Depressive Disorders

Moderate Depression

In between mild and severe

Depressive disorders and ______ disorders were in the same category in the DSM 4 but separated in the DSM 5

Bipolar

New depressive disorders added to the DSM 5

Disruptive mood dysregulation disorder &
Premenstrual dysphoric disorder

Dysthymia and Chronic Depressive Disorders now fall under the category of

Persistent depressive disorder

Of the estimated 17.5 million Americans who are affected by some form of depression, ____ million have major or clinical depression

9.2

_____ of people suffering from depression do not seek necessary treatment

2/3

_____% of all people with clinical depression who have received treatment significantly improve their lives

80

Women experience depression about _____ as often as men

twice

By the year 2020, the World Health Organization estimates that depression will be the number ____ cause of "lost years of healthy life" worldwide

two

Major Depression is _____ times more common among first-degree biological relatives of those with the disorder than among the general population

1.5-3.0

Depressive disorders often co-occur with

anxiety disorders and substance abuse

Major Depressive Disorder is the leading cause of _______ in the U.S. for ages 15-44.

disability

More than ____% of people who kill themselves who kill themselves have a diagnosable mental disorder, commonly and depressive disorder or a substance abuse disorder

90

Signs of Depressive Illness

-Feeling worthless, helpless, or hopeless
-Sleeping more or less than usual
-Eating more or less than usual
-Having difficulty concentrating or making decisions
-Loss of interest in taking parts in activities
-Decreased sex drive
-Avoiding other people
-Overwhelming feelings of sadness or grief
-Feeling unreasonably guilty
-Loss of energy, feeling very tired
-Thoughts of death or suicide

___ to ___% of college students have symptoms of depression

25; 30

Study showed ___% of all student surveyed thought about suicide

20

___% of students attempted suicide

9

__% of students injured themselves

20

Between ________% of people over age of 65 living in the community suffer from major depressive disorder

1 and 2

Emotional Symptoms of Depression

-Sadness
-Worse in morning
-Anxiety
-Anhedonia
-Numbing
-Flat affect
-Dullness
-Irritability

Cognitive Symptoms of Depression/Becks model of depression

Negative view of self
-Low self-esteem
-Feelings of inferiority
-Distorted beliefs about achievement
-Self-blaming & guilt
Negative view of future
-Hopeless view of future
-Future actions ineffective
-Belief that negative future is unable to be changed by action

Motivational Symptoms of Depression

-Lack of response initiation
-Psychomotor retardation
-Inability to make decisions
-Difficulty choosing alternatives

Somatic Symptoms of Depression

-Loss of appetite
-Weight loss (moderate to severe depression)
-Sleep disturbance (normally early morning awakening)
-Weakness & fatigue
-Loss interest in sex
>Erectile difficulty
>Lack of arousal

Other Physical Complaints during Depression

-Headache
-Backaches
-Gastrointestinal symptoms
-Yeast infections
-Upper respiratory infections
-Shoulder aches
-Accidents

Cognitive Triad & Errors in Logic

Negative views about the world
| |
v v Negative views about future <--> Negative views
of oneself

Common features of all depressive disorders is

the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual's ability to function

Disruptive Mood Dysregulation Disorder

-Severe temper outburst verbally or behaviorally at least three times a week
-Temper outburst inconsistent with developmental level
-Mood between outbursts is irritable and angry most of the day
-Present for 12 months and not had 3 months without symptoms
-Not made before six years old or after 18 years
-Symptoms begin before age ten
-Never been a period more than day when criteria not met
-Does not occur exclusively with MDD or explained by other mental disorder

Disruptive Mood Dysregulation Disorder (DMDD) cannot co-occur with

-ODD
-Intermittent Explosive Disorder
-Bipolar disorder
-Manic Episodes

Disruptive Mood Dysregulation Disorder can exist with

-ADHD/ADD
-MDD
-Conduct Disorder
-Substance Abuse Disorder

Major Depressive Disorder (MDD)

Five or more of following symptoms are present during the same 2-week period and represent a change in function
-Depressed mood most of day, nearly every day
>Children or adolescents may be irritable mood
-Marked diminished pleasure in activities nearly every day
-Significant weight loss or gain (5% per month), decreased or increased appetite nearly every day
>Children-failure to meet expected weight gain
-Insomnia or hypersomnia, nearly every day
-Psychomotor agitation or retardation every day
-Fatigue or loss of energy nearly every day
-Feelings of worthlessness or excessive/inappropriate guilt
-Diminished ability to concentrate, think or indecisive
-Recurrent thoughts of death, suicidal ideation (no plan), or attempt or plan for suicide
Symptoms cause clinically significant distress or impairment in social, occupational, or other function
Not attributable to effects of a substance or medical disorder
There has never been a manic or hypomanic episode

Mild Depression

Few if any symptoms in excess of those required to make the diagnosis are present, intensity is distressing, but manageable, minor impairment in functioning

Severe Depression

Symptoms in excess of what required for diagnosis, intensity is seriously distressing, unmanageable, symptoms markedly interfere with function

