Mood Disorders v 2 Hand Out

8/11/2019 Mood Disorders v 2 Hand Out

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Mood Disorders

Dawn Vanderhoef, PhD, DNP, PMHNP/CS-BC

N351 Fall 2014

Objectives

Identify and Review Mood Disorders

Epidemiology

DSM 5 Diagnostic Criteria of Disorders

Review Changes Made from DSM IV TR to DSM 5

Screening and Assessment

Modification of the Diagnostic Interview

Phases of Treatment and Nonpharmalogical

Interventions

Quiz

1. Which of the following are medical conditionsthat should be ruled out before making a diagnosis of

Major Depressive Disorder?

A. Hypothyroidism and Anemia

B. Hypertension and Thrombocytopenia

C. Pneumonia and Chronic Obstructive Pulmonary

Disease

D. Hyperthyroidism and Steven Johnson Syndrome

Went over the Quiz

All DSM-5 disorders have 2 caveats.


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Quiz

3. To meet the criteria for Bipolar I Disorder apatient must have had which of the following

mood states?

A. Major Depression and Mania

B. Mania

C. Mania and Dysthymia

D. Hypomania and Major Depression

Quiz

3. To meet the criteria for Bipolar I Disorder a

patient must have had which of the following

mood states?

A. Major Depression and Mania

B. Mania

C. Mania and DysthymiaD. Hypomania and Major Depression

Quiz

4. What symptom tends to remit first in a

patient treated for Major Depressive Disorder?

A. Appetite

B. Energy

C. Insomnia

D. Mood

A common misconception that bipolar shou

have 2 criteria ....

Energy to carry out the deed is essential


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Quiz

4. What symptom tends to remit first in a

patient treated for Major Depressive Disorder?

A. Appetite

B. Energy

C. Insomnia

D. Mood

Quiz

5. When treating someone for Major DepressiveDisorder, which of the following risk factors places an

individual at risk for a poor outcome of treatment?

A. Chronicity and Negative Style

B. High Socioeconomic Status

C. Good Support System

D. Genetics

Quiz

5. When treating someone for Major DepressiveDisorder, which of the following risk factors places an

individual at risk for a poor outcome of treatment?

A. Chronicity and Negative Style

B. High Socioeconomic Status

C. Good Support System

D. Genetics


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The DSM-5 is Here to Stay

Released May 2013 at the American Psychiatric Association

Annual Meeting in San Francisco, CA

Proposed release to coincide with

ICD 10

ICD 10 proposed release is October 2015

Resource

http://www.psychiatry.org/practice/dsm/dsm5

How does the DSM-5 look different

compared to the DSM IV-TR? No longer have a multiaxial diagnosis

World Health Organization Disability Assessment Scheduled 2.0 (WHODAS)

Lifespan sequence

Chapters based on underlying vulnerabilities

Roman numerals are no longer be used

ICD 9 Code / DSM and ICD 10

Ex. F06.34

No V Codes

What are mood disorders?

Depressive Disorders

Disruptive Mood Dysregulation Disorder

Major Depressive Disorder

Premenstrual Dysphoric Disorder

Substance/Medication Inducted Depressive Disorders

Depressive Disorders due to Another Medical Condition

Other Specified Depressive Disorder

Unspecified Depressive Disorder

Clinical sites are yet to transition to DSM-5

Listen to Franscis's lecture on BB

Need to learn the Axis system ,,,

Axis 1 - Major Psych disorder

Axis 2- Personality disorder (retardation)

Axis 3- Major medical conditions

Axis4 -Psychosocial stressors (mild mod or sever)

Axis 5- Global assessment of function

From DSM-5

(New)

NAS is now replaced by

Axis I = clinical psychiatric disorders (ex. depression, schizophrenia)

Axis II = Personality disorders (ex. bipolar, conduct disorder, borderline)

Axis III= General medical conditions (ex. Diabetes, Hypertension, Stroke)

Axis IV= Psychosocial and environmental problems (ex. Death of loved one, Divorce, Job-loss, Bankruptcy)

Axis V= Global assessment function (ex. scale of 1-100) 1 is low level of function and 100 being superior function. The scale is compil

a physician.


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What Does Depression Look Like?

http://video.who.int/streaming/NMH/MSD/C

OPR_depression_01OCT2012.wmv

What is Mood and Affect?

