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40 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Major Depressive Disorder: Criteria A |
MDD clinical diagnosis requires presence of a major depressive episode, which is suggested by at least 5 of the following: - depressed mood/sadness most of the day, most days (**in children and adolescents, may be irritable mood**) - diminished interest or pleasure in activities - changes in appetite or weight - sleep disturbances - psychomotor retardation or agitation - fatigue or loss of energy - feelings of worthlessness or inappropriate guilt - difficulty thinking or concentrating - thoughts of death or suicidal ideation |
*children and adolescence* |
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MDD: Criteria B |
symptoms cause clinically significant distress or impairment in: - social - occupational - other important fxnings |
impairments? |
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MDD: Criteria C |
episode not attributable to medical condition or effects of a substance |
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MDD: Criteria D |
occurrence of episode is not better explained by a psychotic or dissociative disorder |
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MDD: Criteria E |
no hx of a manic or hypomanic episode |
how is it different from bipolar? |
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MDD vs. Bereavement |
Bereavement: loss from natural disaster, response to significant stressors, or serious illness/disability other possible diagnoses: - Adjustment Disorder with Depressed Mood - Adjustment Disorder with Mixed Anxiety and Depression if response to a loss associated with a death, can diagnose with - Uncomplicated Bereavement |
stressor? |
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MDD Specifiers |
Code using severity and course specifiers: - Mild/Moderate/Severe - Single vs. Recurrent - Other specifiers => with psychotic features => in partial remission => in full remission => unspecified => catatonia => other symptom-specific specifiers |
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key differences in child presentation in depression |
- irritability vs. depressed mood - diminished interest in activities - important to tease out if behavior not only exists but is developmentally inappropriate |
3 main differences |
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8 clinical features of depression in young children |
1. Unlikely for young children toreport dysphoria orhopelessness 2. May show depressed appearance 3. More likely to have somaticcomplaints 4. Irritability 5. Uncooperativeness 6. Apathy 7. Disinterest 8. Seperationanxiety |
8 clinical features |
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Disruptive Mood Dysregulation Disorder |
- new to DSM V - over diagnoses of bipolar in children - key features: irritability + frequent episodes of extreme behavioral dyscontrol |
general overview |
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DMDD: Criteria A |
A. Severe recurrent temper outbursts manifested: - verbally (e.g., verbal rages) and/or - behaviorally (e.g., physical aggression) that are - grossly out of proportion in intensity or duration to the situation or provocation. |
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DMDD: Criteria B |
B. Temper outbursts are inconsistent with developmental level. |
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DMDD: Criteria C |
C. Temper outbursts occur, on average, 3+days/week. |
average frequency |
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DMDD: Criteria D |
D. Mood between temper outbursts is persistently: - irritable or angry most of the day, - nearly every day and - is observable by others. |
mood throughout day |
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DMDD: Criteria E |
E. Criteria A-D have been present for 12+ months. Throughout that time, the child has NOT had a period lasting 3 or more consecutive months |
frequency |
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DMDD: Criteria F |
Criteria A and D are present in 2+ settings and are severe in at least one setting |
setting and severity |
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DMDD: Criteria G |
Diagnosis should NOT be made for the first time before age 6 or afterage 18 years. |
diagnosis specific age range |
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DMDD: Criteria H |
H. Age of onset for Criteria A-E is before 10 years. |
age of onset? |
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DMDD: Criteria I |
I. No distinct period lasting more than 1 day where the full criteria for manic or hypomanic episode is present (except duration) |
distinct period length? |
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DMDD: Criteria J |
J. Behaviors do not occur exclusively during aMDD and are not better explained by another disorder. |
exclusivity |
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DMDD comorbidities |
- CANNOT co-occur with ODD, IED, or Bipolar - CAN co-occur with CD, ADHD/ADD, and Mood Dysregulation DX - symptoms not attributable by substance or other medical or neurological condition |
which disorders can and cannot co-occur? |
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prevalence of DMDD |
Common but actual prevalence unknown - Estimate 2-5% annual prevalence butrates higher in MALES and school age kids than females and adolescents |
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clinical course for DMDD |
Onset must be before age 10 - most kids who persist with DMDD go on to have diagnoses of MDD or anxiety spectrum |
onset? |
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overview of Bipolar Disorders |
Bipolar I - Mustmeet criteria for at least one manic episode - Neitherpsychosis or major depressive episode is needed for dx, but many individualshave one or both in addition to mania - Manicepisode can be preceded or followed by hypomanic or major depressive episode Bipolar II - Noevidence of full-blown manic episode in history Criteria= => 1+hypomanic episodes => 1+ major depressive episodes **Conceptuallydifferent – not just milder form of Bipolar I** |
