diagnosis quiz 2: mood disorders

WHAT IS ASSESSMENT?

"Assessment is a time-limited, formal process that collects information from many sources in order to reach a diagnosis, to make a prognosis, to render a biopsychosocial formulation, and to determine treatment" (Maxmen & Ward, 2008). "The psychological assessment is a structured interview that gathers information from and/or tests a person to evaluate their mental health concerns" (www.minddisorders.com). Procure from Client Family Friends Staff Medical examinations and tests

Depressive episode

**5 (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning*** *at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.* Note: Do not include symptoms that are clearly attributable to another medical condition. Depressed Disinterest Weight loss or gain Sleep issues - Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue Worthlessness, guilt Distractibility Death - recurrent thoughts Impairs functioning DDWSPFWDD (damn dudes with small p* f*king without due diligence) ~ Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) Insomnia or hypersomnia nearly every day. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). Fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Bipolar I versus Bipolar II

1. (must have had a manic episode) 2. (must never have had a manic episode - only hypomanic) A. At least one hypomanic episode and at least one major depressive episode. B. There has never been a manic episode. C. Not better explained by psychotic disorder.

Persistent Depressive Disorder (Dysthymia)

2 years No more than 2 months w/out symptoms depressive, but not MDD 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. Presence, while depressed, of two (or more) of the following: eating issues - poor appetite or overeating sleep issues - insomnia or hypersomnia fatigue - low energy or fatigue esteem - low self-esteem concentration - poor concentration or difficulty making decisions hopelessness - feelings of hopelessness ESFECH Every second, feeling everything, choose hope During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time. No Major Depressive Episode (see Criteria for Major Depressive Episode) has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission. Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, 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. Specifiers: Early Onset: if onset is before age 21 years Late Onset: if onset is age 21 years or olderSpecify (for most recent 2 years of Dysthymic Disorder): Mild, Moderate, Severe

Cyclothymic Disorder

2 years Rapid cycling, no more than 2 months w/out symptoms Hypomanic depressive, but not MDD For at least 2 years, the presence of numerous periods with hypomanic symptoms (see Criteria for Hypomanic Episode) and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time. No Major Depressive Episode (Criteria for Major Depressive Episode), Manic Episode (Criteria for Manic Episode) has been present during the first 2 years of the disturbance.

Addntl mood disorders

293.83 Mood Disorder Due to a General Medical Condition Substance-induced Mood Disorder (see Substance Abuse Disorders) 290.43 Vascular Dementia, With Depressed Mood

Suicide - 3 major risk factors

3 major risk factors to pose serious risk, if have 2 or more 1. Prior history of psychiatric hospitalizations - with severe mental illness at inpatient setting 2. History of attempts 3. Detailed plan for suicide - sometimes - sudden lifting of mood, bc have a plan* / any major changes in appearance, mood, affect

Major Depressive Disorder- What are the criteria for it?

5 or more of the following symptoms present during the same 2-week period and represent a change for previous functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure. DDWSPFWDD 1. Depressed mood most of the day, nearly every day. 2. Diminished interest in pleasure or activities. 3. Significant weight loss or decrease in appetite. 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day. 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or guilt. 8. Diminished ability to think or concentrate or indecisiveness. 9. Recurrent thoughts of death or suicidal ideation. B. Cause significant impairment. C. Not physical or medical.

Bipolar I

A. Criteria has been met for at least one manic episode. B. Manic or depressive episodes are not better explained by schizoaffective disorder, schizophrenia, schzophreniform, delusional, or other psychotic disorder.

Disruptive Mood Dysregulation Disorder

A. Temper outbursts verbally and/or behaviorally that are out of proportion. B. Inconsistent with developmental level. C. 3 or more time per week. D. Mood between is persistently irritable or angry most of the day nearly every day. E. Has been present for 12 or more months. F. In two or more settings. G & H. Diagnosis between 6 and 18 onset before 10. I. Never more than 1 day without. J. Not mood or other disorder. K. Not physical or medical.