Mood sustained emotion that colors the way

we view life

Pervasive and sustained feeling

Influences behavior and how we view the world

Affect external expression of mood

Epidemiology of Depression

The World Health Organization ranked

depression as the forth leading cause of

disability worldwide

In U.S. lifetime prevalence 19.2%

12 month prevalence rate 8.3%

One-third to one-half of lifetime cases have

recurrent episodes in a given year

Kessler & Bromet, 2013

Stigma is a major issue with Depression

Its important to allow the pt. to be okay with it, let loved ones know

is important.

Mood is like the season

Affect is like the weather

Thoughts, Process and thought content are also

important during a MSE
http://video.who.int/streaming/NMH/MSD/COPR_depression_01OCT2012.wmvhttp://video.who.int/streaming/NMH/MSD/COPR_depression_01OCT2012.wmvhttp://video.who.int/streaming/NMH/MSD/COPR_depression_01OCT2012.wmvhttp://video.who.int/streaming/NMH/MSD/COPR_depression_01OCT2012.wmv


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Epidemiology of Depression

Median age of onset is 22.7 years of age In U.S. peak risk period for onset is from mid

to late adolescence to early 40s

Prevalence goes down with age

Women have twofold increase risk compared

to men

Kessler & Bromet, 2013

Major Depressive Disorder and

Morbidity and Mortality Physical disorders common with MDD

Arthritis, asthma, cancer, CVD, diabetes, HTN, chronic respiratory disorders

and chronic pain

Longitudinal studies have shown that MDD is

consistent predictor of first onset of coronary artery

disease, stroke, diabetes, heart attack and certain

cancers MDD is associated with significant elevated risk of

early deathKessler & Bromet, 2013

Major Depressive Disorder and

Morbidity and Mortality

Poor health behaviors linked to MDD

Obesity

Drinking smoking

Low adherence to treatment

Biological dysregulations

Hypothalamic-pituitary-adrenal hyperactivity

Impaired immune functionKessler & Bromet, 2013

SElf medication is common

CVD and co-morbid depression is common

-Eat too much, drink too much


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Past Year Substance Use (dependence or abuse) and

Mental Illness Adults 18 or Older (2012)

National Survey on Drug Use and Health US Dept HHS SAMHSA 2012

Disruptive Mood Dysregulation

Disorder

New to DSM 5

Potential to address concerns about over diagnosis and

treatment of bipolar disorder in children

Onset before age 10

Not applied to children with developmental age of less

than 6 years of age

Diagnosis determined valid in ages 7-18 and should berestricted to this age group

DSM-5 MDD

A. Five or more of the following symptoms present for the same 2week period and represent change in function with at least one of the

symptoms is either 1. Depressed mood or Irritable mood OR 2. Loss of

interest or pleasure

AND at least 34 of the following:

Wishing to be dead or suicidal ideation

Increase or decrease appetite

Increase or decrease sleep

Psychomotor agitation or retardation

Fatigue or loss of energy

Decrease concentration, energy, self worth

Feelings or worthlessness or excessive / inappropriate guilt

With MDD is a co-morbid substance abuse disorder because pts.

usually self medicate


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Note for all Disorders in DSM 5

B. Symptoms must represent change from

previous functioning and produce impairment in

relationships or activities and cause significant

distress or impairment in social, occupational, or

important areas of functioning

C. The episode is not attributable to the

psychological effects of a substance or to

another medical condition

SIGE CAPSSSleep disturbance. Typically, difficulty staying asleep; less often, difficulty falling

asleep

IInterest, pleasure, or enthusiasm for usual activities is diminished

GGuilt, self-doubt, or loss of self-esteem that is excessive or unwarranted

EEnergy level is diminished

CConcentration (or attention) span is poor or worse than usual

AAppetite is impaired. Typically it is diminished and associated with weight loss, but

in some cases the patient overeats and gains weight

PPsychomotor activity is abnormal. Typically the patient moves and thinks moreslowly; some patients, especially the elderly, can be more restless, explosive, or

agitated

SSuicidal thoughts, hopelessness, or thoughts that the patient (and often others)

would be better off if the patient w ere dead

DSM-5 Coding and RecordingSeverity / Course

Specifier

Single episode Recurrent episode NEW - Specify (can

apply to all dx):

With

Mild 296.21 296.31 Anxious distress

Moderate 296.22 296.32 Mixed features

Severe 296.23 296.33 Melancholic

features

With psychotic

features

296.24 296.34 Atypical features

In partial remission 296.25 296.35 Mood congruent

psychotic features

In full remission 296.26 296.36 Mood incongruent

psychotic features

Unspecified 296.20 296.30 Catatonia/

peripartum onset /

seasonal pattern

305b

co-existance of MDD and susbtance abuse (alcohol) is

common ...almost impossible to tease out the difference sometim\

Patients may be drunk when they present themselves.....