Bipolar I vs. Bipolar II |
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Manic Episode: Criteria A |
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). |
general mood and frequency |
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Manic Episode: Criteria B |
B.During the period of mood disturbance, 3 (or more) of the followingsymptoms have persisted (four if the mood is only irritable) andhave been present to a significant degree: (1)inflated self-esteem or grandiosity (2) decreased need for sleep (e.g., feels rested after only 3 hours ofsleep) (3) more talkative than usual or pressure tokeep talking (4) flight of ideas orsubjective experience that thoughts are racing (5) distractibility(i.e., attention too easily drawn to unimportant or irrelevant externalstimuli) (6) increase in goal-directed activity (either socially, at work or school, orsexually) or psychomotoragitation (7) excessive involvement in pleasurable activities that have a high potentialfor painful consequences (e.g., engaging in unrestrained buying sprees, sexualindiscretions, or foolish business investments) |
7 behavioral disorders |
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Manic Episode: Criteria C |
C. The mood disturbance is sufficiently severe to cause marked impairment inoccupational functioning or in usual social activities or relationships withothers, or to necessitate hospitalization to prevent harm to self or others, orthere are psychotic features |
deficits in fxnings |
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Manic Episode: Criteria D |
D. Episode not attributable by effects of a substance or to another medical condition **CriteriaA-D = manic episode; need 1+ lifetime manic episodes for dx of Bipolar I** |
not attributed from what? |
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Hypomanic Episode: Criteria A |
A. Adistinct period of abnormally and persistently elevated, expansive, orirritable mood andpersistently increased activity or energy, lasting at least 4 consecutive daysand present most of the day, nearly every day. |
general mood and frequency |
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Hypomanic Episode: Criteria B |
B.During the period of mood disturbance and increased energy/activity, three (ormore) of the following symptoms have persisted (four if the mood is only irritable) andhave been present to a significant degree: (1)inflated self-esteem or grandiosity (2) decreased need for sleep (e.g., feels rested after only 3 hours ofsleep (3) more talkative than usual or pressure tokeep talking (4) flight of ideas orsubjective experience that thoughts are racing (5) distractibility(i.e., attention too easily drawn to unimportant or irrelevant externalstimuli) (6) increase in goal-directed activity (either socially, at work or school, orsexually) or psychomotoragitation (7) excessive involvement in pleasurable activities that have a high potentialfor painful consequences (e.g., engaging in unrestrained buying sprees, sexualindiscretions, or foolish business investments) |
**same as manic criteria B** |
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Hypomanic Episode: Criteria C |
C. Episode is associated with unequivocal change in functioning that isuncharacteristic of the individual when not symptomatic. |
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Hypomanic Episode: Criteria D |
D. Disturbance in mood and change in functioning is observable by others. |
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Hypomanic Episode: Criteria E |
E. Episode is not severe enough to caused marked impairment in social or occupational functioning or to necessitate hospitalization.
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severity of deficit in fxning |
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Hypomanic Episode: Criteria F |
F. Episode is NOT attributable to effects of substance |
not attributed to what? |
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features of Bipolar Disorder |
1. periods of abnormally and persistently elevated, expansive, or irritable mood, alternating with one or more major depressive episodes
2. maydisplay symptoms such as over-excitement, restlessness, agitation,sleeplessness, pressured speech, flight of ideas, sexual disinhibition,inflated self-esteem, reckless behavior 3. several DSM subtypes, based on whether youngster displays a manic, mixed, or hypomanicepisode |
3 main features |
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BD specifiers |
Severity - mild - moderate - severe Current episode characteristics - manic - hypomanic - depressed, - unspecified |
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prevalence and comorbidity of BP |
- Lifetime estimates of 0.4%-1.2% - In youngsters, milder bipolar II and cyclothymic disorder are more likely than bipolar I; “rapid cycling” also more common - Extremely rare in young children,but increases after puberty (when rates are as high as for adults) - Affects males and females equally - Most commonly comorbid with anxietydisorders, ADHD, conduct disorders, and substance abuse |
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developmental course of BP |
- 25% of bipolar patients had onset before the age of 20
- Peak age of onset between 15 and 19 years of age - Depression usually appears first - Chronic and resistant to treatment,with poor long-term prognosis |
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possible causes of BP |
- Very few studies have looked at thecauses of BP in children and adolescents
- Much adult work finds strong genetic contribution - Imperfect concordance betweenmonozygotic twins however - LaRoche (1997) found 52% of children ofparents with bipolar met criteria for some diagnosis |
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treatments of BP |
Treatment must be multi-modal andoften includes: - education of the patient and the family about the illness - medications - psychotherapeutic interventions to address symptoms and related psychosocial impairments |
3 major treatments |
