wife initiated the divorce after years of dissatisfaction over her Ralph’s low mood, lack of energy, and the absence of any sense of happiness in their relationship. She and their two children continue to live in the family home, and although she supports Ralph staying involved with the children, he seldom seeks contact with them. He reports feeling empty most of the time, with little energy or interest in things. He used to enjoy fishing and tramping, but now says these things no longer excite him.

10. His sleep is poor, as he often awakens in the middle of the night and has difficulty getting back to sleep. He often feels tired and listless during the day. He believes that he is a failure, and it is his fault that his marriage failed. He also believes that he has never lived up to his potential, and that he is now simply living out the rest of his mediocre existence. He sometimes thinks it would be a relief to be dead, although he says that he has no specific plan to end his life. He reports that he has had intense periods of these thoughts and feeling several times since his mid-twenties. His sleep is poor, as he often awakens in the middle of the night and has difficulty getting back to sleep. He often feels tired and listless during the day. He believes that he is a failure, and it is his fault that his marriage failed. He also believes that he has never lived up to his potential, and that he is now simply living out the rest of his mediocre existence. He sometimes thinks it would be a relief to be dead, although he says that he has no specific plan to end his life. He reports that he has had intense periods of these thoughts and feeling several times since his mid-twenties. Diagnosis: Major Depressive Disorder, Recurrent Diagnosis: Major Depressive Disorder, Recurrent

11. Questions - Ralph What criteria does Ralph meet? What criteria does Ralph meet? How do you think Ralph’s reccurrent depressive episodes may be impacting on his family? How do you think Ralph’s reccurrent depressive episodes may be impacting on his family? Is Ralph a high suicide risk? Is Ralph a high suicide risk? What are the precipitating factors to his current depressive episode? What are the precipitating factors to his current depressive episode?

12. Depression Case 2 Depression Case 2 Martha is a 29 year old manager in a large department store. She lives with her husband of three years in a comfortable suburban home. She presents as tearful and distressed, and says that she has felt intense sadness for the past six weeks. She reports that she has lost her appetite for food, and her weight is down five kilograms in the past month, although she is not trying to lose weight. She has also lost her interest in sex, which is leading to tension with her husband. She believes that she is unable to concentrate effectively most of the time, and worries that she will be dismissed from her job. Martha is a 29 year old manager in a large department store. She lives with her husband of three years in a comfortable suburban home. She presents as tearful and distressed, and says that she has felt intense sadness for the past six weeks. She reports that she has lost her appetite for food, and her weight is down five kilograms in the past month, although she is not trying to lose weight. She has also lost her interest in sex, which is leading to tension with her husband. She believes that she is unable to concentrate effectively most of the time, and worries that she will be dismissed from her job.

13. She moves and speaks in a slow, ponderous manner, as if it requires a great effort. She complains of having no energy. She says that she hasn’t experienced any significantly losses recently (e.g. no one she knows has died, they haven’t moved away from friends or family, she has not changed jobs). She also reports that her condition is not at all like the way she usually is, as she has always been an energetic, confident person. She moves and speaks in a slow, ponderous manner, as if it requires a great effort. She complains of having no energy. She says that she hasn’t experienced any significantly losses recently (e.g. no one she knows has died, they haven’t moved away from friends or family, she has not changed jobs). She also reports that her condition is not at all like the way she usually is, as she has always been an energetic, confident person. Diagnosis: Major Depressive Disorder, Single Episode Diagnosis: Major Depressive Disorder, Single Episode

14. Questions - Martha What criteria does Martha meet? What criteria does Martha meet? What further information would you like to find out? What further information would you like to find out? What things may be maintaining her symptoms? What things may be maintaining her symptoms? What treatment options would you consider? What treatment options would you consider?