Moderate Depression

In between mild and severe

Specifiers of Depression

With psychotic features
-Mood congruent: inadequacy, guilt
-Mood incongruent: doesn't involve depressive themes
-Single episode
-Recurrent
In partial remission
-Symptoms present, but full criteria not me, or 2 months without
-Single episode
-Recurrent
In full remission
-Past 2 months no signs or symptoms
-Single episode
-Recurrent
Unspecified

Persistent Depressive Disorder

Depressed mood most of day for more days than not for at least 2 years
-children/adolescence irritable mood for one year
Presence depressed of
-Poor appetite
-Insomnia or hyposomnia
-Low energy or fatigue
-Low self-esteem
-Poor concentration
-Feelings of hopelessness
During the 2 year period never been without A and B symptoms for more than 2 months
Criteria for major depression disorder may be continuously present for 2 years
No manic or hypomanic episodes
No cyclothymia, schizoaffective, or other schizophrenia spectrum disorders
Not a substance or medical condition
Distress

Persistent Depressive Disorder with Pure Dysthymic Disorder

Full criteria met for MDD have not been met in preceding 2 years

Persistent Depressive Disorder with Persistent Major Depressive Episode

Full criteria for major depressive episode have been met through out preceding 2 years

Persistent Depressive Disorder with Intermittent Depressive Episode

Full criteria for major depressive episode been met currently, but been periods of 8 weeks in the preceding 2 years with symptoms below threshold for major depressive disorder

Persistent Depressive Disorder with Intermittent Major Depressive Disorder, Without Current Episode

Full criteria for major depressive episode are not currently met, but one or more major depressive episode in preceding 2 years

Premenstrual Dysphoric Disorder

A. Five symptoms present in first week before onset of menses, improve in a few days after onset of menses, minimal or absent in week post menses
B. One or more of the following
-Market emotional liability
-Marked irritability or anger or increased interpersonal conflicts
-Marked depressed mood, feeling of hopelessness, self-deprecation
C. One or more following to reach a total of 5 symptoms when combined with above:
-Decreased interest in usual activities
-Subjective difficulty in concentration
-Lethargy, fatigability, lack of energy
-Marked change in appetite, overeating, or food cravings
-Insomnia or hypersomnia
-Overwhelmed or out of control feelings
-Breast tenderness, swelling, joint/muscle pain, bloating, weight gain
D. Symptoms of significant distress or interference in functioning
E. Not just exacerbation of another disorder
F. Criterion A should be confirmed by daily ratings during two cycles
G. Not substance abuse or medical condition

Substance/Medication-Induced Depressive Disorder

A. Persistent disturbance in mood
B. Evidence of symptoms developing after intoxication, withdrawal or exposure to medication
C. Medications can produce those symptoms
D. Not better explained by depressive disorder not substance induced
E. Does not occur in delirium
F. Causes clinically significant distress
G. Diagnosis made instead of diagnosis of substance intoxication or withdrawal only when symptoms predominate and are severe

Substances Induce Depressive Disorders

Alcohol
Phencyclidine
Other hallucinogens
Inhalants
Opioids
Sedative, hypnotic, anxiolytics
Amphetamine
Cocaine
Other

Depressive Disorder Due to Another Medical Condition

Evidence from medical results depressive disorder is result of a medical condition
Not explained by another mental disorder
Not part of a delirium
Causes distress and impairment
Specify
-with depressive features
-With major depressive-like episode
-With mixed features

Recurrent Brief Depression

Concurrent presence of depressed mood and four other symptoms of depression for 2-13 days
One per month
Not menstrual cycle for 12 months
No other criteria met

Short-Duration Depressive Episode

Depressed affect and 4 of the 8 other symptoms of major depressive episode
Distress for more than 4 days, but not more than 14
No other criteria met

Depressive Episode with Insufficient Symptoms

Depressed affect and one of the 8 symptoms for 2 weeks
No other criteria met

Depressive Disorders with Anxious Distress

Two of the following
-Keyed up or tense
-Unusually restless
-Difficulty concentrating because of worry
-Fear of something awful happening
-Feeling loss of control

Level of severity
-Mild: Two symptoms
-Moderate: Three symptoms
-Moderate/Severe: Four-five symptoms
-Severe: Four-five symptoms with motor agitation

Depressive Disorders with Mixed Features

At least three present nearly every day
-Elevated, expansive mood
-Inflated self-esteem
-More talkative than usual or pressured speech
-Flight of ideas or racing thoughts
-Increased energy or goal directed activity
-Increased involvement in activities with painful consequences
-Decreased need for sleep, yet rested
Mixed symptoms observed by others
If meet criteria for mania/hypomania- bipolar disorder
Not substance or medical disorder

Depressive Disorder with Melancholic Features

One of the following features
-Loss of pleasure
-Lack of reactivity to pleasure
Three or more of the following
-Distinct quality of depressed mood
-Depression worse in morning
-Early morning awakening
-Marked psychomotor retardation or agitation
-Significant anorexia
-Exercise or inappropriate guilt
Near complete absence of pleasure
Psychomotor changes and distinct quality of mood differs from non-melancholic depressive episode