Causes of depression

Biology Neurotransmitters Hormones Inherited traits Substance Abuse Life events Childhood Trauma Meds Buy new hair items so losers can't mess

Treatment of Bipolar Disorders

Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness. Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members. Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms. Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Steps of assessment

Consists of 8 main steps: Obtaining a History Evaluating the mental status Collecting auxiliary data Summarizing principal findings Rendering a diagnosis Making a prognosis Providing a biopsychosocial formulation Determining a treatment plan

Coding ex.

DOMAIN 1 296.31 (F33.0) Major Depressive Disorder. Recurrent episode, Mild, with seasonal pattern I47.1 supraventricular tachycardia DOMAIN 2 V61.10 relationship distress ~~ DOMAIN I Bipolar 296.44 (F31.2) - bipolar I severe, current episode manic Asthma (secondary bc not presenting problem, and medical) - ICD10 code J45.901 Bipolar 296.41 (F31.2) Bipolar I Disorder, most recent episode Manic, with mood-congruent psychotic features E11.9 Type II diabetes

DOMAIN 1

Developmental, Mental, Addictive or Substance Abuse Disorder with related codes. Medical Conditions & diagnoses (Physical Disorders) based on the ICD-10 Codes. Disorders are listed in order of clinical significance (or to prioritize treatment)

Hypomanic vs. Manic episodes -What are the differences?

Duration and intensity/severity: Hypomanic is 4-6 days, Manic is 1 week or more and is more intense

With peripartum onset

During pregnancy or first four weeks following birth

DSM Criteria

Each disorder has specific criteria that need to be met Criteria are generally signs and symptoms, but could also be experiential (like experiencing a traumatic incident)

Manic Episode

Elevated Mood Lasts 1 week Hospitalization Criteria: grandiosity, less sleep, talkative, racing thoughts, distractibility, goal-directed activity, risky behavior Impairs functioning GSTRDGR Get sleep to reconsider dates getting reckless ~ Criteria for Manic Episode A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, *lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).* During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: 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 racing thoughts. 5. Distractibility. 6. Increase in goal-directed activity. 7. Excessive involvement in activities that have a high potential for painful consequences. C. Causes impairment. D. Not attributable to substance or medical.

Hypomanic episode

Elevated Mood Lasts 4-6 days Criteria: grandiosity, less sleep, talkative, racing thoughts, distractibility, goal-directed activity, risky behavior Impairs functioning GSTRDGR Get sleep to reconsider dates getting reckless ~ Criteria for Hypomanic Episode A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting *at least 4-6 consecutive days and present most of the day, nearly every day.* B. Three of the following symptoms 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 racing thoughts. 5. Distractibility. 6. Increase in goal-directed acitivity. 7. Excessive invovlement in activities that have a high potential for painful consequences. C. Episode is associated with change in functioning that is uncharacteristic of the individual. D. Observable by others. E. Not sever enough to cause a marked impairment. F. Not attributable to physical or medical.

Premenstrual Dysphoric Disorder

In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses. One (or more) of the following symptoms must be present: Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection). Marked irritability or anger or increased interpersonal conflicts. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. Marked anxiety, tension, and/or feelings of being keyed up or on edge. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above. Decreased interest in usual activities (e.g., work, school, friends, hobbies). Subjective difficulty in concentration. Lethargy, easy fatigability, or marked lack of energy. Marked change in appetite; overeating; or specific food cravings. Hypersomnia or insomnia. A sense of being overwhelmed or out of control. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of "bloating," or weight gain.

Difference between Mood Congruent and Mood Incongruent - In DSM-5

It is a psychotic feature of the disease wherein the person's belief or action, whether by hallucination or delusion, does not match with his or her mood. i.e. Laughing when your dog dies Believing you have super powers despite going through a major depressive episode --> Content is inconsistent with polarity themes, i.e. if in depressive episode, might have manic features, thinking they're President / if manic, might think that landlord is sneaking into house and stealing - themes of persecution and lack of power ~ By contrast, mood congruence also describes a psychotic symptom of bipolar disorder, but, in this case, the belief or action *are consistent with that person's mood.* i.e. Feeling suicidal when your dog dies Believing you have super powers when you are going through a manic episode --> With mood congruent psychotic features Content during manic episodes is consistent with manic themes, including paranoia i.e. if in depressive episode, content will be depressive - the world is ending, aliens are going to invade, themes of persecution - if manic, follow themes of grandiosity, god-like, expansive, positive, energetic mood - features of psychosis mirror their mood

Manic/Depressive episodes - What are the differences?