Key is not to judge ... listen to the patient ... establish rapport

Criterion for Depression

296 ==Major expression

2 == single episode

3 == recurrent episode

(last #)mild

moderate

severe

incongruence --> Not congruent with the mo state


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Gender Differences in Presentation of MDD

Men present with the following symptoms Anger

Aggression or irritability

Substance abuse

Risk taking behavior

Workaholics

Relying only on a males report of traditional

symptoms can lead to underdiagnoses

Martin, Neighbors, Griffith, 2013

Remember Depression is a

Syndrome

Clusters of symptoms of depression

Vegetative

Cognitive

Impulsive

Behavioral

Somatic

Stahl, 2004

Risk Factors for MDDRisk Factor Association

Sex 2:1 Females

Age Peak onset age 20-40 years

Family History 1.5 to 3 times higher with positive

history

Marital Status Separated and divorced persons

report higher rates

married males lower rates

married females higher rates

Postpartum An increased for 6 mths after delivery

Negative Life Events Possible association

Early parental death Possible association

Stahl, 2004

-- candidate for CBT

--


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Tips

1. Always look for a mood disorderin any new patient, even if it is not

the chief compliant

2. Never assume a mood disorder

is your patients only problemMorrison, 2014

Epidemiology

of Dysthymia

Persistent Depressive Disorder (Dysthymia)A. Depressed mood for most of the day, for more days than not, as indicated by either

subjective account or observation by others for 2 years. * in children and

adolescents, mood can be irritable and duration is 1 year

B. Presence, while depressed of two (or more) of the following:

-poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue,

low self esteem, poor concentration or difficulty making decisions, feeling of

hopelessness

C. During the 2 year (1 yr C&A) period the person not without criteria A & B for more

than 2 months

D. Criteria for MDD may be continuously present for 2 years

E. Never been manic or hypomanic episode

F. Not better explained by psychotic illness

G. Not due to effects of a substance or another medical condition

H. Symptoms cause clinically significant distress or impairment in social, occupational

and other areas of functioning

This speaks to the co-morbidity of MDD

Double depressio is when a person with depression who never reco

reaches dysthymic state


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Other Depressive Disorders Premenstrual Dysphoric Disorder

Substance / Medication Induced Depressive Disorder

Depressive Disorder Due to Another Medical Condition

Other Specified Depressive Disorder (Was Depressive D/O

NOS 311 in DSM IV-TR - full criteria for other disorders not

met, noes cause clinically significant distress / impairment and

clinician chooses to communicate the reason

Specify type features (as w/ MDD)

Specify is partial or full remission

Specify is mild, moderate, or sever

Unspecified Depressive Disorder clinician chooses not to

specify the reason the criteria are not met for a specific

disorder (i.e. use in ER)

Screening Questions:

Do you ever get so depressed that you cant function

Are you almost always depressed? (Dysthymic Disorder)

Do you have lots of psychological and physical symptoms

occurring around the time of your menstrual periods?

(Premenstrual Dysphoric Disorder)

Might your depressions be related to your use of alcohol,

drugs, or medications? (SubstanceInduced Depressive DO)Please tell me about your medical illnesses and their

treatment. (Depressive DO due to Medical Condition)

Allen, 2013

Medical Differential Diagnosis: MDD

Endocrine Disorders: hypothyroidism, diabetes,hyperaldosteronism, Cushing or Addisons disease

Neurological Disorders: Parkinsons, dementing illness, epilepsy,cerebrovascular disease, tumors, multiple sclerosis, fibromyalgia, sleep apnea

Cardiac Disorders: MI, CHF, HTN

Infectious Disease: mononucleosis, HIV/AIDS, pneumonia, TB

Nutritional Disorders: anemia, Vit D, Folate, Thiamine, B12

PMDD is now its own disorder

Identify if the depression is

substance abuse induced(alcohol)

PMDD

dsm-5 HAS THESE SCREENIGN TOOLS IN THE BACK OF THE B


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Depression Presentation (Morrison, 2014)

Mr. Smith inherited a small business from his father and built it into a large

successful company. He sold the company, invested money and bought a small

farm. He did not need to make money, he felt full value from keeping busy

and fit At age 55 farming started to become a chore, he let t he tractor sit inthe barn.

