2. Presented By: Jessica Stewart

3.  Major Depressive Disorder  Dysthymic Disorder  Depressive Disorder Not Otherwise Specified  Bipolar I Disorder  Bipolar II Disorder  Cyclothymic Disorder  Bipolar Disorder Not Otherwise Specified  Mood Disorder Due to a General Medical Condition  Substance-Induced Mood Disorder  Mood Disorder Not Otherwise Specified DSM –IV-TR Mood Disorders

4.  A period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities  Must also experience other symptoms (4 or more) Changes in appetite, weight loss or gain Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate or indecisiveness Recurrent thoughts of death, suicidal ideation or a suicide attempt  Must have clinically significant distress or some interference in an important area of functioning  Episode has ended when the full criteria have not been met for at least two consecutive months Major Depressive Episode

5.  One or more Major Depressive Episodes  Episodes of Substance-Induced Mood Disorder or Mood Disorder Due to General Medical Condition do not count towards diagnosis  If Manic, Mixed or Hypomanic Episodes develop, diagnosis is changed to Bipolar Disorder (unless these are a direct result of antidepressant treatment, substance use or toxin exposure) – See Rachel Depner’s Presentation  The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder NOS Major Depressive Disorder

6.  296.XX  Fourth Digit: 2 - Single Major Depressive Episode (used only for the first episode) 3 - Recurrent Major Depressive Episodes Major Depressive Disorder Diagnostic Codes

7.  296.xx  Fifth Digit: Severity of Episode 0 - Severity or Status is Unspecified 1 - Mild Severity 2 - Moderate Severity 3 - Severe without Psychotic Features 4 - Severe with Psychotic Features 5 - In Partial Remission 6 - In Full Remission Major Depressive Disorder Diagnostic Codes

8.  Specifiers to Describe Features Chronic With Catatonic Features With Melancholic Features With Atypical Features With Postpartum Onset  Specifiers to Indicate the Pattern of Episodes With and Without Full Interepisode Recovery With Seasonal Pattern Major Depressive Disorder Diagnostic Codes

9.  Chronically depressed mood that occurs for most of the day more days than not for at least 2 years  Symptom free intervals last no longer than 2 months  Criteria for a Major Depressive Episode is not met within the initial 2 years  No manic, mixed or hypomanic episodes  Depression does not occur due to a Psychotic Disorder, the effects of substance use or a general medical condition  Symptoms must cause clinically significant distress or impairment Dysthymic Disorder

10.  300.4  Specifiers: Early Onset Late Onset With Atypical Features Dysthymic Disorder Diagnostic Codes

11.  Diagnostic Code 311  Disorders with Depressive features that do not meet the criteria for other Depressive Disorders  Examples: Premenstrual Dysphoric Disorder Minor Depressive Disorder When a clinician concludes that a depressive order is present, but is unable to determine whether it is primary, due to a general medical condition or substance-induced Depressive Disorder NOS

12.  Sleep EEG Abnormalities  Dysregulation of Neurotransmitters  Alterations of several Neuropeptides  Hormonal Disturbances  Alterations in Cerebral Blood Flow Laboratory Abnormalities

13.  Total Prevalence 6.4% of US population  More Female than Male  Average Age of Onset = 32 years old  Estimated 50% are receiving treatment Prevalence

14.  Having biological relatives with depression  Being a woman  Having traumatic experiences as a child  Having family members or friends who have been depressed  Experiencing stressful life events, such as the death of a loved one  Having few friends or other personal relationships  Having been depressed previously  Having certain personality traits, such as having low self- esteem and being overly dependent, self-critical or pessimistic Risk Factors

15.  Disruptive Behavior Disorders  Attention-Deficit Disorders  Anxiety Disorders  Substance Related Disorders  Eating Disorders Comorbidity

16.  Not all cultures experience and communicate depression the same way Somatic symptoms Nerves, headaches, weakness, tiredness, imbalance, problems of the heart  Different cultures view the severity of depression differently Certain Symptoms provoke more concern than others Cultural Differences

17.  Core Symptoms are the same for children and adolescents Somatic complaints, irritability and social withdrawal are common in children Motor retardation, hypersomnia and delusions are more common in adolescents and adults  In elderly adults, cognitive symptoms are prominent Age Differences

18.  Many individuals struggling with depression do not seek help  Depressed clients often have decreased energy or a lack of interest – they may not be able to implement changes to help them through it  Often co-occurs with other disorders (Anxiety) and treatment needs to occur for multiple issues Issues in Treatment

19.  Beck Depression Inventory (BDI) Developed by Aaron Beck in 1961 Revised 1978 & 1996 21 Question Inventory Multiple Choice Answers (rating 0-3) Self-Report (weaknesses apply) Used to assess for the severity of depression Copywritten – fees must be paid for use Assessing for Depression

20. 1. 0 I do not feel sad. 1 I feel sad 2 I am sad all the time and I can't snap out of it. 3 I am so sad and unhappy that I can't stand it. 2. 0 I am not particularly discouraged about the future. 1 I feel discouraged about the future. 2 I feel I have nothing to look forward to. 3 I feel the future is hopeless and that things cannot improve. 3. 0 I do not feel like a failure. 1 I feel I have failed more than the average person. 2 As I look back on my life, all I can see is a lot of failures. 3 I feel I am a complete failure as a person. BDI - Sample Questions

21.  When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression's severity. The standard cut-offs are as follows: 1-10 These ups and downs are considered normal 11-16 Mild mood disturbance 17-20 Borderline clinical depression 21-30 Moderate depression 31-40 Severe depression Over 40 Extreme depression BDI-Scoring

22.  Shortcomings high item difficulty lack of representative norms (doubtful objectivity of interpretation) controversial factorial validity instability of scores over short time intervals (over the course of 1 day) poor discriminant validity against anxiety  Advantages high internal consistency high content validity validity in differentiating between depressed and non-depressed subjects sensitivity to change international propagation Review of BDI (Richter, Werner, Heerlein, Kraus, & Sauer, 1998)

23.  American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC  http://www.mayoclinic.com/health/depression  http://www.nimh.nih.gov/statistics/1mdd_adult.shtml  Richter, P., Werner, J., Heerlein, A., Kraus, A., & Sauer, H. (1998). On the validity of the Beck Depression Inventory: A review.Psychopathology, 31(3), 160-168. doi:10.1159/000066239  http://en.wikipedia.org/wiki/Beck_Depression_Inventory References