Depressive Disorders (Behavior)

Types of Depressive Disorders

Disruptive Mood Dysregulation Disorder

Major Depressive Disorder

Persistent Depressive Disorder (Dysthymia)

Premenstrual Dysphoric Disoder

Substance / Medication induced depressive disorder

Depressive Disorder due to another medical condition

Other specified vs unspecified depressive disorder

DSM 5-TR for Disruptive Mood Dysregulation Disorder

A. Severe recurrent temper outbursts manifested verbally or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation

B. Temper outbursts are inconsistent with developmental levels

C. Temper outbursts occur on average 3 or more per week

D. Mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, observed by others

E. Occurs for at least 12 months and no longer than 3 months without symptoms A through D

F. A and D are present in at least 2 or 3 settings (home, school, peers) and are severe in at least one of these

G. Cannot be before 6 y/o or after 18 y/o

H. Age of Onset of A through E is before 10 y/o

I. There has never been a period more than 1 day in which criteria for mania or hypomanic episode is met

J/K. Not better explained by another disorder, substance or medical condition.

DSM-5 TR Major Depressive Disorder

5 or more of the following (A) have been present during the same 2 week period and represent change from previous functioning with at least one symptom being (A1) or (A2)

A. Criteria Symptoms

1. 1. Depressed mood most of the day, nearly every day, by self or observation

2. 2. Markedly diminished interest (apathy) / inability to experience pleasure (anhedonia) in all or almost all activities most of the day, nearly every day

3. 3. Significant weight change >5% when not dieting (Loss), or increased intake (Gain), or medical reason (Gain)

4. 4. Insomnia or hypersomnia nearly every day

5. 5. Psychomotor agitation or retardation nearly every day, by observation

6. 6. Fatigue or loss of energy nearly every day

7. 7. Feeling of worthlessness or excessive/inappropriate guilt nearly every day

8. 8. Diminished ability to think or concentrate nearly every day, self or observation

9. 9. Recurrent thoughts of death, suicidal ideations without specific plan, specific suicidal plan, or suicide attempt

B. Symptoms are causing clinically significant distress or impairment to functioning

C. Not attributable to effects of substance or another medical conditions

D.  Occurrence of major depressive episode is not better explained by another disorder

E. There has never been a manic or hypomanic episode.

Specifiers for Major Depressive Disorder

With mixed features

With anxious distress

With seasonal feature

With atypical features

With melancholic features

With psychotic features

With peripartum onset

In partial remission

In full remission

Single Episode Major Depressive Disorder

A patient who experiences the it first depressive episodes

Recurrent Major Depressive Disorder

A patient who has experienced several depressive episodes in the past but has had remissions.

Criteria for “With Mixed Features” Specifier of MDD

3 of the following:

• Elevated mood

• Inflated self-esteem

• More talkative than usual

• Flight of Ideas or Subjective Racing thoughts

• Increase in energy or goal-directed activity

• Increased or excessive involve in activities with high potential for painful consequences

• Decreased need for sleep

Does not meet criteria for manic / hypomanic episode (Bipolar Dx)

Criteria for “With Anxious Distress” Specifier of MDD

2 or More of the Following:

• Feeling keyed up or tense

• Feeling restless

• Difficulty concentrating due to worry

• Fear that something awful will happen

• Feeling individual will lose control of self

Classified on How Many

• Mild = 3

• Moderate = 4-5 w/o motor agitation

• Severe = 4-5 w/ motor agitation

Criteria for “With Seasonal Features” Specifier of MDD

Recurrent MDD

• Temporal relationship between onset of MDD and time of year

• Full remission occur at characteristic time of year

• 2 or more episodes of depressive disturbances in previous 2 years

• Seasonal episodes outnumber non-seasonal episodes

Criteria for “With Atypical Features” Specifier of MDD

Mood Reactivity - Situational factors have strong influence to mood

2 or more of the following:

• Weight Gain or Appetite Increase

• Hypersomnia

• Leaden Paralysis (Heavy Extremities)

• Hx of Sensitivity to Interpersonal Rejection resulting in social and occupational impairment

Criteria for “With Melancholic Features” Specifier of MDD

Must have anhedonia or lack of reactivity to pleasurable stimuli

3 or more of the following:

