Depressive Dx Flashcards

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1

Depressive Dx- list

  1. DMDD
  2. MDD
  3. Persistent Depressive Dx
  4. Premenstrual Dysphoric Dx
  5. Substance/Medication Induced Depressive Dx
  6. Depressive Dx due to another medical condition
  7. Other specified depressive Dx
  8. unspecified depressive dx
  9. unspecified mood dx

2

Disruptive Mood Dysregulation Dx

  • A. severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation
  • B. temper outbursts are inconsistent with developmental level
  • C. outbursts occur 3 or more times per week
  • D. mood between temper outburst sis persistently irritable or angry most of the day, nearly everyday, and is observable by others
  • E. criteria A-D have been present for 12 + months. During this time, there has not been a period of 3 or more months without the symptoms
  • F. present in at least 2 of 3 settings (home, school, with peers) and is severe in at least on setting
  • G. diagnosis made between age 6-18
  • H. by hx or observation, the age of onset is before age 10
  • I. never been a distinct period lasting more than 1 day during which the full criteria (besides durations) for hypomania or mania is met
  • J. bx do not occur exclusively during mdd and not better explained by another mental disorder
  • K. symptoms not attributable to the physiological effects of the substance or another medical or neurological condition

3

DMDD facts

  • DMDD cannot coexist with ODD, intermittent explosive Dx, or bipolar dx
  • can coexist with others, including MDD, adhd, conduct dx, and substance use dx
  • if one meets the criteria for both DMDD and ODD, then they should only be given the diagnosis of dmdd

4

Major Depressive Dx

  • A. 5+ 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 depressed mood or loss of interest/ pleasure
    1. depressed mood most of day nearly everyday
    2. diminished interest/pleasure in almost all activities
    3. significant weight loss or weight game or decrease or increase in appetite
    4. insomnia or hypersomnia
    5. psychomotor retardation nearly everyday
    6. fatigue or loss of energy
    7. feelings of worthlessness or inappropriate guilt
    8. diminished ability to think or concentrate
    9. recurrent thoughts of death, SI, or attempt
  • B. symptoms cause significant distress or impairment in social, occupational, other areas of functioning
  • C. episode not attributable to the effects of a substance or another medical condition
  • D. at least 1 major dep. episode is not better explained by schizoaffective dx and not superimposed on schizophrenia, schizophreniform (etC) dx
  • E. there has never been a manic or hypomanic episode

5

Major Depressive Dx- specifiers

  • coding depends on whether its a single or recurrent episode, current severity, presence of psychotic symptoms, and remission status
  • current severity and psychotic features are only indicated if full criteria are currently met

6

Persistent Depressive Dx

  • A. depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years (in children and adolescents, mood can be irritable but for at least 1 year)
  • B. presence, while depressed, of 2+ of the following:
    • 1. poor appetite, 2. insomnia or hypersomnia, 3. low energy, 4. low self esteem, 5. poor concentration, 6. feels of hopelessness
  • C. during the 2 year period, the individual has never been without the symptoms of A and B for more than 2 months at a time
  • D. criteria for major depressive disorder may be continuously present for 2 years
  • E. never been a manic or hypomanic episode
  • F. disturbance is not better by persistent schizoaffective dx, or other psychotic dx
  • G. symptoms not attributable to substance use or other medical condition
  • H. symptoms cause significant distress or impairment in social, occupational, other areas of functioning

7

Persistent Depressive Dx- specifiers

  • specify if
    • w anxious distress
    • w atypical features
  • specify if
    • in partial/full remission
  • specify if
    • early/ late onset (before/after age 21)
  • specify if : (if we're talking about the previous 2 yrs)
    • w pure dysthymic syndrome= mdd criteria not meet continuously for full 2 yrs
    • with persistent major depressive ep= mdd criteria met for full 2 yrs
    • with intermittent mdd, curren tepisode
    • with intermittent mdd, without current episode
  • specify severity