Manic episodes are characterized by X... while depressive are characteized by X

Can you have BPII in the future if you have BPI?

May have had bipolar II diagnosis in past, but can't have bipolar II in future bc already had manic episode and no longer bipolar II* if only have 1 manic episode in life, and rest of life have hypomanic, still bipolar I

CAUSES OF BIPOLAR DISORDER

Neurotransmitters Genetic Circadian Rhythms Nuns get crunk

Other Specified Mood Disorder

Other Specified Mood Disorder means that the client meets almost all the criteria for a diagnosis of a Mood Disorder but one or two that don't quite add up. For instance, maybe the 5 or more depressive mood symptoms have only lasted 10 days instead of 14 days (minimum duration for a Depressive episode).

WHAT IS THE PIE?

PIE is a holistic, four factor classification system used by social workers to describe and code social functioning problems with common descriptors. The four factors address problems and strengths under the following headings: • Social Roles in Relationship to Others • Social Environment • Mental Health • Physical Health

Bipolar II Disorder

Presence (or history) of one or more Major Depressive Episodes (see Criteria for Major Depressive Episode). Presence (or history) of at least one Hypomanic Episode (see Criteria for Hypomanic Episode). There has never been a Manic Episode (see Criteria for Manic Episode). The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DOMAIN 2

Psychosocial, contextual and environmental factors that may contribute to, or exacerbate, current symptoms and issues. Could include relationship, social, occupational, educational and other impairments. Includes V-Codes

Treatment - Depressive Disorders

Psychotherapy (Individual and Group) Psychodynamic Interpersonal Cognitive Behavioral Therapy Dialectical Behavioral Therapy Support Groups Medication Adherence and Health Education Electroconvulsive Treatment (ECT) Transcranial Magnetic Stimulation

Bipolar I - With seasonal pattern

Regular, temporal relationship with episodes and seasonal time of yr - cannot line up with other major events - like starting school* on quiz no other major events that correlate with onset of symptoms no other non-seasonal episodes occurred during this time Regular, temporal relationship with episodes and seasonal time of yr - cannot line up with other major events - like starting school* on quiz - no other major events that correlate with onset of symptoms, no other non-seasonal episodes occurred during this time

MSE

The MSE describes the patient's appearance, behavior, speech, emotions, and cognitive and perceptual processes. While psychiatric history provided by the client is a subjective account, the MSE is an objective report of the client's current mental state as observed by the clinician. Appearance Behavior (including impulse control) Speech Emotion (mood-affect) Thought Process Perception Attention Orientation Memory Judgment Intelligence Insight

Unspecified Mood Disorder

Unspecified Mood Disorder means that it is a provisional diagnosis. In other words, you suspect the client suffers from a Mood Disorder but you need more information before you make a judgment. This is used because in many agencies, you cannot get approval from insurance to treat a client until they have a DSM V coded disorder on their charts. But some insurance companies don't accept the diagnosis of an Unspecified Disorder. So in that case, you can code one of the following: Bipolar I Disorder (provisional) Bipolar I Disorder (rule-out) Bipolar I Disorder (deferred)

DOMAIN 3

WHODAS 2.0 SCORE

Specifiers for Major Depressive Disorder -In DSM-5

With anxious distress With mixed features With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia. Coding note: Use additional code 293.89 (F06.1). With peripartum onset With seasonal pattern (recurrent episode only)

Bipolar I Disorders- Specifiers

With anxious distress With mixed features With rapid cycling With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia. Coding note: Use additional code 293.89 (F06.1). With peripartum onset With seasonal pattern Mild - 2 Symptoms. Moderate - 3 Symptoms. Moderate-Severe - 4 to 5 Symptoms. Severe - 4 to 5 Symptoms with psychomotor agitation.

With psychotic features

always considered severe - if not psychotic features with mood-incongruent or congruent, then write "severe" and add specifiers Diff btwn schizoaffective - bipolar I with psychotic features if mood disorder is predominant

Early Onset

if onset is before age 21 years