• Despondency, despair, morosensess

• Early AM depression

• Early AM awakening

• Anorexia / Weight loss

• Excessive Guilt

• Psychomotor agitation or retardation

Criteria for “With Psychotic Features” Specifier of MDD

Hallucinations and/or Delusions

Criteria for “With Peripartum Onset” Specifier of MDD

During pregnancy OR first 4 weeks after delivery

Criteria for “In Partial Remission” Specifier of MDD

Symptoms are Present but do not meet full criteria

OR

Period of time < 2 months with no symptoms

Criteria for “In Full Remission” Specifier of MDD

greater than 2 months with no symptoms

DSM 5-TR Persistent Depressive Disorder (Dysthymia)

A. Depressed mood for most of the day for more days than not, by self or observed, for at least 2 years

• (A1) In children/adolescence, mood can be irritable and only needs at least 1 year

B. Presence, while depressed, of two or more of the following:

• 1. Poor appetite

• 2. Insomina or hypersomnia

• 3. Low energy / Fatigue

• 4. Low self esteem

• 5. Poor concentration or difficulty

• 6. Feelings of hopelessness

C. During 2 year period (1 year peds) of disturbance, person is not without A and B for > 2 months at a time

D. Criteria of MDD may continously present for 2 years

E. Never been manic or hypomanic episode AND criteria for cyclothymic disorder is not met

F/G/H. Not better explained by another diagnosis, medication, substance. Must cause significant distress/impairment in social, occupational or other important areas of functioning.

Specifiers for Persistent Depressive Disorder

With Pure Dysthymic Syndrome

With Persistent Major Depressive Episodes

With Intermittent Major Depressive Episodes

Criteria for “With Pure Dysthymic Syndrome” for Dysthymia Specifier

meets dysthymia criteria (full 2 year (adults) 1 year (children)

does not meet MDD criteria

Criteria for “With Persistent Major Depressive Episode” for Dysthymia Specifier

meets dysthymia criteria (full 2 year (adults) 1 year (children)

meets MDD criteria

Criteria for “With Intermittent Major Depressive Episodes” for Dysthymia Specifier

meets dysthymia criteria (full 2 year (adults) 1 year (children).

At times meets MDD criteria (but does not always meet MDD criteria)

DSM5-TR Premenstrual Dysphoric Disorder (PMDD)

A. In majority of menstrual cycles, at least five symptoms are present in the final week before menses and improves few days after onset of mense and becomes minimal or absent in week post-menses

B. At least one of the following AND total of five with (C)

1. 1. Marked affective lability

2. 2. Marked irritability or anger or increased conflicts

3. 3. Marked depressed mood, feelings of hopelessness or selfdepractiong

4. 4. Marked anxiety tension or keyed up

C. At least one of the following AND total of five with (B)

• 1. Decreased interest in usual activity

• 2. Subjective difficulty in concentration

• 3. Lethargy, easy fatiguability, or marked lack of energy

• 4. Marked change in appetite

• 5. Insomina or hypersomnia

• 6. Sense of being overwhelmed or out of control

• 7. Physical symptoms like breast tenderness, joint pain, bloating sensation

D. Clinically significant distress with school, work, usual social activity, or relationships

E. Not exacerbation of existing psychiatric condition

F. documented across at least two symptomatic cycles

G. Is not from substance or medical condition

DSM 5-TR Substance/Medication Induced Depressive Disorder

A. Prominent and persistent disturbance in mood that predominates clinical picture characterized by depressed mood or marked diminished interest or pleasure in all or most activities

B. Evidence of both the following:

1. 1. Symptoms developed soon after intoxication or withdrawal from substance or exposure to medication

2. 2. Involved substance / medication is caple of producing symptoms

C.  Not better explained by a disorder not involving a substance or medication

D. Does not occur exclusively during the course of delirium

E. Causes clinically significant distress or impairment to functioning

Specifier for Substance/Medication Induced Depressive Disorder

Onset During Intoxication

Onset During Withdrawal

What are the additional depressive disorders?

Depressive Disorder due to Another Medical Condition

Other Specified Depressive Disorder

Unspecified Depressive Disorder

Other Specified Depressive Disorder

Deemed to be serious enough to warrant treatment, but does not meet full criteria for major depression.