Depression Overview - Psychiatry - Lecture Slides, Slides of Psychiatry

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Depression Overview

Depressive Disorders

• Major Depressive Disorder
• Dysthymic Disorder
• Depressive Disorder Not Otherwise Specified (NOS)

Depression

Modifications in DSM- IV for children:

 irritable mood (vs. depressive mood)

 observed apathy and pervasive boredom (vs. anhedonia)

 failure to make expected weight gains (rather than

significant weight loss)

 somatic complaints

 social withdrawal

 declining school performance

What type of depression??

• Tonya has come for an initial appointment to the SBHC. During the risk assessment, Tonya reports a number of depressive symptoms, including suicidal ideation. Tonya seems to display a lot of negative thinking and cognitive distortions. For example, she believes that “nobody” likes her and that she will “never” be successful in school. Her math teacher often compliments her work, but Tonya dismisses the teacher’s comments as him “just trying to be nice.” Tonya has good grades in all classes except for one, yet she only acknowledges her below average Chemistry grade. Tonya has felt extremely sad for about three weeks, which is a contrast from her usually happy disposition.

Major Depressive Disorder

II. Symptoms cause clinically significant distress or impairment in social or academic functioning

III. Symptoms are not due to the direct physiological effects of a substance (drugs or medication) or a general medical condition

• Although there is a different diagnostic category for individuals who suffer from Bereavement, many of the symptoms are the same and counseling techniques may overlap.

What type of depression??

• Maria comes for a follow-up appointment

to the SBHC. Her risk assessment showed that she has felt sad or blue for at least two weeks. Upon further inquiry, Maria reports that she generally feels sad, and finds little enjoyment in activities. She reports having felt this way for several years. In fact, she can’t recall a time when she didn’t feel mostly down. She denies suicidal ideation, and is doing pretty well in school. She is not very social, but does have a few friends. Docsity.com

Depressive Disorder NOS

• Disorders with depressive symptoms BUT do not meet criteria for: Major Depressive Disorder, Dysthymic Disorder, Adjustment Disorder with Depressed Mood, or Adjustment Disorder with Mixed Anxiety and Depressed Mood
• Examples: premenstrual dysphoric disorder, minor depressive disorder (at least 2 weeks, but < 5 symptoms)
• Also used in situations in which clinician has concluded that a depressive disorder is present, but is unable to determine whether it is primary, due to medical condition, or substance induced

Depression Versus Normal

Adolescent Development

Adolescent Development

 Periods of transient milder problems with

low self-esteem, anxiety, depressive feelings

are quite common.

 Needs to be differentiated from clinical

depression!

Depression and Suicide

Adolescents and Suicide

• In 1998, 4,153 young people , ages

15-24, committed suicide in the United States an average of 11.3 per day. 1

• Suicide is the third leading cause of death

in this age group following unintentional injury and homicide^2

• Suicide accounts for 13.5% of all deaths in

this age-group^1

(^1) Murphy, SL, 1998 2 The Surgeon General’s Call to Action to Prevent Suicide, 1999

Mortality in Children Ages 1-19 years

Suicide Homicide Accidents Cancer Congenital Other

Source: CDC Wonder Mortality Statistics; Center for Disease Control and Prevention, 2001

What is Cognitive Behavior Therapy (CBT)?

• Relatively short-term, focused

psychotherapy

• Focus:
  • How you are thinking (your cognitions)
  • How you are behaving and communicating
• Emphasis on present rather than past
• Learn coping skills

What is Interpersonal Therapy (IPT)?

• Short term, usually involves up to 20 sessions
• Focuses on 1-2 key interpersonal issues most closely

related to the depression.

• Interpersonal events include:
  • interpersonal disputes / conflicts
  • interpersonal role transitions
  • complicated grief