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Course 3.4 Affective disorders- Depression pt.1
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Lecture notes of 40 pages for the course 3.4 Affective Disorders at EUR (Problem 1)
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Problem One: Depression Pt.1DSM-V Criteria Depression
Introduction Depressive disorders include: disruptive mood dysregulation disorder, MDD, Dysthymia, premenstrual
dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another
medical condition, other specified depressive disorder, and unspecified depressive disorder.
MDD= characterized by discrete episodes of at least 2 weeks' duration involving clear-cut changes in affect,
cognition, and neurovegetative functions and interepisode remissions.
Persistent depressive disorder (dysthymia)= diagnosed when the mood disturbance continues for at least
2 years in adults or 1 year in children.
Major Diagnostic Criteria
Depressive A. 5+ of the following symptoms have been present during the same 2-week period & represent a
Disorder change from previous functioning: at least one of the symptoms is either (1) or (2).
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report
or observations made by others (e.g., appears tearful) (In children and adolescents, can be
irritable mood).
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite
nearly every day (In children, consider failure to make expected weight gain).
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, recurrent suicidal ideation with out a specific plan, or a suicide
attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical
condition.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic disorders.
, E. There has never been a manic episode or a hypomanic episode.
Prevalence: 12 month prevalence of MDD is +-7%. Prevalence in 18-29yo is 3x higher than in ppl age 60 or
over. Females experience 1.5-3x higher rates than males beginning in early adolescence
Dysthymia:
Persistent
Depressive
Disorder
Questions from Post-Discussion
● What are the two core symptoms of depression?
○ Two essential symptoms: Depressed mood and loss of interest and pleasure
○ Symptoms can be long-lasting or recurrent
● What is the difference between clinical depression and being a little depressed?
○ It has to do with the extent to which depression limits your daily functioning
○ No trigger in depression
○ The symptoms must be present for at least two weeks
● What is the difference between persistent depressive disorder and major depression?
○ Dysthymia - a persistent/chronic form of mild depression; the symptoms are similar to depressive
episodes but tend to be less intense and last longer.
, ○ Major depressive disorder / depressive episode - involves symptoms such as depressed mood,
loss of interest and enjoyment, and decreased energy; depending on the number and severity of
symptoms, a depressive episode can be categorized as mild, moderate, or severe.
How do you categorize mild, moderate, and severe?
Based on types of symptoms: e.g. mild is not taking pleasure in some activities, severe is not taking pleasure
at all
How long must dysthymia last to be considered chronic?
It’s a matter of two years. Without a phase of remission longer than two months
WHO (2017) Depression and Other Common Mental Disorder
Data This article is about types of depression & prevalance.
Sources
Depressive Disorder= characterized by sadness, loss of interest or pleasure, feeling guilt or low self-esteem,
disturbed sleep of appetite, tiredness and poor concentration.
It can be long-lasting or recurrent. Individuals have trouble working, studying or coping with daily life. More
severe forms can lead to suicide.
2 sub categories:
1. Major Depressive Disorder/ Depressive Episode: symptoms such as depressed mood, loss of interest
& enjoyment, decreased energy. Depending on the nbr and severity of symptoms: depressive episode
can be categorized as mild, moderate or severe depending on the nbr and severity of symptoms.
2. Dysthymia: persistent or chronic form of mild depression. Symptoms are similar but tend to be less
intense and last longer.
, Important distinction: depression in people with or without a history of manic episodes.
Bipolar affective disorder consists of manic & depressive episodes separated by normal mood periods.
Global & DEPRESSION
regional ● Global Population with depression: 4.4%= females
estimates of (5.1%) males (3.6%)
prevalence ● Western Pacific regions: 2.6% for males; African
region: 5.9% for females
● Peaks in older adulthood (above 7.% in females aged
55-74 and 5.5% for males)
● Total nbr of ppl with depression: 322 million: half of
these live in the South-East Asia and Western
Pacific region (larger population of region)
● There is a growth in prevalence of depression in different age groups.
COMMON MENTAL DISORDERS
Many people experience both disorders simultaneously, it is inappropriate to add the figures together to arrive to
a total for common mental disorders.
Global & Common mental disorders lead to losses in health and functioning.
regional Prevalence of these disorders x Average level of disability associated with them
estimates of = estimates of Years Lived with Disability (YLD).
health loss YLDs are added to Years of Life Lost (YLL) to compute Disability-Adjusted Life Years (DALYs)= key metric
used to assess the Global Burden of Disease (GBD).
- For depression & anxiety disorders, no YLL are attributed to the disorders in the GBD analyses. But
depression is a major contributor to suicide.
DEPRESSION
Global total of over 50 million Years Lived with Disability (YLD)
More than 80% of this non-fatal disease burden occurs in low/middle income countries
SUICIDE
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