Lab 9: DepressionLab 9: Depression

Video #1 Dysthymic Disorder

What criteria for Dysthymic Disorder does What criteria for Dysthymic Disorder does Susan meet?Susan meet?

Why does she not meet the criteria for Why does she not meet the criteria for major depression?major depression?

How/would would you ask about any How/would would you ask about any suicidal thoughts and behaviours?suicidal thoughts and behaviours?

How would her symptoms impact on her How would her symptoms impact on her life? life?

DSM IV Criteria Dysthymic Disorder

Depressed mood for most of the day, for more days than Depressed mood for most of the day, for more days than not, for at least 2 yrsnot, for at least 2 yrs

Presence while depressed of 2 or more of the followingPresence while depressed of 2 or more of the following Poor appetite or overeatingPoor appetite or overeating Insomnia or hyposomniaInsomnia or hyposomnia Low energy or fatigueLow energy or fatigue Low self-esteemLow self-esteem Poor concentration or difficulty making decisionsPoor concentration or difficulty making decisions Feelings of hopelessnessFeelings of hopelessness

Criteria Dysthymic Disorder cont

During the 2 yr period of the disturbance the During the 2 yr period of the disturbance the person has never been without the symptoms in person has never been without the symptoms in above criteria for more than 2 months at a timeabove criteria for more than 2 months at a time

No Major Depressive Episode has been present No Major Depressive Episode has been present during the first 2 yrs of the disturbanceduring the first 2 yrs of the disturbance

Symptoms cause clinically significant distress or Symptoms cause clinically significant distress or impairmentsimpairments

Video #2 Major Depressive Disorder - Recurrent

Is Max in a depressive episode at the time of the Is Max in a depressive episode at the time of the interview?interview?

What is the difference between Max’s depressive What is the difference between Max’s depressive symptoms and Susan’s symptoms?symptoms and Susan’s symptoms?

What further information would be important to What further information would be important to find out about?find out about?

What impact do you think Max’s symptoms are What impact do you think Max’s symptoms are having on his life?having on his life?

DSM IV Criteria Major Depressive Disorder Recurrent

Presence of 2 or more major depressive episodes (MDE)Presence of 2 or more major depressive episodes (MDE) MDE’s not better accounted for by psychotic disorderMDE’s not better accounted for by psychotic disorder No maniaNo mania Specify (for the most current episode)Specify (for the most current episode)

SeveritySeverity Psychotic elementsPsychotic elements Remission specifiersRemission specifiers ChronicChronic Catatonic featuresCatatonic features Melancholic featuresMelancholic features Atypical featuresAtypical features Postpartum onsetPostpartum onset

MDD recurrent criteria cont

Specify Specify Longitudinal course specifiers (with and Longitudinal course specifiers (with and

without interepisodic recovery)without interepisodic recovery) Seasonal patternSeasonal pattern

Major Depressive Episode DSM IV Criteria

Presence of 5 of the following symptoms for at least two weeksPresence of 5 of the following symptoms for at least two weeks Either depressed mood or loss of interest in pleasure must be Either depressed mood or loss of interest in pleasure must be

one of the 5 symptomsone of the 5 symptomsSad depressed mood, most of the day, nearly every daySad depressed mood, most of the day, nearly every dayLoss of interest and pleasure in usual activitiesLoss of interest and pleasure in usual activitiesSleep disturbanceSleep disturbanceShift in activity levelShift in activity levelAppetite disturbance, weight loss or gainAppetite disturbance, weight loss or gainLoss of energy, fatigueLoss of energy, fatigueNegative self-concept, feelings of worthlessness and guiltNegative self-concept, feelings of worthlessness and guiltDifficulty concentrating slowed thinkingDifficulty concentrating slowed thinkingReccurrent thoughts of death or suicide Reccurrent thoughts of death or suicide