His mood blackened, he was fatigued, going bed at 9 pm and was up at 2-3 am

and could not fall back asleep. He develop obsessive worry and rumination.

Mornings were the worst; hard to g et through another damn day. His

appetite decreased and his belt buckle was two notches smaller.

His wife said he just seemed to lose interest in everything and he doesnt

enjoy anything. He worries about debt, but we are doing fine financially.

Mr. Smith would ruminate about his health, and ask his wife to take his b/p

multiple times a day. He paced the house and would check his pulse

constantly.

He told his wife they need to sell the farm even though he had more money

then they needed. On exam MMSE 30/30

Mr. Smith

What additional information do you want to

know?

What are your differential diagnoses?

What is your full DSM 5 diagnosis?

What are mood disorders?

Bipolar and Related Disorders

Bipolar I Disorder

Bipolar II Disorder

Cycolothymic Disorder

Substance / Medication Induced Bipolar and Related

Disorder

Bipolar and Related Disorder Due to Another Medical

Condition

Other Specified Bipolar and Related Disorder

Unspecified Bipolar and Related Disorder

PRE-MORBID LEVEL OF FUNCTIONING

As a PSYCH np YOU WOLD ASK FOR

cbc

THYROID TEST

Rule out medical issues, substance issues


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What Does Bipolar Disorder Look

Like?

https://www.ted.com/talks/joshua_walters_o

n_being_just_crazy_enough

Lifetime and 12-Month Prevalence

and Age of Onset (n = 9282)

Merkiangas, K.R., Akiskal, H.S. & Kessler, R.C. (2007).

BP as something that has helped him rather then debilitate him?

Spectrum of Bp is discussed in this ted talk

Life time prevelance is 4.4 mo (much less than MDD)

Onset is 20s
https://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enoughhttps://www.ted.com/talks/joshua_walters_on_being_just_crazy_enough


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Bipolar Disorder

37% of patients with Bipolar Disorder were initially

diagnosed by a mental health professional as having

unipolar depression

72% of patients were misdiagnosed with unipolar

depression in multisite primary care study

19% of patients with Bipolar Disorder commit suicide

DSM-5 Manic EpisodeA. Distinct period of abnormal and persistent elevated, expansive, or irritable mood

and abnormally and persistent increase in goal directed activity or energy, lasting

at least a week an d present most of the day, nearly all day

B. During the period of mood disturbance and increased energy or activity, three of

the following symptoms (four if mood is irritable) are present to a significant

degree and represent a noticeable change from usual b ehavior

Inflated self esteem or grandiosity, decrease need sleep, more talkative, flight of ideas, distractibility,

increase goal directed activities, excessive involvement in activities that have a high risk for painful

consequences

C. The mood disturbance is sufficiently server to cause marked impairment in

social, occupational functioning or to n ecessitate hospitalization to prevent harm

to self or others

D. The episode is not attributable to the physiological effects of a substance or to

another medical condition

NOTE: A full manic episode that emerges during antidepressant treatment but persists at a fullysyndromal level beyond the physiologic effect of treatment is sufficient evidence for a manic

episode

unipolar depression is MDD


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DSM-5 Hypomanic Episode

A. Distinct period of elevated expansive, or irritable mood, lasting at

least 4 days, that is clearly different from nondepressed mood

B. 3 or more (four if mood is irritable) grandiosity, decreased sleep, pressured

speech, racing thoughts, hyperverbal, distractible, increase in goaldirected

activity, and excessive involvement in pleasu rable activities that may have negative

consequences

C. Change in behavior in uncharacteristic for the person

D. Other people notice the change in mood and functioning

E. Episode does not cause marked impairment in functioning, does

not require hospitalization and there is no psychosis

F. Symptoms are not d/t substance use or a general medical condition.

Symptoms of mania or a manic

episode include:

Symptoms of depression or a

depressive episode include:

Mood Changes

A long period of feeling "high," or an overly

happy or outgoing mood

Extreme irritability

Behavioral Changes

Talking very fast, jumping from one idea to

another, having racing thoughtsBeing easily distractedIncreasing activities, such as taking on new

projectsBeing overly restless

Sleeping little or not being tired

Having an unrealistic belief in one's abilities

Behaving impulsively and engaging in

pleasurable, high-risk behaviors

Mood Changes

An overly long period of feeling sad or

hopeless

Loss of interest in activities once enjoyed,

including sex.