8

Premenstrual Dysphoric Dx

  • A. In the majority of menstrual cycles, at least 5 symptoms present in final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal in the week postmenses:
  • B. one or more must be present
    • 1. affective lability (mood swings), 2. irritability, 3.depressed mood, 4. anxiety or tension
  • C. One or more present (to reach a total of 5 symptoms)
    • decreased interest in usual activities, 2. trouble concentrating, 3. lethargy/ easily fatigued, 4. change in appetitive, 5. hypersomnia or insomnia, 6. overwhelmed or out of control, 7. physical symptoms like breast tenderness
  • D. symptoms cause clinically significant distress or interference with work, school, normal actvities
  • E. not merely an exacerbation of the symptoms of another disorder, such as mdd, panic dx, or persistent depressive dx, or personality dx
  • F. Criterion A confirmed by daily ratings at least 2 cycles
  • G. symptoms not attributable to the effects of a substance or medical condition

9

specifiers for depressive dx

  • anxious distress
  • with mixed features
  • with melancholic features
  • with atypical features
  • with psychotic features
  • with catatonia
  • with peripartum onset
  • seasonal pattern
  • in partial/full remission
  • mild/moderate/severe

10

Anxious distress

  • defined as the presence of at lest 2+ of the following during the majority of the days of the current major depressive episode or current persistent depressive dx:
    1. feeling keyed up or tense
    2. feeling unusually restless
    3. difficulty concentrating bc of worry
    4. fear that something awful may happen
    5. feeling that the individual might lose control of self
  • must also specify the severity of the anxious distress
    • mild= 2 symptoms
    • moderate= 3 symptoms
    • moderate-severe= 4-5 symptoms
    • severe= 4-5 symptoms and motor agitation

11

mixed features

  • showing manic/hypomanic symptoms during a depressive episode

12

melancholic features

  • A. one of the following present during the most severe period of the current major depressive episode:
    • loss of pleasure in all or almost all activities
    • lack of reactivity to usually pleasurable stimuli
  • B. 3+ of the following
    • distinct quality of depressed mood characterized by profound despondency, despair, or moroseness
    • depression that is regularly worse in the AM
    • early morning awakening
    • marked psychomotor agitation
    • significant anorexia or weight loss
    • excessive or inappropriate guilt

13

atypical features

  • specifier applied when these features predominate during the majority of days of the current major depressive episode or current persistent depressive disorder:
  • A. mood reactivity (brightens)
  • B. 2+ of the following:
    • significant weight gain or increase in appetitive
    • hypersomnia
    • leaden paralysis
    • a long standing pattern of interpersonal rejection sensitivity that results in significant social/occupational impairment

14

psychotic features

  • delusions and or hallucinations are present at any time in the current major depressive episode. If present, must specify if mood congruent or mood incongruent
  • mood congruent= content of delusions/ hallucinations are consistent with typical depressive themes
  • mood incongruent= content of delusions/hallucinations are inconsistent with typical depressive themes

15

with catatonia

  • specifier applied to the current major depressive episode if catatonic features are present during most of the episode

16

peripartum onset

  • specifier applied to teh current major depressive episode (or the recent major depressive episode if mdd is currently in full or partial remission) if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery

17

seasonal pattern

  • applies to recurrent major depressive dx
  • A. been a regular temporal relationship btwn onset of major depressive eps in mdd and a particular time of the year
  • B. full remissions also occur at a characteristic time of the year
  • C. in the past 2 years, two major depressive eps have occurred that demonstrated the temporal seasonal relationships defined above and no nonseasonal major depressive eps have occurred during that same period
  • D. seasonal major depressive episodes substantially outnumber the nonseasonal major depressive episodes that may have occurred over the individual's lifetime

18

in partial/full remission

  • partial=may still be symptoms, but full criteria for previously diagnosed depressive dx have not been met for 2 months
  • full remission= 2+ months of not meeting full criterial of previous depressive dx

19

Severity specifier for depression

  1. mild=few if any sx in excess of those required to make the diagnosis, intensity of sx is distressing but manageable, and symptoms result in impairment in functioning
  2. moderate= btwn mild and severe
  3. severe= # of symptoms is substantially in excess of that required to make the diagnosis, intensity of sx is seriously distressing, and interfering with functioning