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30 Cards in this Set

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Disruptive Mood Dysregulation Disorder


(3 Diagnostic Criteria)

A. Severe recurrent temper outbursts manifested verbally or behaviorally. that are grossly out of proportion in intensity or duration to the situation or provocation.




B. The temper outbursts are inconsistent with developmental level.




C. The temper outbursts occur, on average, three or more times a week.

Disruptive Mood Dysregulation Disorder


(Prevalence)

Common among children presenting to pediatric mental health clinics. Based on rates of chronic and severe persistent irritability, which is the core feature of the disorder, the overall 6-12 month prevalence rate ranges between 2%-5%.

Disruptive Mood Dysregulation Disorder (Development and Course)

The onset must be before10 years of age, and the dx should not be applied to children with a developmental age of less than 6 years. Approx. 1/2 of children with severe, chronic irritability will have a presentation that continues to meet criteria for the condition 1 year later.


Disruptive Mood Dysregulation Disorder is more common than bipolar disorder prior to adolescence, and symptoms of the condition generally become less common as children transition into adulthood.

Disruptive Mood Dysregulation Disorder


(Risk and Prognostic Factors)

Temperamental: Children with chronic irritability typically exhibit complicated psychiatric histories.




Genetic: Children presenting with chronic, non-episodic irritability can be differentiated from children with bipolar disorder in their family based risk.

Disruptive Mood Dysregulation Disorder (Gender Issues)

Predominantly male. This difference in prevalence between males and females differentiates Disruptive Mood Dysregulation Disorder from Bipolar Disorder, in which there is an equal gender prevalence.

Disruptive Mood Dysregulation Disorder (Functional Consequences)

The primary symptom of chronic, severe irritability, is associated with marked disruption in a child's family and peer relationships, as well as in school performance.


Dangerous behavior, suicidal ideation, suicide attempts, severe aggression, and psychiatric hospitalization are common.

Disruptive Mood Dysregulation Disorder (Comorbidity)

Rates of comorbidity are extremely high. The strongest overlap is with oppositional defiant disorder.

Major Depressive Disorder


(3 Diagnostic Criteria)

A. 5 or more of the following symptomshave been present during the same 2-week period and represent a change fromprevious functioning; at least one of the symptoms is either 1 or 2.


1. Depressed mood most of the day,nearly every day (as reported or observed).


2. Markedly diminished interest orpleasure in all/almost all activities most of the day.


3. Significant weigh loss when notdieting or weight gain (a change of more than 5% of body weight in a month), ordecrease/increase in appetite nearly every day.


4. Insomnia or hypersomnia nearlyevery day.


5. Psychomotor agitation orretardation nearly every day.


6. Fatigue or loss of energy nearlyevery day.


7. Feelings of worthlessness orexcessive or inappropriate guilt (which may be delusional).




B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.




C. Not attributable to the effects of substance use or to another medical condition.

Major Depressive Disorder


(Prevalence)

12 month prevalence in the U.S. is about 7%.



Major Depressive Disorder


(Development and Course)

May first appear at any age. The likelihood of onset increases markedly with puberty. In the U.S., incidence appears to peak in the 20s; however, first onset late in life is not uncommon.


Chronicity of depressive symptoms increases the likelihood of other underlying disorders.


Recovery typically begins within 3 months of onset for 2 in 5 individuals, and within 1 year for 4 in 5 individuals.


The risk of recurrence becomes progressively lower over time as the duration of remission increases.


The likelihood of suicide attempts lessens in middle and later life, but the risk of completed suicide does not.

Major Depressive Disorder


(Risk and Prognostic Factors)

Temperamental: Neuroticism (Negative affectivity).




Environmental: Adverse / stressful childhood experiences.




Genetic: First-degree family members. Heritability is about 40%.

Major Depressive Disorder


(Culture Issues)

7 fold differences in 12 month prevalence rates across cultures, but much more consistency in female to male ratio.


Clinicians should be aware that the majority of cases of depression go unrecognized in primary care setting.


Insomnia and loss of energy are the most uniformly reported symptoms.

