Presented By: Jessica StewartAxis I Diagnosis:Depressive disorders

1Major Depressive DisorderDysthymic DisorderDepressive Disorder Not Otherwise SpecifiedBipolar I DisorderBipolar II DisorderCyclothymic DisorderBipolar Disorder Not Otherwise SpecifiedMood Disorder Due to a General Medical ConditionSubstance-Induced Mood DisorderMood Disorder Not Otherwise Specified

DSM IV-TR Mood Disorders

A period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activitiesMust also experience other symptoms (4 or more)Changes in appetite, weight loss or gainInsomnia or hypersomniaPsychomotor agitation or retardationFatigue or loss of energyFeelings of worthlessness or excessive or inappropriate guiltDiminished ability to think or concentrate or indecisivenessRecurrent thoughts of death, suicidal ideation or a suicide attemptMust have clinically significant distress or some interference in an important area of functioningEpisode has ended when the full criteria have not been met for at least two consecutive months

Major Depressive Episode

One or more Major Depressive EpisodesEpisodes of Substance-Induced Mood Disorder or Mood Disorder Due to General Medical Condition do not count towards diagnosisIf 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 Depners PresentationThe 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

296.XXFourth Digit: 2 - Single Major Depressive Episode (used only for the first episode)3 - Recurrent Major Depressive EpisodesMajor Depressive Disorder Diagnostic Codes

296.xxFifth Digit: Severity of Episode0 - Severity or Status is Unspecified1 - Mild Severity2 - Moderate Severity3 - Severe without Psychotic Features4 - Severe with Psychotic Features5 - In Partial Remission6 - In Full RemissionMajor Depressive Disorder Diagnostic Codes

Specifiers to Describe FeaturesChronicWith Catatonic FeaturesWith Melancholic FeaturesWith Atypical FeaturesWith Postpartum OnsetSpecifiers to Indicate the Pattern of EpisodesWith and Without Full Interepisode RecoveryWith Seasonal PatternMajor Depressive Disorder Diagnostic Codes

Chronically depressed mood that occurs for most of the day more days than not for at least 2 yearsSymptom free intervals last no longer than 2 monthsCriteria for a Major Depressive Episode is not met within the initial 2 yearsNo manic, mixed or hypomanic episodesDepression does not occur due to a Psychotic Disorder, the effects of substance use or a general medical conditionSymptoms must cause clinically significant distress or impairmentDysthymic Disorder

300.4Specifiers:Early OnsetLate OnsetWith Atypical Features

Dysthymic Disorder Diagnostic Codes

Diagnostic Code 311Disorders with Depressive features that do not meet the criteria for other Depressive DisordersExamples:Premenstrual Dysphoric DisorderMinor Depressive DisorderWhen 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-inducedDepressive Disorder NOS

Sleep EEG AbnormalitiesDysregulation of NeurotransmittersAlterations of several NeuropeptidesHormonal DisturbancesAlterations in Cerebral Blood FlowLaboratory Abnormalities

Total Prevalence 6.4% of US populationMore Female than MaleAverage Age of Onset = 32 years oldEstimated 50% are receiving treatment

Prevalence

Having biological relatives with depressionBeing a womanHaving traumatic experiences as a childHaving family members or friends who have been depressedExperiencing stressful life events, such as the death of a loved oneHaving few friends or other personal relationshipsHaving been depressed previouslyHaving certain personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimistic

Risk Factors

Disruptive Behavior DisordersAttention-Deficit DisordersAnxiety DisordersSubstance Related DisordersEating DisordersComorbidity

Not all cultures experience and communicate depression the same waySomatic symptomsNerves, headaches, weakness, tiredness, imbalance, problems of the heartDifferent cultures view the severity of depression differentlyCertain Symptoms provoke more concern than others

Cultural Differences

Core Symptoms are the same for children and adolescentsSomatic complaints, irritability and social withdrawal are common in childrenMotor retardation, hypersomnia and delusions are more common in adolescents and adultsIn elderly adults, cognitive symptoms are prominentAge Differences

Many individuals struggling with depression do not seek helpDepressed clients often have decreased energy or a lack of interest they may not be able to implement changes to help them through itOften co-occurs with other disorders (Anxiety) and treatment needs to occur for multiple issuesIssues in Treatment

Beck Depression Inventory (BDI)Developed by Aaron Beck in 1961Revised 1978 & 199621 Question InventoryMultiple Choice Answers (rating 0-3)Self-Report (weaknesses apply)Used to assess for the severity of depressionCopywritten fees must be paid for use

Assessing for Depression

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

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 disturbance17-20 Borderline clinical depression 21-30 Moderate depression31-40 Severe depression Over 40 Extreme depressionBDI-Scoring

Shortcomings high item difficultylack of representative norms (doubtful objectivity of interpretation)controversial factorialvalidityinstability of scores over short time intervals (over the course of 1 day)poor discriminantvalidityagainst anxietyAdvantages high internal consistencyhigh contentvalidityvalidityin differentiating between depressed and non-depressed subjectssensitivity to changeinternational propagationReview of BDI(Richter, Werner, Heerlein, Kraus, & Sauer, 1998)

American Psychiatric Association. (2000).Diagnostic and statisticalmanual of mental disorders(4th ed., text rev.). Washington, DChttp://www.mayoclinic.com/health/depressionhttp://www.nimh.nih.gov/statistics/1mdd_adult.shtmlRichter, 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:10.1159/000066239http://en.wikipedia.org/wiki/Beck_Depression_InventoryReferences