Depressive Disorders with Atypical Features

Mood reactivity
-Mood brightens to positive events
Two of the following
-Weight gain or increased appetite
-Hypersomnia
-Leaden paralysis
-Reaction sensitivity

Depressive Disorders with Psychotic Features

Delusions and hallucinations present
Mood congruent psychotic features
-delusions/hallucinations consistent of depressive themes
Mood incongruent psychotic features
-delusions/hallucinations opposite of depressive themes

Depressive Disorders with Seasonal Pattern

Seasonal pattern of at least one type of episode
Time of the year and onset of mania, hypomania, depressive episode
Full remission when seasons change
Last 2 years, temporal relationship to remission
Seasonal mania or depression outnumber any other mania or depression

Depressive Disorders with Peripartum Onset

Onset during pregnancy or postpartum
Present with or without psychotic features
Infanticide most often associated with this

Once woman has had postpartum episode with psychotic features recurrence at ___% to ___%

30; 50

____ to ____% of children will experience an episode of major depression before the age of 15

7; 14

Out of 100,000 adolescents, 2,000 to 3,000 will have a mood disorder, of which __ to __ will commit suicide

8; 10

Depression in youth may also predict

more severe illness in adulthood

Depressed in Children

-Somber almost ill appearance
-Frequent complaints of physical problems for which no medical difficulties can be found
-Lack of bounce and enthusiasm characteristics of non-depressed peers
-Tearfullness for little to no identifiable reason
-Spontaneous irritability (not just when don't get way)
-Frequent negative self-statements
-Self-injurious or self-destructive behaviors at times
-Anhedonia

Elementary Children and Depression

-Disruptive behavior
-Academic difficulties or declining school performance
-Frequent problems with peers
-Increased irritability and aggression compared to peers and to their own non-depressed state
-Suicidal threats & ideation
-Anhedonia
-Statements that they hate themselves and everything around them
-Sleeping too much
-Rapid, unpredictable emotional changes
-Physical complaints (headaches, stomach aches, nausea, vomiting)

Adolescent Depression

-About 20% will experience depression before they reach adulthood
-Between 10-15% have some symptoms of teen depression at any one time
-About 5% are suffering from major depression at any one time
-As many as 8.3% suffer from depression for at least a year at a time
-Most will suffer more than one episode
>20-40% will have more than one episode within two years
>70% will have more than one episode before adulthood
-Episodes of depression generally last about 8 months

Adolescent Depression

-Acting out behavior (missing curfew, unusual defiance
-Appetite changes (usually decreases)
-Criminal behavior (shoplifting)
-Depressed or irritable mood
-Difficulty concentrating
-Difficulty making decisions
-Episodes of memory loss
-Excessive sleeping or daytime sleepiness
-Excessively irresponsible behavior patterns
-Excessive or inappropriate guilt
-Failing relations with family and friends
-Faltering school performance
-Substance use/abuse
-Temper
-Thoughts about suicide or obsessive fears/worries about death
-Weight change
-Loss of interest in activities
-Persistent difficulty falling/staying asleep
-Plans to commit suicide or suicide attempts
-Preoccupation with self
-Reduced pleasure in daily activities

__ out of 10adolescents who commit suicide give warnings

9

Adolescent Suicides

-Depression
-Substance use/abuse
-Withdrawal
-Decreased activity and attention
-Lack of concentration
-Sleep and appetite change
-Suicidal ideation
-Verbal & written suicidal cues
-Giving away possessions
-Low feelings of self worth
-Relationship breakup
-Gender identity crisis
-Low grades
-Drop in grades
-Suicide in friends or relatives

Most common implement in adolescent suicide

drugs

Most frequent method for completed suicide in adolescents

guns

Second most frequent method for completed suicide in adolescents

hanging

Males die 5 times ____ often from adolescent suicides than females

more

Adolescent females think about and attempt three times ___ often than males

more

Depression in elderly people often goes untreated because many believe depression is

a normal aging process

_______ ______ have challenges through loss, medical vulnerability, and mortality of self and others

Elderly people

Elderly people and families mistake symptoms of depression for signs of

Dementia
Alzheimer's disease
Arthritis
Cancer
Heart disease
Parkinson's disease
Stroke
Thyroid disorders

Depression symptoms in elderly

-Memory problems
-Confusion
-Social withdrawal
-Loss of appetite
-Weight loss
-Vague complaints of pain
-Inability to sleep
-Irritability
-Delusions
-Hallucinations

Older depressed individuals often have severe feelings of sadness, but these feelings frequently

are not acknowledged

General clues that someone may be experiencing depression are

Persistent and vague complaints
Help-seeking
Moving in a slower manner
Demanding behavior

Older Americans are disproportionately likely to die by

suicide

Suicide is ____ common among the elderly than any other age group

more

Nearly all older adults who committed suicide had major depression, typically a

first episode

Elderly white men were at the ______ risk of suicide with a rate of 31.1 per 100,000 each year

highest

Suicide is the ___ leading cause of death overall in Americans

11th

Suicide is the ____ leading cause of death for young Americans between the ages of 10-24

3rd

In 2016, the highest rate of suicide was among

adults between 45 and 54 years of age