Dr. Carman Gill Wednesday, April 29th

4/29/2015
Dr. Carman Gill
Wednesday, April 29th
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4/29/2015
Impacted diagnoses
Major changes and rationale
Special considerations
Implications for counselors
A sustained condition of prolonged emotional
dejection, sadness, and withdrawal
A persistent affective state “colors a person’s
perception of the world” (Reid & Wise, 1995, p. 145).
Diagnosed when an individual’s depressed
mood is prolonged enough to interfere with
regular daily functioning (APA, 2013a; NIMH, 2012).
10% of the population
High comorbidity with anxiety disorders
60% of clients diagnosed with MDD have
symptoms related to Anxiety Disorders
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4/29/2015
Stand alone chapter (previously part of
mood)
Chronic depression spectrum
Removal of bereavement clause
Clarifications to differentiate between
depression and significant loss such as
bereavement or financial devastation
Addition of Disruptive Mood Dysregulation
Disorder (DMDD)
Dysthymic Disorder becomes Persistent
Depressive Disorder
Premenstrual Dysphoric Disorder (PMDD)
Specifiers: with anxious distress; with
mixed features
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4/29/2015
The DSM-5 continues to use three groups of
criteria to diagnose Depressive Disorders,
1) episodes
2) specific disorders
3) specifiers indicating the most recent episode
and course
Either depressed mood or loss of interest or
pleasure plus four others for at least 2 weeks
Coded by…
Episodes- Single or Recurrent
Severity-mild, moderate or severe
Psychosis or remission noted
296.33 Major Depressive Disorder, recurrent episode,
severe without psychotic features
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4/29/2015
1)
2)
3)
4)
5)
6)
7)
8)
With anxious distress
With mixed features
With melancholic features
With atypical features
With mood-congruent psychotic features
or with mood-incongruent psychotic
features
With catatonia (code separately)
With peripartum onset
With seasonal pattern
Same criteria
No more bereavement clause exclusion
Language to assist clinicians
Note: Many people with chronic illness experience
depression. In fact, depression is one of the most common
complications of chronic illness. It is estimated that up to
one-third of individuals with a serious medical condition
experience symptoms of depression.
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4/29/2015
Grief
Feelings of
loss/emptiness
“pangs of grief”
occurs in
waves/decreases
over time
Positive emotional
experience
Thoughts of joining
deceased
Depression
Persistent
sadness/depressed
mood
Negative future
thoughts/ selfcritical
Lack of interest
Worthlessness
Suicidal
ideation/plans
New in response to the rise in children
diagnosed with Bipolar Disorder (Blader & Carlson,
2007; Moreno et al., 2007)
Between the ages of 6 and 18 with onset
before the age of 10
Higher rates noted in males
Displaying severe, non-episodic irritability with
hyper arousal symptoms of mania but lacking
well-demarcated periods of elevated or irritable
mood characteristic of bipolar disorder.
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4/29/2015
Marked by severe, recurrent outbursts of
temper, either verbal or behavioral
Significantly out of proportion in intensity
and duration for circumstances and
developmental stage
The individual’s mood between temper
outbursts is persistently irritable or angry.
Averages at least three times per week for at
least 12 months or more
Behavior must be observable by others (e.g.,
parents, teachers, and/or peers)
These behaviors must occur in at least two
settings (e.g., school and home) and severe
in at least one of these settings
The individual cannot be free from severe
recurrent temper outbursts for longer than
three months (APA, 2013a).
No history of mania or hypomania
Cannot be explained by substance use,
medication or medical condition or another
mental disorder
Must occur outside MDEs
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4/29/2015
Rule outs
MDD, behavior only occurs during an episode
Bipolar supersedes (full manic or hypomanic
episode)
DMDD supersedes ODD
Medical, substance, neurological
In specific…
DMDD has an underlying constant irritable mood,
whereas ODD is intermittent and directed at
authority and ADHD has the hallmark of inability to
concentrate.
No scientific explanation - theories
include
psychological trauma and abuse
Poor family structure (recent death in the
family, divorce, relocation)
poor diet (lack of nutrition or vitamin
deficiencies, underlying medical conditions)
neurological disability that causes poor
behavior, such as migraine headaches.
