Depressive Disorders

Major Depressive Disorder (MDD) is also known as clinical depression or unipolar depression and refers to distinct episodes of depression lasting >2 weeks and having a negative impact on everyday functioning. Criteria include;

  • Depressed mood for 2 weeks, with or without anhedonia… PLUS 4 of the following
    • Insomnia/Hypersomnia
    • Significant weight loss or gain
    • Fatigue
    • Poor concentration
    • Agitation or psychomotor retardation
    • Worthlessness or guilt
    • Recurrent thoughts of death, suicidal ideation, attempt or plan
    • Impairment or distress
  • Exclude or
  • Exclude medical or substance abuse rxns, must not be better accounted for by any other diagnosis…
  • Specifies:
    • W/ Anxious distress
    • W/ Mixed Features manic or hypomanic sx),
    • W/ Melancholic features
    • W/ Atypical features (eating excessively, seeping, a “leaden” feeling in the limbs, or being sensitive to rejection)
    • W/ Peripartum onset
    • W/ Seasonal pattern (occurs usually in winter… assoc w/ low levels of sunlight)

Screen for bipolar affective disorder  a low may have a high in the past and completely change the way we treat wit medications

Lifetime risk of M:F; 10-25%:5-12%,
nb1. men can develop symptoms prior to puberty, whereas women may develop symptoms from puberty til middle age…
nb2. 50+ the risk equilibrates M=F

Causes, onset and course of depression

– Depression is common, affecting ~20% of Australians over a lifetime… Depression is a word often used to describe feelings of sadness and grief that all people experience at times. However, for a person to be clinically diagnosed with a depressive disorder, his or her symptoms are usually much more intense and must have been present for at least 2 weeks… Depression is commonly accompanied by feelings o anxiety or agitation. Bereavement following death of a loved one is not considered a psychiatric illness  however one must carefully evaluation whether the symptoms have gone beyond grief and into a state of depression (which cannot co-exist with bereavement…
– Persistent complex bereavement disorder is not recognised as an illness yet but is being considered for further study… it consists of impaired functioning following a death of at least a year for adults and six months for children…
– People may experience depression as a result of any one or more of a range of factors including; Biochemistry, physical stress, chronic or sustained illness, seasonal influences, genetic predispositon, life stressors, personality factors…
– Depression may have acute or gradual onset and can be experienced at any time over the course of a person’s life…

 

Difficulties in diagnosis.

– Depression can be difficult to diagnose as people present complaining of physical problems that obscure psychiatric diagnosis. Depressive disorders often coexist with, and may be secondary to other medical disorders… particularly high rates of depression are found in people with alcohol related disorders, eating disorders, schozophrenia and somatoform disorders (vague physical complaints with no physical basis). Determining which disorder is primary and which is secondary is often a difficult task.

– Many of the people clinicians care for, both young and old are at risk of developing depression due to long standing physical illness and disability, further depression can present as early signs of dementia. It is important then for clinicans to remain alert to this possibility.

Goals for managing person’s experience of epression

  • Developing a relatonship based on empathy and trust
  • Promoting a person’s positive self regard
  • Promote positive health behavours… including medication compliance and healty lifestyle choices,
  • Promoting person’s engagement with social and support networks
  • Ensuring effective collaboration with other relevant service providers through effective working relationships and communication
  • Support and promotion of self care activities for families and carers of person with depression.

Frequently assess, document and manage risk for suicide and self har…

Associated disorders

  • Persistent depressive disorder (aka dysthymia), diagnosed when mood disturbance occurs for >2 years in adults…
  • Cyclothymic disorder: chronic disorder >2 years of alternating periods of low and high moods that are less severe than major depression or mania. It can be described as a mild form of bipolar…
  • Premenstrual Dysphoric Disorder – newly places in DSMV, at least 5 symptoms overall present before onset of menses, wit decrease or disappearance by onset of menses. At least one or more of the following: lability, irritability, depressed mood, anxiety/tension. at least one or more for the following as well: decreased interest, concentration difficulty, lethargy, change in appetite, sleeping too much or too little, overwhelmed, physical symptoms such as breast tenderness, bloating or weight gain.
  • Dysruptive mood dysregulation disorder: Diagnosis of children up to 12 y.o wo present with persistent irritability and frequent episodes of extreme behavioural dyscontrol…Children with this diagnosis often develop unipolar depression or anxiety disorders in adulthood, rather than bipolar conditions…
  • Substance/Medication induced depressive disorder…
  • Depressive disorder due to other medical condtitio
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