Major Depressive Disorder


(Gender Issues)

Higher prevalence in females.


However, there are no clear differences between genders in symptoms, course, treatment response, or functional consequences.


Females have higher suicide attempt, but lower completion.

Major Depressive Disorder


(Suicide)

Most completed suicides are not preceded by unsuccessful attempts.

Major Depressive Disorder


(Functional Consequences)

Many of the functional consequences derive from individual symptoms. Impairment can range from mild to very severe.


Those with MDD have more pain and physical illness and greater decreases in physical, social, and role functioning.

Major Depressive Disorder


(Comorbidity)

Commonly comorbid with substance use disorders, panic disorders, OCD, anorexia nervosa, bulimia nervosa, and borderline personality disorder.

Persistent Depressive Disorder (Dysthymia)


(3 Diagnostic Criteria)

A. Depressed mood for most of the day, for more days than not, for 2 years.




B. Presence, while depressed, 2+ of the following:


1.Poor appetite or overeating.


2. Insomnia or hypersomnia.


3. Low energy or fatigue.


4. Low self-esteem.


5. Poor concentration or difficulty making decisions.


6. Feelings of hopelessness.




C. During the 2 year period, the individual has never been without criteria A or B for more than 2 months at a time.



Persistent Depressive Disorder (Dysthymia)


(Prevalence)

12 month prevalence rate in the U.S. is about 0.5%.

Persistent Depressive Disorder (Dysthymia)


(Development and Course)

Early and insidious onset and a chronic course.


Early onset is under 21 years old.

Persistent Depressive Disorder (Dysthymia)


(Risk and Prognostic Factors)

Temperamental: higher levels of neuroticism, greater symptom severity, poorer global functioning, and presence of anxiety or conduct disorders.


Environmental: Childhood risk factors include parental loss or separation.


Genetic: higher proportion of first degree relatives with dysthymia.

Persistent Depressive Disorder (Dysthymia)


(Functional Consequences)

The degree to which it impacts functioning varies widely.


Could be greater than MDD.

Persistent Depressive Disorder (Dysthymia)


(Comorbidity)

High risk for psychiatric comorbidity in general, and for anxiety and substance use disorders in particular.

Premenstrual Dysphoric Disorder


(Diagnostic Criteria)

A. In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of the menses, start to improve within a few days after menses onset, and become minimal or absent in the week post-menses.




B. 1+ of following symptoms:


1. Marked affective lability.


2. Marked irritability or anger or incr. interpersonal conflicts.


3.Marked depressed mood.


4. Marked anxiety.




C. 1+ of following symptoms must additionally be present, to reach a total of 5 symptoms when combined with criterion B:


1. Decreased interest in usual activities.


2. Subjective difficulty in concentration.


3. Lethargy, marked lack of energy.


4. Marked change in appetite.


5. Hypersomnia or insomnia.


6. A sense of being overwhelmed or out of control.


7. Physical symptoms



Premenstrual Dysphoric Disorder


(Prevalence)

12 month prevalence rate is between 1.8% and 5.8% of menstruating women.

Premenstrual Dysphoric Disorder


(Development and Course)

Many individuals, as they approach menopause, report that symptoms worsen.


Symptoms cease after menopause.

Premenstrual Dysphoric Disorder


(Risk and Prognostic Factors)

Environmental: stress, history of interpersonal trauma, seasonal changes.


Genetic: Thought to be about 50% heritable.

Premenstrual Dysphoric Disorder


(Culture Issues)

Not a culture-bound syndrome. Frequency, intensity, and expressivity of symptoms may be significantly influenced by cultural factors.

Premenstrual Dysphoric Disorder


(Diagnostic Markers)

Confirmed by 2 months of prospective symptom ratings.

Premenstrual Dysphoric Disorder


(Functional Consequences)

Symptoms must be associated with clinically meaningful distress.


Chronic marital or job problems should not be confused with dysfunction that occurs only in association with the premenstrual disorder.

Premenstrual Dysphoric Disorder


(Comorbidity)

Most frequently associated with a major depressive episode.