Depression and Suicide _ ______________________________________________________________________
• Geriatric Depression Scale (GDS): Developed to assess depression in older adults. • Hamilton Rating Scale for Depression (HAM-D or HDRS): Extensively used in clinical research. • Montgomery-Åsberg Depression Rating Scale (MADRS): Greater sensitivity to medication or other treatment response than the HAM-D. • Edinburgh Postnatal Depression Scale (EPDS): The most widely used assessment tool for postpartum depression, administered to patients six weeks after delivery. • CAGE Questionnaire: Recommended due to high rates of excessive alcohol and substance use in depression. Use to screen patients undergoing further evaluation. Ask the patient if they have ever: - Felt you ought to cut down on your drinking (or drug use)? - Had people annoy you by criticizing your drinking (or drug use)? - Felt bad or guilty about your drinking (or drug use)? - Had a drink (or drug use) as an eye opener first thing in the morning to steady your nerves or get rid of a hangover or to get the day started? Each affirmative response earns one point. One point indicates a possible problem. Two points indicate a probable problem. • The Distress Thermometer: Developed for patients with significant language or communication difficulties, this one-question screen identifies distress from any source. The person marks a scale that asks: “How dis- tressed have you been during the past week on a scale of 0 to 10?” Scores of 4 or more indicate significant distress that requires further investigation. ASSESSMENT As noted, a positive screen may indicate the presence and severity of depression, but it does not provide the clinical information required for diagnosis and treatment. Addi- tional psychologic testing with the Millon Clinical Multiaxial Inventory-III (MCMI-III) or Minnesota Multiphasic Personality Inventory-2 (MMPI-2) can help determine diagnosis or differ- ential diagnoses [71]. Both instruments should only be inter- preted by licensed psychiatrists or psychologists with training in psychologic testing and assessment. Assessing for self-harm is also important. Persons who survive a serious suicide attempt may sustain injuries such as broken bones, brain damage, or organ failure and often experience continued depression and other mental health problems [72; 73].
An appropriate patient history includes information about the present illness, the medical history and medication history, including any substance abuse or dependence [21]: • History of present illness: Determine onset, severity, prior history, concurrent psychiatric conditions, and psychosocial stressors • Medical history: Rule out medical disorder cause of major depression • Medication history and substance use disorder
According to the American Psychiatric Association, patients should receive a thorough diagnostic assessment in order to establish the diagnosis of major depressive
disorder, identify other psychiatric or general medical conditions that may require attention, and develop a comprehensive plan for treatment. (https://psychiatryonline.org/pb/assets/raw/sitewide/ practice_guidelines/guidelines/mdd.pdf. Last accessed July 6, 2023.) Strength of Recommendation : I (Recommended with substantial clinical confidence) DIAGNOSIS OF DEPRESSION In 2013, the American Psychiatric Association (APA) pub- lished their most recently revised diagnostic criteria for depres- sion and other psychiatric illness in the DSM-5, including major depression (i.e., MDD) [10]. The DSM-5 underwent a text revision in 2022, with the addition of prolonged grief dis- order and new symptom codes that allow clinicians to indicate the presence or history of suicidal behavior and nonsuicidal self-injury. As stated, the DSM-5-TR umbrella of depressive disorders includes MDD (including major depressive episode), persis- tent depressive disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, unspecified depressive disorder, and dis- ruptive mood dysregulation disorder, a new diagnosis added to address concerns about the potential overdiagnosis of and treatment for bipolar disorder in children up to 12 years of age [10]. Persistent Depressive Disorder Persistent depressive disorder is a depression of less severity than MDD that usually begins in childhood and adolescence. The depressed mood lasts for most of the day, for more days than not, must be present for at least two consecutive years (at
174
EliteLearning.com/Psychology
Powered by FlippingBook