Transcript DSM-IV-TR in Action Powerpoint

Major Depressive Episode:
 loss of interest and pleasure for at least 2 weeks
Manic Episode:
 elevated an expansive mood for at least 1 week
Mixed Episode:
 alternating moods that last at least 1 week, must
meet criteria for both manic and depressive almost
daily
Hypomanic Episode:
 expansive, irritable, and elevated mood that lasts
at least 4 days
Bipolar
I
Bipolar II
Cyclothymia
(We expect major changes in this criteria with
regard to children in DSM-5)
Major
Depressive Disorder
Dysthymia (different criteria for children)
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Bipolar I Disorder: one or more manic episodes,
usually with a history of depressive episodes (can
have psychotic aspects)
Bipolar II Disorder: one or more depressive with at
least one hypomanic episode, no psychosis
Cyclothymic Disorder: persistent mood
disturbance lasting at least two years, must not be
without for two months, less severity than bipolar
Bipolar Disorder NOS
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Major Depressive Disorder: one or more
major depressive episodes, episodes must
last at least two weeks
Dysthymia: two-year history of depressed
mood, must not be without for two months,
less severity than major depression,
constant for a period of two years (children
one year agitated depression)
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More information on co-morbidity of alcohol and
substance abuse (Bipolar Disorders)
Major Depressive Disorder: now the symptoms
must last two months after loss of a loved one
(used to be two weeks) tried to separate from
condition called Bereavement.
Dysthymia—in DSM-IV-TR—outcome is better with
active treatment
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New diagnosis proposed: mixed anxiety
depression.
Each mood disorder diagnosis is
accompanied by some type of anxiety
dimension.
A rating of anxiety should be included from 0
(no anxiety) to 4 (severely anxious with 5
symptoms and motor agitation).
Tricyclics (TCA): Examples of TCAs include:
• Tofranil (generic name Imipramine)
• Elavil/Amitriptyline
MAO Inhibitors: Many dietary restrictions, no foods with the chemical
tyramine (e.g., cheese, beef or chicken liver, pickled herring, red wine,
chocolate, coffee, raisins, pineapple, bananas)
• Eldepryl (Selegiline)
Other Anti-Depressants: Selective Serotonin Re-uptake Inhibitors (SSRIs).
• Prozac/Fluoxetine
• Paxil/Paroxetine hydrochloride
• Zoloft
Side effect of the SSRIs: sexual disinterest and ORGASMIC DELAY
In 2004, the FDA ordered the strongest safety
warning possible:
Antidepressants increase the risk of suicidal
thinking and behavior (suicidality) in children and
adolescents with major depressive disorder (MDD)
and other psychiatric disorders. Anyone
considering the use of [Drug Name] or any other
antidepressant in a child or adolescent must
balance this risk with the clinical need. (Prozac is
the exception.)
In 2006 added “young adults.”
Anafranil (clomipramine)
Asendin (amoxapine)
Aventyl (nortriptyline)
Celexa (citalopram hydrobromide)
Cymbalta (duloxetine)
Desyrel (trazodone HCl)
Effexor (venlafaxine HCl)
Elavil (amitriptyline)
Etrafon (perphenazine/amitriptyline)
Fluvoxamine maleate
Lexapro (escitalopram hydrobromide)
Limbitrol (chlordiazepoxide/amitriptyline)
Ludiomil (maprotiline)
Marplan (isocarboxazid)
Nardil (phenelzine sulfate)
Norpramin (desipramine HCl)
Pamelor (nortriptyline)
Parnate (tranylcypromine sulfate)
Paxil (paroxetine HCl)
Pexeva (paroxetine mesylate)
Prozac (fluoxetine HCl)
Remeron (mirtazapine)
Sarafem (fluoxetine HCl)
Serzone (nefazodone HCl)
Sinequan (doxepin)
Surmontil (trimipramine)
Symbyax (olanzapine/fluoxetine)
Tofranil (imipramine)
Tofranil-PM (imipramine pamoate)
Triavil (perphenazine/amitriptyline)
Vivactil (protriptyline)
Wellbutrin (bupropion HCl)
Zoloft (sertraline HCl)
Zyban (bupropion HCl)