Depression and Suicide _ ______________________________________________________________________
Criteria for Melancholic Features Specifier For a patient with MDD to be classified as meeting the DSM- 5-TR criteria for melancholic features he or she must have either a loss of pleasure in all, or almost all, activities or a lack of reactivity to usually pleasurable stimuli (i.e., does not feel much better, even temporarily, when something good hap- pens). In addition, three (or more) of the following symptoms must be present [10]: • Distinct quality of depressed mood (e.g., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one) • Depression regularly worse in the morning • Early morning awakening (at least two hours before usual time of awakening) • Marked psychomotor retardation or agitation
Criteria for Mood-Incongruent Psychotic Specifier The criteria for MDD with mood-incongruent psychotic fea- tures is satisfied when the content of delusions/hallucinations does not involve typical depressive themes or the content is a mix of mood-incongruent and mood-congruent themes [10]. Criteria for Catatonia Specifier The specifier for catatonia can apply to an episode of depres- sion if catatonic features are present during most of the episode. The clinical picture of the catatonic type of MDD is dominated by at least three of the following [10]: • Stupor (i.e., motoric immobility; not actively relating to environment) • Catalepsy (i.e., passive induction of a posture held against gravity) • Waxy flexibility (i.e., slight, even resistance to position- ing by examiner) • Mutism (i.e., no, or very little, verbal response) • Negativism (i.e., opposition or no response to instruc- tions or external stimuli) • Posturing (i.e., spontaneous and active maintenance of a posture against gravity) • Mannerism (i.e., odd, circumstantial caricature of normal actions) • Stereotypy (i.e., repetitive, abnormally frequent, non- goal-directed movements) • Agitation, not influenced by external stimuli • Grimacing • Echolalia (i.e., mimicking another’s speech) • Echopraxia (i.e., mimicking another’s movements) Criteria for Peripartum Onset Specifier Mood episodes can have their onset either during pregnancy or postpartum. Between 3% and 6% of women will experience the onset of a major depressive episode during pregnancy or in the weeks or months following delivery. Fifty percent of “postpartum” major depressive episodes actually begin prior to delivery [10]. Thus, these episodes are referred to collectively as peripartum episodes. Peripartum-onset mood episodes can present either with or without psychotic features. Postpartum mood (major depressive or manic) episodes with psychotic fea- tures appear to occur in from 1 in 500 to 1 in 1,000 deliveries. After a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is between 30% and 50%. This specifier may be applied to a current episode of MDD if the onset is within four weeks postpartum [10].
• Significant anorexia or weight loss • Excessive or inappropriate guilt Criteria for Atypical Features Specifier
Mood reactivity (i.e., mood brightens in response to actual or potential positive events) is the characteristic feature of MDD with atypical features. In addition, at least two of the following symptoms must be present [10]: • Significant weight gain or increase in appetite • Hypersomnia • Leaden paralysis (i.e., heavy, leaden feelings in arms or legs) • Long-standing pattern of interpersonal rejection sen- sitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impair- ment Essentially, atypical MDD is characterized by vegetative symp- toms of reversed polarity (e.g., increased rather than decreased sleep, appetite, weight), marked mood reactivity, hypersensitiv- ity to rejection, phobic symptoms, or a sense of severe fatigue that creates a sensation of leaden paralysis or extreme heaviness of the extremities [22]. Criteria for Mood-Congruent Psychotic Specifier According to the DSM-5-TR, MDD with psychotic features includes the presence of delusions and/or hallucinations. Spe- cifically, with mood-congruent psychotic features, the content of all delusions/hallucinations is consistent with the typical depressive themes (i.e., personal inadequacy, guilt, disease, death, nihilism, deserved punishment) [10].
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