Behavioral ChangesFeeling tired or "slowed down"Having problems concentrating, remembering,

and making decisions

Being restless or irritableChanging eating, sleeping, or other habits

Thinking of death or suicide, or attempting

suicide

NIMH, 2014

Bipolar I or Bipolar II

Bipolar I Has one or more manic episodes or Mixed Episodes

Individuals usually also have had one Major Depressive episode.

* *Has 6 separate criteria sets BPD I single manic episode, Most recent

episode hypomanic, Most recent episode manic, Most recent episode

mixed, Most recent episode depressed, and Most recent episode

unspecified.

Bipolar II Has one or more Major Depressive episodes and at least one

Hypomanic episode.

**Specifiers are used to indicate the nature of the current episode hypomanic

or depressed. If depressed, specifiers are mild, moderate, severe without psychotic

features or severe with psychotic features, chronic, w/ catatonic features, w/

melancholic features, w/ atypical features or w/ postpartum onset


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Medical Differential Diagnosis: Bipolar

Endocrine Disorders: hyperthyroidism, diabetes, cushing orAddisons disease

Neurological Disorders: Epilepsy, cerebrovascular disease,tumors, head trauma, lupus, multiple sclerosis

Cardiac Disorders: MI, CHF, HTN

Infectious Disease: HIV/AIDS, lyme disease, syphilis

Bipolar Presentation (Barnhill, 2014)

Olivia is a 22 year old graduate student studying to be an architect. She was

referred by student health for an urgent mental health evaluation after she told

her roommate she was suicidal. Olivia had a history of mood instability, but her

moods were well controlled on Zoloft and Lithium. Her depressive symptoms

returned when she arrived in a new town, at a new school, about 3 months ago.

She has been preoccupied with killing herself. She wants to shoot herself in the

head, while dangling her head out the window. She does not have a gun but has

been searching to web for places she can access a gun.

Her hx is at age 15 she started drinking on a regular basis, smoking marijuana

and having out late at clubs. At age 17 she developed brief intense mood sx:

depressive tearful, feelings of g uilt, anhedonia, hopeless, low energy, poor

concentration, and hypersomnia.

After a few weeks of being depressed she would go into periods of pressured

speech, increase energy, unusual creativity and paranoid.

On exam she reports feeling very depressed, cant get out bed or go class,

sleeping a lot, hopeless. She reports feelings of depersonalization and panic

Olivia

What additional information do you want to

know?

What are your differential diagnoses?

What is your DSM 5 diagnosis?

Comorbidity with Borderline personality disorder

Impulsiveness

Attention seeking


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Suicidal Thoughts Adults 18 or

Older (2012)

Suicidal Thoughts and Behavior

Adults 18 or Older (2012)

Suicide Risk Assessment Demographic Risk Factors:

Male

Caucasian

Rural residence

Teens / young adults / elderly

Imprisoned

Widowed / divorced / separated

Living alone

No children or none living in the homeJacobs, 2007

college age students are high risk!


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Suicide Risk Assessment

Psychosocial Risk Factors: Loss of social supports

Loss of job / income

Sense of hopelessness

History of victimization (abuse)

Relationship conflict

Aggressive or impulsive traits

Writing suicide notes, previous notes

Family history of suicide

Gun ownership

Occupational risk: physician, dentist, nurse,

pharmacist, veterinarian, farmer Jacobs, 2007


Medical Risk Factors:Stroke

Multiple sclerosis

Huntingtons disease

Head injury

Spinal cord injury

Systemic lupus erythematosus

AIDS

Epilepsy

Chronic pain

Malignant cancer

Renal disease

Peptic ulcer Jacob, 2007


Internal Protective

Factors

Positive coping skills

Spirituality

Frustration tolerance

Optimism

Resiliency

Prior successful response

to stress

External Protective

Factors

Children

Pets

Religious beliefs

Positive relationships

Family

Social support

Financial incentive

Jacob, 2007


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Suicide Risk Assessment: ideation, plan,

means, intent Have you felt so sad or depressed th at you thought life is not worth

living?

Have you thought about hurting yourself or taking your life?

Have you thought about a way or plan to kill yourself?

Do you have the means to complete the plan? (Gun, pills)

Have you practiced or rehearsed this plan to end your life?