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4/29/2015
In the DSM-IV-TR, Dysthymic Disorder
Originally called Neurotic Depression (Sprock &
Fredendall, 2008)
PDD is a consolidation of chronic Major
Depressive Disorder and Dysthymia
Presents with depressed mood almost all day,
more days than not (APA, 2013a)
It is not uncommon for MDD to precede PDD,
meaning that MDD symptoms may be
continuously present for more than one year
No longer excludes an MDE in the first two
years of onset
Exclusive to women
Characterized by intense emotional and
physical symptoms
Occurring just prior to menses often
continuing into menstruation (Daw, 2002).
Originally “late luteal phase dysphoric
disorder” in DSM-III-R
Changed to Premenstrual Dysphoric Disorder
in the DSM-IV (Cunningham, Yonkers, O’Brien & Eriksson, 2009)
as “Depressive Disorder Not Otherwise
Specified.”
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4/29/2015
For most women, mild physical and
emotional symptoms can occur, frequently
referred to as PMS
About 8% of menstruating women report
symptoms distressing enough to cause
impairment in daily functioning (Pilver, Desai, Kasl, &
Levy, 2011)
The symptoms must occur in most menstrual
cycles the year before this diagnosis is given
The individual must experience five
symptoms including at least one of the
following:
(1) severe mood swings (affective lability)
including feeling suddenly sad or tearful and/or
becoming overly sensitive to rejection
(2) increased interpersonal conflicts or
significantly increased anger or irritability
(3) feelings of hopelessness, self-critical
thoughts, or distinctly depressed mood or
(4) noticeable anxiety, tension, or feeling of
edginess (APA, 2013a).
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4/29/2015
Additional symptoms can include
lack of interest in normal activities
self-reported problems with concentration,
fatigue or lack of energy
changes in eating habits to include under or
overeating and/or cravings
sleep disturbance
feeling of loss of control or being overwhelmed
physical symptoms such as tenderness in the
breasts, pain in the muscles or joints, swelling,
bloating and/or weight gain (APA, 2013a)
Confirmed by daily ratings during at least two
symptomatic cycles. (Note: The diagnosis may be
made provisionally prior to this confirmation)
Clinically significant impairment in social,
work, school or usual activities
Cannot be related to substance use or
medical issues
Cannot be an exacerbation of another
disorder
Statistically, related to high levels of stress
and being overweight
These women are at least 60% more likely to
have experienced physical or sexual abuse
(Girdler, Leserman, Bunevicius, Klatzkin, Pedersen, & Light, 2007)
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4/29/2015
Added for both MDD and Bipolar disorders
Largely due to the high comorbidity
Almost identical except…
For MDD, the symptoms will be present most days
of the Major Depressive episode
For Bipolar, the symptoms will be present most
days during manic or hypomanic episodes
Two of the following symptoms are reported:
1.
2.
3.
4.
5.
being keyed up or tense
experiencing increased restless
excessive worry that leads to difficulty
concentrating
irrational fear that something negative is about
to occur
fear of loss of self-control
2=mild, 3=moderate, 4-5=moderate-severe
Severe= 4 or five with motor agitation
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4/29/2015
Replaces mixed episode
Depressive presentation predominant but
some manic or hypomanic symptoms
including
elevated mood
inflated self-esteem
decreased need for sleep
increase in energy or
goal-directed activity.
At least 3 must be
present nearly every
day during the most
recent 2 weeks of the
major depressive
episode
Removal of NOS - “Other specified” and
“Unspecified” Disorders
Rationale= overuse
Other specified
NOS
Unspecified
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4/29/2015
For technical questions djohnson@counseling.org
For content questions rburke@counseling.org
May 6th
Schizophrenia Spectrum Disorders
Todd F. Lewis, Ph.D, LPC, NCC
May 13th
Assessment/Emerging Measure/Recording-Coding
Casey A. Barrio Minton Ph.D
May 20th
Wrap Up/Bonus Session
Stephanie F. Dailey, EdD, LPC, NCC, ACS
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