Depressive Disorders

Define early onset and late onset for persistent depressive disorder.

In persistent depressive disorder, early onset occurs before age 21 and late onset occurs at age 21 or older.

Describe the course of key symptoms of premenstrual dysphoric disorder during the menstrual cycle.

In premenstrual dysphoric disorder, symptoms manifest in the final week before the onset of menses, improve after the onset of menses, and are minimal or absent in the week postmenses.

Name the four hallmark symptoms of premenstrual dysphoric disorder; that is, the four symptoms of which at least one must be present to meet criteria for the diagnosis.

Mood lability, irritability, dysphroia, and anxiety are the hallmark symptoms of premenstrual dysphoric disorder.

What is the minimum duration of symptoms for children and adolescents to meet criteria for persistent depressive disorder?

One year is the minimum duration of symptoms for children and adolescents to meet criteria for persistent depressive disorder.

In disruptive mood dysregualtion disorder, onset must be before what age in a child?

Onset of disruptive mood dysregualtion disorder must be before age 10 years.

How long must temper outbursts have been present to meet criteria for disruptive mood dysregualtion disorder?

Temper outbursts must have been present for at least 12 months to meet criteria for disruptive mood dysregulation disorder.

How frequent must temper outbursts be to meet criteria for disruptive mood dysregulation disorder?

Temper outbursts must occur an average of three or more times weekly to meet criteria for disruptive mood dysregulation disorder.

Depressive disorders

The core feature of depressive disorders is the changes in the individual's mood from what is "normal" for that individual. Not all individuals recognize or can accurately describe their feelings. There is also a significant change in the individual's level of functioning. Depressive disorders are very common and equally affect males and females. The disorders that are classified under the heading of Depressive Disorders include the following: - Disruptive Mood Dysregulation Disorder - Major Depressive Disorder - Persistent Depressive Disorder (Dysthymia) - Premenstrual Dysphoric Disorder

What is the fewest number of symptoms necessary for a diagnosis of persistent depressive disorder?

At least three symptoms are necessary for a diagnosis of persistent depressive disorder.

Roger is an eight-year-old boy whose parents describe as "an unhappy spiteful child". Since the age of six Roger has had severe temper tantrums at school and home where he becomes "completely out of control" for even the most minor situations. Roger becomes verbally abusive, throws items, and "rages" for at least an hour. These temper tantrums (his parents call them "temper rages") happen at least three times a week. When Roger is not having one of his temper "rages", he is unpleasant, irritable and angry every day. His parents are "exhausted". The have tried time out, positive reinforcement (e.g., allowing Roger more time to play his video games), punishmet, and play therapy. Nothing has made a difference. The school has placed Roger in a behavioral classroom. He is frequently teased by his peers which makes him more irritable and angry. HIs pediatrician has not found any medical reason for his behavior. Roger's behaviors are indicative of? A. Disruptive Mood Dysregulation Disorder B. Major Depressive Disorder, severe without psychotic features C. Conduct Disorder, childhood-onset type, mild D. Intermittent Explosive Disorder

The correct answer is "A" - Disruptive Mood Dysregulation Disorder. Roger has severe recurrent temper outbursts that are both verbally abusive and behaviorally disruptive. In the absence of temper outbursts, Roger's demeanor is irritable and angry. "B" - Major Depressive Disorder, severe, without psychotic features is not correct. Roger does not exhibit any depressive symptoms at present. "C" - Conduct Disorder, childhood-onset type is incorrect. Although Roger engages in destructive behaviors at times, those occur during his temper outbursts and he does not meet other qualifying critieria. "D" - Intermittent Explosive Disorder is also incorrect. Intermittent Explosive Disorder has characteristics of verbal aggression and behavioral disruption; however, the individual is generally remorseful after such events and does not exhibit continued anger and irritability.

Trina, a 38-year-old female, described to a psychiatrist how she has been experiencing severe problems with sleeping for a year and a half. She would go to bed at 6 pm and sleep straight through until 7 am. On weekends she would remain in bed all day only rising to go to the bathroom or eat meals. The client has a history of severe, recurrent periods of depression since age 13. For several months before she went to the psychaitrist, she was having crying episodes in her office. These episodes would occur suddenly, which made it difficult to hide the emotions. She acknowledged having trouble concentrating on her work and noted that she was under some pressure to complete projects on time, which had not occurred previously. She had been harboring angry and pessimistic feelings for the past several years and noted that these were becoming more severe. Recently she had allowed for weight to get out of control. At this evaluation she weighed about 30% above her ideal weight. She felt guilty that she was physically damaging herself and believed it was slowly causing her to die. She sometimes thought she deserved to be dead. She had been treated from age 18 to 33 with psychotherapy, during which time her depression gradually worsened. More recently she had a trial of different antiderpessants, each of which made improvements in her mood and wakefulness and lasted several months. She tended to fall asleep during evening group psychotherapy sessions. Tina had done poorly in high school and went to college for four years but failed to gradulate. She had some hope of a romantic relationship, but never had a steady boyfriend. She currently resides at home with her mother and has no close friends outside her family. During the interview, Tina gazed continually downward and spoke in a low monotone. She answered questions as presented, but without elaboration. At various points in the interview, she began crying and was unable to continue for several minutes. Tina endorsed depressed mood, thoughts of worthlessness, anhedonia, increased appetite, and hypersomnia. She stated she was not suicidal nor did she have a history of suicidal thoughts. What is Tina's diagnosis? A. Major Depressive Disorder, moderate B. Bipolar II Disorder, depressed, moderate C. Cyclothymic Disorder D. Persistent Depressive Disorder (Dysthymia) with early onset, moderate

