depressive disorder due to another medical condition|My course tutor

Posted: February 25th, 2023

What are the three most important things you learned this week?

What questions remain uppermost in your mind?

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Is there anything you did not understand?

Just a few sentences for each question based on powerpoint

Depressive disorders

Feb 20 2023

 

 

Announcements

Office hours – Wed Feb 22 at 1030am

Writing the HPI and other note writing resources

APA surviving residency guide

Canvas

Course related questions?

 

What were your takeaways from the learning materials?

Podcast – diet and exercise as treatments

Quiz question #5 – depressive disorder due to another medical condition

TMS/ECT/ketamine treatment – research is ongoing, effects of ketamine are variable, ECT is effective, past hx of efficacy of ECT can predict future outcomes

Refer for ECT/TMS evaluation

Differences between MDD and dysthymia – diagnoses can co-exist, may change diagnoses over time

ECT for treatment resistant cases

DSM description of co-existing diagnoses – something like bereavement can cause symptoms that meet criteria for MDD

 

 

What questions do you have?

When is ECT recommended/used?

What would warrant ECT during pregnancy?

Anticonvulsants during ECT – hold the night before treatment

Is a seizure disorder a contraindication to ECT? No?

 

 

Review of pathophysiology of depressive disorders

What can contribute to depressive symptoms?

Heterogeneous diagnostic category

The only depressive disorders diagnoses that require a certain etiology are medication/substance induced and due to a medical condition

 

Assessing patients presenting with depressive symptoms

Terminology: Depressed vs. distressed

Communication approaches

Other factors: Grief and loss, stress, trauma, medical conditions

Specific symptomatology

Duration and course of illness

Appearance on MSE

SAFE-T

 

Treatment options

It’s not all about medication

What are other evidence based treatment recommendations?

How to make treatment decisions

How to talk about these with patients

 

DSM Depressive disorders category

Disruptive mood dysregulation disorder (DMDD)

Major depressive disorder (MDD)

Persistent depressive disorder (dysthymia)

Premenstrual dysphoric disorder

Substance/medication induced depressive disorder

Depressive disorder due to another medical condition

Other specified depressive disorder

Unspecified depressive disorder

 

DMDD (F34.8)

History of this diagnosis (new to DSM-5)

Diagnosed between the ages of 6 and 18, age of onset before 10

Severe recurrent temper outbursts that are not developmentally appropriate

Differentiating between mood elevation/mania/hypomania

Childhood bipolar should not be diagnosed based on irritability, distractibility, poor judgment

Elated mood, decreased need for sleep (not the same as insomnia), and episodicity are more diagnostic

Note mutually exclusive diagnoses: ODD, IED, bipolar

Can be diagnosed along with: MDD, ADHD, substance use disorders, conduct disorder

 

MDD (F32 [single episode] or 33 [recurrent episodes] plus

Heterogenous diagnostic category, several diagnoses were combined in DSM-III

Can be episodic or chronic based on DSM criteria

At least 5 criteria need to be met (must incl. depressed mood OR loss of interest or pleasure), at least two weeks, change from previous level of functioning

Mutually exclusive with psychotic disorders (but there is MDD with psychotic features)

No history of manic or hypomanic episodes

Specifiers (next slide)

 

Specifiers

With anxious distress

With mixed features – includes at least 3 specific manic/hypomanic symptoms present nearly every day for the majority of days of the MDE

With melancholic features

With atypical features

With mood congruent or mood incongruent psychotic features

With catatonia

With peripartum onset

With seasonal pattern

In partial remission, in full remission

Mild, moderate, severe

 

Dysthymia (F34.1)

Used to be considered a personality trait (depressive personality disorder)

Depressed mood more days than not for at least 2 years (chronic)

In children/adolescents, mood can be irritable and lasting 1 year

Also needs 2 or more of 6 other symptoms

If full criteria for MDD have been met at some point, MDD should be diagnosed

No manic or hypomanic episodes or cyclothymia or psychotic disorders

Specifiers (next slide)

 

Dysthymia specifiers

Many are the same as MDD

With early onset (prior to age 21), with late onset (21 or older)

With pure dysthymic syndrome

With persistent MDE

With intermittent MDE, with current episode

With intermittent MDE, without current episode

 

Premenstrual dysphoric disorder (N94.3)

In the majority of menstrual cycles in the past year, at least 5 symptoms must be present in the week before the onset of menses and improve with onset of menses

Symptoms are not the result of an exacerbation of another disorder

 

Substance/medication induced depressive disorder (various ICDs)

Prominent and persistent disturbance in mood, includes depressed mood or anhedonia

Requires direct evidence that symptoms developed after exposure to the substance, and the substance is capable of producing the symptoms

Not better explained by a different depressive disorder

Does not occur during delirium

 

Depressive disorder due to another medical condition (F06.31, 32, or 34)

Mood symptoms must be the direct physiologic effect of the medical condition

Symptoms are not better explained by another disorder

Does not occur in the context of delirium

 

Other specified depressive disorder (F32.8)

Depressive symptoms with an explanation of why the symptoms don’t meet criteria for another disorder

Examples of designations:

Recurrent brief depression

Short-duration depressive episode

Depressive episode with insufficient symptoms

 

Unspecified depressive disorder (F32.9)

Symptoms do not meet full criteria for another disorder and no explanation of why

May include situations where there is insufficient information to make another diagnosis

 

Group work

Start out by discussing group norms for communication and workflow, will you use google docs, how will you all agree when the assignment is ready to submit, etc.

Consider assigning group leads for all of the modules you’ll be working on with this group

Group leader should be responsible for creating working documents, submitting assignments, and organizing the work for the week

Two assignments for each week: case study and mini-paper

Mini-paper is due as a DB post by Wednesday, case study is due as an assignment submission by Saturday

 

Student responsibilities

You are responsible for developing a working knowledge and understanding of all of the other diagnoses in the week’s diagnostic category

You are responsible for reviewing all other group mini-paper DB submissions and using them to guide your studying of the other diagnoses for that week

You are responsible for sharing anything you are confused about on your one minute paper for the week

There is no requirement for responses to DB posts, but feel free to reply if you want

 

Other follow ups

Be sure to rotate tasks/jobs within your group so everyone gets a chance to write different sections of the note

Check in at the beginning of each week’s class to review how things went the previous week and whether you need to revise any of your group norms

APA format NOT needed

Citations – do not need to cite the DSM, if you are mentioning statistics/numbers, etc., let us know where you got them from with a link or name of the reference

Paraphrase the information to “teach” your classmates

DSM diagnostic criteria vs. symptom presentation

SOLUTION

This appears to be notes from a class or a seminar on depressive disorders. The notes include announcements, learning materials, quiz questions, treatment options, DSM categories, specifiers, and other relevant information about depressive disorders. The notes cover various topics such as ECT and TMS treatments, assessment of patients presenting with depressive symptoms, communication approaches, duration and course of illness, and differentiating between mood elevation/mania/hypomania. The DSM Depressive disorders category is also discussed, including disruptive mood dysregulation disorder (DMDD), major depressive disorder (MDD), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder.

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