Depression Case 1Depression Case 1 Ralph is a 45 year old male of European descent Ralph is a 45 year old male of European descent

who has been living by himself in a flat since his who has been living by himself in a flat since his divorce 3 years ago. His wife initiated the divorce divorce 3 years ago. His wife initiated the divorce after years of dissatisfaction over her Ralph’s low after years of dissatisfaction over her Ralph’s low mood, lack of energy, and the absence of any mood, lack of energy, and the absence of any sense of happiness in their relationship. She and sense of happiness in their relationship. She and their two children continue to live in the family their two children continue to live in the family home, and although she supports Ralph staying home, and although she supports Ralph staying involved with the children, he seldom seeks involved with the children, he seldom seeks contact with them. He reports feeling empty most contact with them. He reports feeling empty most of the time, with little energy or interest in things. of the time, with little energy or interest in things. He used to enjoy fishing and tramping, but now He used to enjoy fishing and tramping, but now says these things no longer excite him. says these things no longer excite him.

His sleep is poor, as he often awakens in the His sleep is poor, as he often awakens in the middle of the night and has difficulty getting back middle of the night and has difficulty getting back to sleep. He often feels tired and listless during to sleep. He often feels tired and listless during the day. He believes that he is a failure, and it is the day. He believes that he is a failure, and it is his fault that his marriage failed. He also believes his fault that his marriage failed. He also believes that he has never lived up to his potential, and that that he has never lived up to his potential, and that he is now simply living out the rest of his he is now simply living out the rest of his mediocre existence. He sometimes thinks it would mediocre existence. He sometimes thinks it would be a relief to be dead, although he says that he has be a relief to be dead, although he says that he has no specific plan to end his life. He reports that he no specific plan to end his life. He reports that he has had intense periods of these thoughts and has had intense periods of these thoughts and feeling several times since his mid-twenties.feeling several times since his mid-twenties.

Diagnosis: Major Depressive Disorder, RecurrentDiagnosis: Major Depressive Disorder, Recurrent

Questions - Ralph

What criteria does Ralph meet?What criteria does Ralph meet? How do you think Ralph’s reccurrent How do you think Ralph’s reccurrent

depressive episodes may be impacting on depressive episodes may be impacting on his family?his family?

Is Ralph a high suicide risk?Is Ralph a high suicide risk? What are the precipitating factors to his What are the precipitating factors to his

current depressive episode?current depressive episode?

Depression Case 2Depression Case 2 Martha is a 29 year old manager in a large Martha is a 29 year old manager in a large

department store. She lives with her husband of department store. She lives with her husband of three years in a comfortable suburban home. She three years in a comfortable suburban home. She presents as tearful and distressed, and says that she presents as tearful and distressed, and says that she has felt intense sadness for the past six weeks. has felt intense sadness for the past six weeks. She reports that she has lost her appetite for food, She reports that she has lost her appetite for food, and her weight is down five kilograms in the past and her weight is down five kilograms in the past month, although she is not trying to lose weight. month, although she is not trying to lose weight. She has also lost her interest in sex, which is She has also lost her interest in sex, which is leading to tension with her husband. She believes leading to tension with her husband. She believes that she is unable to concentrate effectively most that she is unable to concentrate effectively most of the time, and worries that she will be dismissed of the time, and worries that she will be dismissed from her job. from her job.

She moves and speaks in a slow, ponderous She moves and speaks in a slow, ponderous manner, as if it requires a great effort. She manner, as if it requires a great effort. She complains of having no energy. She says that she complains of having no energy. She says that she hasn’t experienced any significantly losses hasn’t experienced any significantly losses recently (e.g. no one she knows has died, they recently (e.g. no one she knows has died, they haven’t moved away from friends or family, she haven’t moved away from friends or family, she has not changed jobs). She also reports that her has not changed jobs). She also reports that her condition is not at all like the way she usually is, condition is not at all like the way she usually is, as she has always been an energetic, confident as she has always been an energetic, confident person.person.

   Diagnosis: Major Depressive Disorder, Single Diagnosis: Major Depressive Disorder, Single

EpisodeEpisode

Questions - Martha

What criteria does Martha meet?What criteria does Martha meet? What further information would you like to What further information would you like to

find out?find out? What things may be maintaining her What things may be maintaining her

symptoms?symptoms? What treatment options would you What treatment options would you

consider?consider?