what is depression?
a general term for a vast array of symptoms, but the essential features of depression are low mood, anhedonia (loss of pleasure in life) and some degree of functional impairment that lasts for more than two weeks. Depression often co-exists with anxiety.
Depression can be a result of physical illness or accompany physical illness. When presented with a client who has symptoms of, or fits the criteria for, any type of depression, there is an obligation to rule out physical causes.
what is an adjustment disorder?
occurs after a significant life stress. Feelings of hopelessness, helplessness, anxiety, sadness, and worthlessness predominate. Thoughts often ruminate on the events leading up to the stressful episode. Sleep dysfunction is common. This condition is usually self-limiting and is typically over in six months.
Criteria for Diagnosis of Adjustment Disorder – DSM-5
The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s).
The symptoms or behaviours are clinically significant and include one or both of the following:
Marked distress that is out of proportion to the severity or intensity of the stressor
Significant impairment in social, occupational, or other domain of functioning
The disturbance is not an exacerbation of another psychological condition.
The symptoms are not representative of normal bereavement.
Once the stressor has been terminated, the symptoms do not persist for longer than six more months.
what are the three predominant features of an adjustment disorder?
depressed mood, anxiety, or conduct issues (angry outbursts for example). DAC
These three features can occur alone or in any combination including all three.
what are risk factors for MDD?
living alone is a risk factor, as is living in a stressful home or in an abusive situation, or experiencing a series of losses or negative events. Habitual negativity, personality disorders, chronic anxiety are all associated with the risk of MDD.
what brain abnormalities are associated with MDD?
decreased activity in the frontal lobe & increased activity in the limbic system.
what hormone is often increased in depression?
cortisol
Diagnostic Criteria of Major Depressive Disorder
The mnemonic SIGECAPS
Sleep Disturbance -increased or decreased (nearly every day)
Interest reduced – anhedonia (most of the day, nearly every day)
Guilt or worthlessness (it must be excessive given the context and be present every day)
Energy loss and fatigue (nearly every day)
Concentration problems (indecisiveness, decreased ability to think, nearly every day)
Appetite changed - increased or decreased (more than 5% of body weight in a month and not due to intentional dieting)
Psychomotor agitation or retardation (nearly every day, observable by others)
Suicidal thoughts with or without the means or intentions (recurrent thoughts of death - not fear of dying)
what is grief?
a feeling of loss external to the self
self-esteem is preserved in grief or depression?
grief
Feelings of emptiness and loss but a trust in the future that one will eventually feel better is present in?
Grief
There are periods of joy and laughter and periods of forgetting about the loss for a while - grief or depression?
Grief
what is complicated grief?
defined as a worsening, unrelenting state of mourning. Risk factors include those with previous anxiety or depressive disorders or episodes, dependent parent-child relationships, a history of substance abuse, and a history of poor coping skills. typically the individual cannot emerge from grief.
what are symptoms of complicated grief?
Prolonged, intense longing
Rumination and focus on the loss
Depersonalization
Derealization
Anhedonia
Irritability or agitation
Loss of meaning of life or purpose
Unable to function effectively
Self-isolation
Guilt, inability to trust, bitterness
Denial about the loss
What is dysthymia (persistent depressive disorder)?
a chronic condition with low-grade depression-like characteristics. When the condition persists beyond two years, this condition is called dysthymia. Dysthymia can be debilitating in terms of functional impairment. It is possible to suffer severe depression on top of chronic dysthymia. Common in personality disorders.
what are risk factors for dysthymia?
*A history of parental loss or separation
* Negative-affect personality traits
* Family members with dysthymia or depression – strong correlation
anxious dysthymia symptoms?
pronounced symptoms of low self-esteem, undirected restlessness, and interpersonal rejection sensitivity. They also characterized these patients as help-seeking and more likely to make lower-lethality suicide attempts and to have a better response to selective serotonin reuptake inhibitors (SSRIs).
symptoms of anergic dysthymia? HAL
Low energy, hypersomnia, anhedonia HAL
response to treatment with agents that increase norepinephrine or dopamine
Diagnostic Criteria for Persistent Depressive Disorder/ Dysthymia – DSM-5
- A depressed mood most of the day, for more days than not, as indicated by subjective mood or as observed by others.
- When feeling depressed the following occur (two or more)
- Appetite changes
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration and or difficulty making decisions
- Feelings of hopelessness - During the two years, the individual has never been free from criteria 1 or 2 for more than two months at a time.
- During the two years, some of the criteria for major depressive disorder may have been continually present.
- There have been no manic or hypo-manic episodes.
- There is not a more valid and applicable diagnosis.
- The symptoms are not caused by alcohol, medication or other substances.
- The symptoms cause clinically significant distress or impairment in social, occupational or other important functional domains.
