_______________________________________________________________________ Depression and Suicide
least one year in children and adolescents), and must include the presence (while depressed) of two or more of the following symptoms [10]: • Poor appetite or overeating • Insomnia or hypersomnia • Low energy or fatigue • Low self-esteem • Poor concentration or difficulty making decisions • Feelings of hopelessness Major Depressive Disorder To meet the diagnosis of MDD, a person must have at least five of the following symptoms for at least two weeks’ duration and represent a change from previous functioning. At least one of the symptoms must be either depressed mood or loss of interest or pleasure [10]: • Depressed mood most of the day, nearly every day • Markedly diminished interest or pleasure in all or almost all activities most of the day or nearly every day • Significant weight loss or gain (>5% body weight) or increase or decrease in appetite • Insomnia/hypersomnia nearly every day • Psychomotor agitation or retardation nearly every day • Fatigue/loss of energy nearly every day • Feelings of worthlessness or inappropriate guilt nearly every day • Diminished concentration or indecisiveness nearly every day • Recurrent thoughts of death or suicide, suicide attempt, or a specific plan for attempting suicide In addition, the symptoms must not meet the criteria for a mixed episode. The patient with MDD has never experienced a manic, mixed, or hypomanic episode. Symptoms should cause clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning. Additionally, the symptoms may not be due to the direct physiologic effects of a recreational or prescribed drug or be better accounted for by bereavement (i.e., after the loss of a loved one, the symp- toms persist for longer than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation) [10]. The diagnostic symptoms of MDD represent the domains of affective, behavioral, cognitive, and somatic impairment. Affec- tive or mood symptoms include depressed mood and feelings of worthlessness or guilt, while behavioral symptoms include social withdrawal and agitation. Cognitive symptoms include difficulties with concentration or decision making, and somatic or physical symptoms include insomnia or fatigue.
The DSM-5-TR diagnostic criteria for MDD also include several specifiers to further describe the nature of the current episode of MDD. These specifiers include [10]:
• Anxious distress • Mixed features • Melancholic features • Atypical features
• Mood-congruent psychotic features • Mood-incongruent psychotic features • Catatonic features • Peripartum onset • Seasonal pattern Criteria for Anxious Distress Specifier
In order for a patient with MDD to be classified as meeting the criteria for anxious distress, he or she must have at least two of the following symptoms during the majority of days [10]:
• Feeling keyed-up or tense • Feeling unusually restless
• Having difficulty concentrating due to worry • Fearing that something awful may happen • Worrying about losing control
High levels of anxiety are associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse. It is therefore clinically useful to accurately specify the severity level of anxious distress: • Mild: Two symptoms • Moderate: Three symptoms • Moderate-to-severe: Four or five symptoms • Severe: Four or five symptoms, with motor agitation Criteria for Mixed Features Specifier MDD with mixed features is a significant risk factor for the development of bipolar I or II disorder. A patient with MDD may be classified as meeting the criteria for mixed features when at least three of the following manic/hypomanic symp- toms are present during the majority of days of a depressive episode [10]: • Elevated, expansive mood • Inflated self-esteem, grandiosity • More talkative than usual or feeling pressure to con- tinue talking • Ideas, thoughts are racing • Increase in energy or goal-directed activity • Increased or excessive involvement in activities with high potential for painful consequences • Decreased need for sleep
175
EliteLearning.com/Psychology
Powered by FlippingBook