Transcript Major Depressive Disorder

Mood
Disorders
Level of analysis
• Depression as a symptom
• Depression as a syndrome
• Depression as a disorder
Dimensions of Depression
• cognitive
• behavioral
• physiological
Categories
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major depressive disorder
major depressive episode
dysthymic disorder
depressive disorder NOS
bipolar disorder
manic episode
cyclothymic disorder
hypomanic episode
bipolar disorder NOS
mood disorder due to a general medical condition
substance-induced mood disorder
mood disorder NOS
Depression
• A. At least one of the following three
abnormal moods which significantly
interfered with the person's life:
– 1. Abnormal depressed mood most of the
day, nearly every day, for at least 2 weeks.
– 2. Abnormal loss of all interest and pleasure
most of the day, nearly every day, for at
least 2 weeks.
– 3. If 18 or younger, abnormal irritable mood
most of the day, nearly every day, for at
least 2 weeks.
Major Depressive Disorder
• Persists for two weeks and causes
significant personal distress or functional
impairment.
• Major Depression: 5 of 9 symptoms,
which must include either:
1. Depressed mood or
2. Anhedonia.
Major Depression Diagnostic
Criteria (cont’d)
• B. At least five symptoms have been
present during the same 2-week period.
– 1. Abnormal depressed mood (or irritable
mood if a child or adolescent) .
– 2. Abnormal loss of all interest and pleasure.
– 3. Appetite or weight disturbance, either:
• Abnormal weight loss or decrease in appetite.
• Abnormal weight gain or increase in appetite.
Major Depression Criteria
(cont’d)
– 4. Sleep disturbance, either abnormal
insomnia or abnormal hypersomnia.
– 5. Activity disturbance, either abnormal
agitation or abnormal slowing (observable by
others).
– 6. Abnormal fatigue or loss of energy.
– 7. Abnormal self-reproach or inappropriate
guilt.
– 8. Abnormal poor concentration or
indecisiveness.
– 9. Abnormal morbid thoughts of death (not
just fear of dying) or suicide.
Major Depression Criteria
(cont’d)
• C. The symptoms are not due to a moodincongruent psychosis.
• D. There has never been a Manic Episode,
a Mixed Episode, or a Hypomanic Episode.
• E. The symptoms are not due to physical
illness, alcohol, medication, or street
drugs.
• F. The symptoms are not due to normal
bereavement.
Essential Features
• Not due to “rule-outs”
• Abnormal depressed mood
– Persists continuously for at least 2
weeks.
– Causes marked functional impairment.
– Causes disabling physical symptoms.
– Causes disabling psychological symptoms.
Essential Features (cont’d)
• Abnormal loss of interest and
pleasure mood:
– Reduced capacity to experience pleasure
(anhedonia).
– Result=lack of motivation.
– Abnormal irritable mood:
• May present primarily with irritable, rather
than depressed or apathetic, mood.
• Unfortunately, irritability=alienating loved
ones with their cranky mood and constant
criticisms.
Essential Features (cont’d)
• Physical symptoms
– Abnormal appetite
– Abnormal sleep
– Fatigue or loss of energy
– Agitation or slowing
Essential Features (cont’d)
• Cognitive symptoms
– Abnormal self-reproach or inappropriate
guilt
– The "negative thinking"
– Abnormal poor concentration or
indecisiveness
– Marked forgetfulness
– Abnormal morbid thoughts of death (not
just fear of dying) or suicide
Comorbidity
• 40-70% meet criteria for another
disorder; 20-50% have 2 or more
comorbid disorders
• Most common:
– Anxiety Disorders
– Disruptive Behavior Disorders
– Substance Abuse Disorders
Dysthymia
• Chronic
– at least 2 years in adults,
– 1 year in children.
• Milder depression than Major Depressive
Disorder.
Dysthymia Diagnostic Criteria
• A. Depressed mood for most of the
day, for more days than not, as
indicated either by subjective
account or observation by others, for
at least 2 years.
• Note: In children and adolescents,
mood can be irritable and duration
must be at least 1 year.
Dysthymia Diagnostic Criteria
(cont’d)
• B. Presence, while depressed, of two
(or more) of the following:
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1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficulty
making decisions
– 6. feelings of hopelessness
Dysthymia Diagnostic Criteria
(cont’d)
• C. The person has never been without the symptoms in
Criteria A and B for more than 2 months at a time.
• D. No Major Depressive Episode has been present
during the first 2 years of the disturbance (1 year for
children and adolescents
– Note: There may have been a previous Major Depressive
Episode provided there was a full remission before
development of the Dysthymic Disorder.
– After the initial 2 years (1 year in children or adolescents) of
Dysthymic Disorder, there may be superimposed episodes of
Major Depressive Disorder, in which case both diagnoses may
be given when the criteria are met for a Major Depressive
Episode.
Dysthymia Diagnostic Criteria
(cont’d)
• E. There has never been a Manic Episode, a
Mixed Episode, or a Hypomanic Episode, and
criteria have never been met for Cyclothymic
Disorder.
• F. The disturbance does not occur exclusively
during the course of a chronic Psychotic
Disorder.
• G. The symptoms are not due to the direct
physiological effects of a substance.
• H. The symptoms cause clinically significant
distress or impairment in social, occupational,
or other important areas of functioning.
Bipolar Disorder
• Individual experiences depressed episode
followed by manic episode.
• Lifetime prevalence ~1%
• Male=Female
• Age of onset: Usually late teens to mid
30s
• Extremely controversial in children
Manic Episode
• Manic Episode=period (at least 1 week) of
elevated, expansive, or irritable mood including 3
of 7 symptoms.
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1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts
are racing
– 5. distractibility
– 6. increase in goal-directed activity or psychomotor
agitation
– 7. excessive involvement in pleasurable activities that
have a high potential for painful consequences
Manic Episode (cont’d)
• C. The symptoms do not meet criteria for a
Mixed Episode.
• D. The mood disturbance is sufficiently severe
to cause marked impairment in occupational
functioning or in usual social activities or
relationships with others, or to necessitate
hospitalization to prevent harm to self or
others, or there are psychotic features.
• E. The symptoms are not due to the direct
physiological effects of a substance or a
general medical condition.
Child Assessment Methods
for Depression
• Clinical interviews (parent, child)
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Meet diagnostic criteria?
Assess associated features (e.g., social funct.)
Suicidal and/or homicidal ideation?
Check for “rule-outs”
• Self-report measures
– Children’s Depression Inventory
– Broadband measures (e.g., BASC-2, ASEBA)
• Projective testing
• Refer for medical evaluation?
• Direct Observations
Adolescent Assessment
Methods for Depression
• Clinical interviews (adolescent, parent)
– Ditto child
• Self-report measures
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– Reynolds Adolescent Depression Scale-2
– Broadband measures (e.g., BASC-2, ASEBA)
Projective testing
Refer for medical evaluation?
Lab testing
Observations
Child Treatment Methods for
Depression
• Cognitive-behavioral therapy
– (e.g., Primary and Secondary Control
Enhancement Training)
• Interpersonal therapy
• Family therapy
• Psychodynamic therapy
• Psychopharmacological intervention
Adolescent Treatment Methods
for Depression
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Cognitive-behavioral therapy
Interpersonal therapy
Family therapy
Milieu therapy
Integrated treatment (Adolescent Coping with
Depression Course)
• Inpatient treatment
• Psychodynamic therapy
• Psychopharmacological intervention