mood dysregulation disorder have been left unaddressed (APA, 2022). The symptoms of disruptive mood dysregulation disorder include persistent irritability, frequent and extreme behavioral outbursts, and anger. The diagnosis should not be applied to children at a developmental age younger than 6 years or those older than age 18, and symptom onset should be noted before 10 years of age (APA, 2022). Persistent Depressive Disorder (Dysthymia) In DSM-5-TR , persistent depressive disorder represents a consolidation of what DSM-IV referred to as chronic major depressive disorder and dysthymia (APA, 2022). An adult client is diagnosed with persistent depressive disorder when he or she experiences a depressed mood on most days for a period of at least two years. During that time, symptoms may represent a chronic form of mild depression with only a few symptoms present, or the symptoms may meet the criteria for a major depressive disorder continuously for two years or more. However, individuals who meet the criteria for a major depressive disorder continuously for two years should be given both a diagnosis of major depressive disorder and persistent depressive disorder. A child or adolescent may be diagnosed with persistent depressive disorder when symptoms occur over a period of one year rather than the two-year minimum with adults (APA, 2022). Premenstrual Dysphoric Disorder In DSM-5-TR , premenstrual dysphoric disorder has been moved from its placement in the DSM-IV Appendix on Criteria Sets and Axes Provided for Further Study to the main body of the manual as a distinct diagnosis. Premenstrual dysphoric disorder is characterized by the repeated presentation of a number of symptoms during a woman’s premenstrual phase, with symptom improvement within a few days after the onset of menses. Symptoms include mood lability, irritability, dysphoria, and anxiety. For a woman to receive this diagnosis, the symptoms must be present during most menstrual cycles over the past year (APA, 2022). Substance/Medication-Induced Depressive Disorder This category refers to symptoms of a depressive disorder that are associated with the ingestion, injection, or inhalation of a substance and that persist beyond what would be expected, given the physiological effects of the associated substance, intoxication, and withdrawal. The symptoms of the depressive disorder must develop within one month after use of the substance. They cannot be better explained by another depressive disorder (i.e., one that preceded substance use). When making this diagnosis among individuals with histories of recurrent major depressive episodes, clinicians must judge whether the substance/medication caused the symptoms or whether they represent a recurrence independent of the substance/ medication use (APA, 2022). Depressive Disorder Due to Another Medical Condition This diagnosis is given when the presence of persistent depressed mood or markedly diminished interest or pleasure in all or most activities is attributed to the direct physiological effects of another medical condition (e.g., hypothyroidism, stroke, Parkinson’s disease, or traumatic brain injury). To determine the association between the depressive symptoms and the medical condition, the clinician must establish the presence of the medical condition (often through collaboration on multidisciplinary treatment teams) and then determine that the symptoms are etiologically related to that medical condition through a physiological mechanism. Some medical conditions, such as cerebrovascular accidents, carry a particularly high risk for depressive symptoms, which tend to follow a particular course. It is important to evaluate clients soon after such
Self-Assessment Question 2 MDD is a serious, chronic, recurrent illness that: (Select all that apply.) a. Without treatment, episodes last an average of 9 months. b. Without treatment, episodes are less likely to achieve remission. c. Has recurrence rates ranging from 50-90%. d. Has a better prognosis for younger people experiencing psychotic symptoms. Children and Adolescents. It is beyond the scope of this course to provide detailed information about depression in children and adolescents. However, a brief overview is warranted and may be helpful in identifying past childhood and adolescent depressive episodes in adult clients. Although the same symptoms of depression may be present in children, adolescents, and adults alike, some important distinctions exist. A child or adolescent may experience feelings of sadness and emptiness as well as being tearful. However, depression in children may appear as an irritable or grumpy mood rather than a sad mood (APA, 2022). In addition to the signs and symptoms that adults may experience, parents and clinicians may see an abrupt change in a child’s grades, a change in concentration or activity levels, or a failure to make expected weight gains (National Library of Medicine, 2020; CDC, 2023; APA, 2022). Children and adolescents are more likely to describe somatic complaints, such as an upset stomach or headaches, rather than emotional upset. They may somaticize their feelings rather than express them emotionally. Teachers and parents may complain that their children and adolescents withdraw socially from their friends and peer groups (Black et al., 2023). Anxiety disorders are most commonly associated with major depression in adolescents and children (CDC, 2022; Cummings & Fristad, 2012). Such disorders may complicate treatment and negatively affect treatment outcomes, as children and adolescents with comorbid anxiety may present with more severe depression and higher levels of functional impairment (Cummings & Fristad, 2012). Similarly, adolescents with a history of depression have a higher risk of relapse, as well as comorbid anxiety and substance use disorders (Peters et al., 2016). Early treatment decisions can be crucial for children and adolescents who begin to exhibit symptoms; parents and caregivers play a vital role in treatment and are the most likely people to recognize changes in their child’s behavior (CDC, 2022). Clinicians can create unique treatment strategies that include different types of therapies in order to best intervene early. Children and adolescents who have depression can benefit from psychopharmacology, psychotherapies, family therapy, and social therapies that are suited to their particular ages and symptoms. The application of these treatment methods in work with adults is described in greater detail later in the course. For more information on treating children and adolescents with depression, please see the Resources section at the end of this course. Within the category of depressive disorders, DSM-5-TR also includes a new diagnosis for children up to 12 years old: disruptive mood dysregulation disorder. Although this new diagnosis is controversial, according to the APA, it is intended to address overdiagnosis and misdiagnosis of bipolar disorder in children. Children who have been misdiagnosed with bipolar disorder may have been overtreated, while the underlying symptoms of disruptive
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