The correct answer is "A" - Major Depressive Disorder, moderate. Trina has distinct episodes of depression in which her symptoms moderately exceed of the minimal criteria with significant functional impairment. Because she has distinct episodes of depression, this would eliminate. "D" - Persistent Depressive Disorder, with early onset, moderate. Persistent Depressive Disorder would show Trina having consistent symptoms for at least two years. She has never had manic or hypomanic episodes, which excludes "B" - Bipolar II Disorder, depressed, moderate and "C" - Cyclothyic Disorder.

Leon is a 45-year-old postal employee who was evaluated at a clinic specialized in the treatment of Mood Disorders. He claims to have felt constantly depressed since the first grade, without a period of "normal" mood for more than a few days at a time. His depression has been accompanied by lethargy, little or no interest or pleasure in anything, trouble concentrating, and feelings of inadequacy, pessimism, and resentfulness. His only periods of normal mood occur when he is home alone, listening to music or watching TV. Upon further questioning, Leon reveals he cannot ever remember feeling happy. Even before kingergarten, if he was asked to speak in front of a group of his parents' friends, his mind would "go blank" and he saw himself as a failure. He never felt like the answers he provided in class were correct. Even in his input was requested, Leon frequently mumbled. He met new children with his eyes lowered, fearing their scrutiny because he felt they would know he was worthless. He expected to feel humiliated and embarassed. He was convinced that everyone around him though he was "dumb" or "a jerk". Leon remains very self-conscious and "terrified" of meeting strangers. He has trouble finding a job because he did not think anyone would hire him. He passed the Civil Service exam at age 24 and was offered a job at the post office on the evening shift. He enjoyed his job, as it involved little contact with others. Although now he supervises a number of employees, he still finds it difficult to give instructions, even to people he has known for years.Leon has tried multiple antidepressants, but they have not been effective. Leon presents with a flat affect and poor eye contact. Speech is linear and goal directed, but he speaks softly. He continues to endorse feelings of wothlessness, low energy and hopelessness. Leon has never met the criteria for a major depressive episode nor had suicidal ideation. What is Leon's diagnosis? A. Bipolar I Disorder, depressed, moderate B. Major Depressive Disorder, moderate C. Persistent Depressive Disorder (Dysthymia), moderate, with early onset D. Unspecified Depressive Disorder

The correct answer is "C" - Persistent Depressive Disorder with early onnset, moderate. Leon has been depressed for years with only a few days or "normal mood". The specifier, "with early onset", would also be appropriate because Leon has been depressed since childhood. The severity of symptoms is moderate. Leon meets the minimal number of criteria but slightly exceeds those, but is symptoms are not severe. "A" - Bipolar I Disorder, depressed, moderate is not correct. Leon experiences chronic depressive symptoms but has never met the full criteria for either a depressed or manic epiosde. "B" = Major Depressive Disorder, moderate is incorrect because the scenario states he has never meet the full criteria for a major depressive episode. "D" - Unspecified Depressive Disorder is also incorrect because Persistent Depressive Disorder is the best explanation of his symptoms.

Jeannie is a 26-year-old female patient being seen at a gynecology office. She sought treatment for symptoms that made her feel "crazy". Jeannie described having an increase in the severity of her symptoms over the last several years to the point where she found them intolerable. Jeannie told her OBGYN that ever since she started her menstrual cycle at age 14, she has had significant mood swings, feels tense, has negative thoughts about herself and is irritable or can become very agitated with her co-workers and family. She has difficulty concentrating, craves sweets, and feels overwhelmed and out of control. Physically, she feels "bloated" and her breasts are swollen and sore. She noted that these symptoms start several days before her period and basically disappear by the end of her menstrual cycle. Jeanie tearfully asked her OBGYN if there was something wrong with her, hoping that her physician would not tell her "it's all in your head" like other doctors had told her in the past. Jeannie was adamant in stating that she does not have any of these symptoms any other time and was a "happy, easy going person". What is Jeannie's most likely diagnosis? A. Major Depressive Disorder, moderate B. Persistent Depressive Disorder (Dysthymia), early onset, moderate C. Premenstrual Dysphoric Disorder D. Unspecified Anxiety Disorder

The correct answer is "C" - Premenstrual Dysphoric Disorder. Jeannie only experiences symptoms around the time of her menstrual cycle and then the symptoms disappear until the next menstrual cycle. "A" - Major Depressive Disorder, moderate is incorrect. Jeannie does have some depressive symptoms, but only at the time of her menstrual cycle. This does not meet the criteria for a major depressive episode. "B" - Persistent Depressive Disorder (Dysthymia), early onset, moderate is also not correct. Jeannie would need to have depressive symptoms consistently for 2 years. Early onset would be consistent with her symptoms. "D" Unspecified Anxiety Disorder is not correct. Jeannie has some anxiety symptoms, but there are not enough criteria noted that would lead the clinician to determine if Jeannie had an anxiety disorder.

