Title 09 AbPsy - Depressive Disorders.pdf ✅

09 – Unipolar Depressive Disorders ABPSY | 2024 - 2025 | NOT FOR SALE OUTLINE 1. Disruptive Mood Dysregulation Disorder 2. Defining Depression 3. Major Depressive Disorder 4. Persistent Depressive Disorder 5. Premenstrual Dysphoric Disorder DISRUPTIVE MOOD DYSREGULATION DISORDER ★ Unipolar Depressive Disorders – disorders in which a person experiences only depressive episodes ★ Include MDD, PDD, and DD DEFINING DISRUPTIVE MOOD DYSREGULATION DISORDER (DMDD) Disruptive Mood Dysregulation Disorder – chronic, severe persistent (non-episodic) irritability through frequent verbal and/or behavioral temper outbursts in response to frustration and persistent irritable or angry mood between the outbursts ● Should not be applied to children with a developmental age of less than 6 years ● Must be before age 10 years and likely to change as children mature DIAGNOSTIC CRITERIA A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) 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 per week. D. The mood between temper outbursts is persistently irritable or angry most of the day nearly every day, and is observable by others (e.g., parents, teachers, peers). E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these. G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. H. By history or observation, the age at onset of Criteria A-E is before 10 years. I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania. J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]). Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned. K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition CAUSES / RISK FACTORS Temperamental Risks ● Children with chronic irritability typically exhibit complicated psychiatric histories ● Many children with disruptive mood dysregulation disorder have symptoms that also meet criteria for ADHD and for an anxiety disorder Suicide Risk ● Evidence documenting suicidal behavior and aggression, as well as other severe functional consequences, in disruptive mood dysregulation disorder should be noted when evaluating children with chronic irritability Genetic and Physiological Risks ● Children presenting with chronic, non-episodic irritability can be differentiated from children with bipolar disorder in their family-based risk DIAGNOSTIC ISSUES Gender ● Children presenting to clinics with features of disruptive mood dysregulation disorder are predominantly male DIFFERENTIAL DIAGNOSIS AND COMORBIDITY Bipolar Disorders 1 | @studywithky
● Symptoms in BDs are episodic with discrete episodes of mood perturbation ● Change in mood must also be accompanied by the onset, or worsening, of associated cognitive, behavioral, and physical symptoms in BDs ● Irritability of disruptive mood dysregulation disorder is persistent and is present over many months ● Diagnosis of DMDD cannot be assigned to a child who has ever experienced a full-duration hypomanic or manic episode ● Another differentiating feature of BD is the presence of elevated or expansive mood and grandiosity Oppositional Defiant Disorder ● Mood symptoms of DMDD are relatively rare in children with ODD ● Children with ODD are typically verbal and target authorities while children with DMDD are verbal/behavioral and with more than 1 setting ● If both criteria are met (alongside IED), only DMDD should be diagnosed. Intermittent Explosive DIsorder ● Unlike DMDD, IED does not require persistent disruption in mood between outbursts ● It also requires only 3 months of active symptoms, in contrast to the 12-month requirement od DMDD Comorbidity ● Strongest overlap is ODD ● Diagnosis of DMDD should not be assigned if the symptoms occur only in an anxiety provoking context, when the routines of a child with ASD or OCD are disturbed, or in the context of a MD episode. DEFINING DEPRESSION DEPRESSION Depression – mental state of low mood and aversion to activity From Grief to Depression ● Integrated Grief: an acute form of grief in which the finality of death and its consequences are acknowledged and the individual adjusts to the loss ○ Often recurs at significant anniversaries ○ Considered as a natural way of confronting and handling loss ○ Occasional hallucinatory experiences of the deceased may occur ● Complicated Grief: persistent intense symptoms of acute grief ○ Can develop without a preexisting depressed state ○ Presence of thoughts, feelings, or behaviors reflecting excessive or distracting concerns about the circumstances or consequences of the death THEORIES OF DEPRESSION Psychodynamic Freud believed we unconsciously hold negative feelings toward those we love, in part because of their power over us Depression is anger turned inward Behavioral People become depressed when their responses no longer produce positive reinforcement or when their rate of negative experiences increase Beck's Cognitive Theory Negative cognitions lead to dysfunctional beliefs Helplessness / Hopelessness Theories Ruminative Response Styles Theory: tend to dwell too much (ruminate) on how they feel and why they feel that way Attributional Style – ways in which people explain the cause of events within their lives ● Internal-External ○ Who or what is responsible for the event ○ Whether something unique about the person (internal) or something about the situation caused the event (external) ● Stable-Unstable ○ Perceived permanence of the cause ○ An event can be viewed as constant and likely to happen again (stable) or it only happens once (unstable) ● Global-Specific ○ Universal throughout your like (global) or specific to a part of your life (specific) Cognitive Theory of Depression – persons susceptible to depression develop inaccurate/unhelpful core beliefs about themselves, others, and the world as a result of their learning histories ● Depressed people constantly think in illogical ways and keep arriving at self-defeating conclusions ● They tend to overgeneralize / draw broad negative conclusions on the basis of single insignificant event (cognitive bias) ● Depressive Cognitive Triad: depressed people make cognitive errors in thinking negatively about themselves, immediate world, and their future ● Negative Schema: an enduring negative cognitive system about some aspects of life 2 | @studywithky