What is the minimum duration of the symptoms to meet criteria for major depressive disorder?

The minimum duration of the symptoms of 2 weeks to meet criteria for major depressive disorder.

What is the minimum duration of symptoms for adults to meet criteria for persistent depressive disorder?

Two years is the minimum duration of symptoms for adults to meet criteria for persistent depressive disorder.

Major Depressive Disorder

involves a minimum of one Major Depressive Episode and causes clinically significant distress or impairment. A Major Depressive Episode is defined as depressed mood (or a loss of interest or pleasure) that is distinctly different from the individual's normal mood. Children and adolescents may present with irritability instead of sadness. The individual must have at least five of the symptoms listed below with a marked changed in functioning. Symptoms associated with depressed episode include the following: - Depressed mood or loss of pleasure must have been present for a minimum of 2 weeks. The depressive episode is accompanied by a variety of symptoms (e.g., sleep and appetite disturbance) and the symptoms result in clinically significant impairments. Different cultural backgrounds may have difficulty agreeing that a problem is related to depression. - The presenting symptoms may vary greatly. For example, an individual may complain of feeling anxious or agitated, or complain of fatigue (e.g., tiredness or lack of energy). - Significant weight loss (not attributable to dieting) or weight gain; decreased or increased appetite. - Insomnia or hypersomnia nearly every day. - Difficulty concentrating. - Thoughts of death, or suicidal ideations without a plan, or suicidal ideations with a plan, or a suicide attempt. - A noticeable change in the level of functioning may be reported by the individual. A depressive episode should not be diagnosed when, regardless of the severity or duration of symptoms, there is substance use or a general medical disorder. Specify severity: (1) mild - 2 syptoms; (2) moderate - 2 symptoms; (3) moderate-severe - 4-5 symptoms; (4) severe - 4 or 5 symptoms with motor agitation. Major Depression and Bereavement. An individual who has experienced a loss of a loved one can, in some cases, develop a major depressive episode. This is more likely to occur when the individual has previously had a major depressive episode prior to the loss. The depressive episode in these cases is generally more severe with feelings of wothlessness, more suffering and possible suicidal ideation.

Disruptive Mood Dysregulation Disorder

is characterized by chronic, severe persistent irritability in children. The child has severe temper outbursts that are grossly out of proportion in intensity or duration to the situation and are not consistent with the child's developmental level. The child may threaten or bully siblings and parents, and may have refused to complete homework, chores or basic hygeine. The outbursts occur regularly (three or more times per week) and in at least two settings (e.g., home, school). When the outbursts are absent, the child's mood is persistently irritable and angry. Symptoms have been present for at least 12 months. Symptoms cause significant interference with family and peer relationships. The diagnosis cannot be made before age six or after 18. The onset is typically before age 10. This disorder is more common in males than females.

Persistent Depressive Disorder (Dysthymia)

is characterized by depressive symptoms that do not meet the criteria for a Major Depressive Episode. Symptoms must have been present a minimum of 2 s of depressed mood (1 year in children and adolescents) in combination with other depressive symptoms. It is common for the individual to develop Major Depressive Episodes; however, once the episode clears, the individual returns to the chronic state of Dysthymia. The individual has two or more of the following: - poor appetite or overeating - insomnia or hypersomnia - low energy or fatigue - low self-esteem - poor concentration - feelings of hopelessness Specify onset: (1) early onset (before age 20); (2) late onset (after age 21) Specify severity: (1) mild - few symptoms are in excess of those required for the diagnosis; (2) moderate - number of. symptoms and intensity of symptoms between mild & severe; (3) severe symptoms are in excess of those required intensity of symptoms in seriously distressing.

Premenstrual Dyshporic Disorder

is characterized by symptoms that occur during a majority of the woman's menstrual cycle. The symptoms begin in the final week before the onset of menses, begin to improve within a few days after the onset of menses, and become minimal or absent in the week post menses. The symptoms cause clinically significant impairment or distress. The onset of the disorder begins in adolescence and ends with meopause. Mood lability and irritability are the primary symptoms . The individual must have one or ore of the first three symptoms and up to five additional symptoms must be present: - significant affective lability - significant irritability or anger or increased interpersonal conflict - marked anxiety, tension, and/or feelings of being keyed up or on edge - decreased interest in usual activity - subjective difficulty in concentration - lethargy, fati, or lack of energy - significant change in appetite; overeating or specific food cravings - hypersomnia or insomnia - sense of being overwhelmed or out of control - physical symptoms (e.g., breast tenderness/swelling, joinit/muscle pain, sensation of bloating or weight gain)