Do you have a location picked out?

What has stopped you from acting on this plan?

Have you ever attempted suicide?

Has anyone in your family ever attempted or committed suicide?

Have you ever wished you wouldnt wakeup?

Jacob, 2007

Suicidal Thoughts in Past Year:

Ages 18 22 (2012)

Suicidal Thoughts in Past Year: Adults

18 or Order and Selected Illicit DrugUse (2012)


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Safety Plan

Removal of firearms Contracts

Contact individuals

Crisis numbers

Responsible person to stay with suicidal

ideation is gone

Consider the need for hospitalization

Screening Tools for Mood

Disorders Beck Depression Inventory (BDI)

Hamilton Depression Scale (HRSD)

Mood and Feelings Questionnaire (MFQ) (Daily feeling/mood log)*

Mood Disorders Questionnaire (MDQ)*

Brief Symptom Inventory (BSI)

Center for Epidemiological Studies Depression Scale Modified (CESD)*

Kutcher Adolescent Depression Scale (KADS)*

Patient Health Questionnaire (PHQ2 and PHQ9)*

Edinburgh Postnatal Depression Scale (EPDS)*

Geriatric Depression Scale (GDS)*

Young Mania Rating Scale (YMRS)(Bipolar)*

Massachusetts General Website with screening tools and hotlinks:

http://www2.massgeneral.org/schoolpsychiatry/screeningtools_table.asp

Modification of a Diagnostic

Interview Tone of voice

Demeanor and body

posture

Redirection of interview

Touch USE with

CAUTION

Validate feelings

Differentiate normal

and clinical

Boundaries

Timing

Setting: quiet, private,

decrease stimuli

Give pts. a sense of hope....

Give pt a choice ..tell him/her I need more data

...I'll set a structure


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Phases of Illness & Treatment

Acute / Initiation: monitor status and safety,

build therapeutic alliance, and provide

education

Stabilization: prevent relapse

Maintenance: prevent recurrence

Risk Factors for Poor Outcome

Greater severity

Chronic or multiple episodes

Negative cognitive style

Family problems

Low socioeconomic status

Exposure to negative events

PreventionMaterial Assessment

Early recognition of mood disorders (especially in mothers) results in less

psychiatric disorders in children

Amelioration of Risk Factors

Regular Sleep

Exercise

Coping Plan for Stress (meditation, yoga, exercise, social activities)

Enjoyable and Meaningful Activities

Recurrent Depression

Proactive Lifestyle

Avoid Stressors

Coping Plan for Stress

Planning


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Treatment Planning and

Intervention

Patient Centered

Biopsychosoical Approach to Treatment

Bio: medical

Psycho: individual, group, family therapy,

psychosocial rehab

Social: family, support groups, community, self

care

Patient Education

The outcome of ANY treatment is grounded in the pt/provider relationship

and is a cooperative effort

Patients should be told: dx, prognosis, tx options, including duration and

SE

Inform pts that depression is a medical illness, not a character defect or

weakness

Recovery is the rule, not the exception

An effective treatment can be found for nearly all patients

The goal of treatment is remission, not just gett ing better, but getting

better and staying well

The risk of recurrence is significant: 50% after one episode, 70% after the

second, and 90% after the third

Pt and family should be alert to early s igns/symptoms of recurrence and

seek treatment Stahl, 2004

Take a piece of paper and answer

the following questions

1. One thing I learned today is

2. One thing that remains unclear is ..


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References

Allen, F. (2013). Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM5.

New York, NY: Guildford Press. American Psychiatric Association (2013). DSM5 Diagnostic and Statistical Manual of Mental

Disorders, 5th Ed. Washington DC: American Psychiatric Association

Jacobs, DG. (2007). A resource guide for implementing JCAHO 2007

patient safety goals on suicide. http://www.sprc.org/library/jcahosafetygoals.pdf

Kessler, R.C. & Bromet, E.J. (2013). The epidemiology of depression across cultures.Annu

Review Public Health, 34, 119-38.

Martin, L. A., Neighbors, H.W., Griffith, D. (2013). The experience of symptoms of depression

in men vs women: Analysis of the National Comorbidity Survey Replication.JAMA Psychiatry.

Merkiangas, K.R., Akiskal, H.S. & Kessler, R.C. (2007). Lifetime and 12-Month Prevalence of

Bipolar Spectrum Disorder in the National Comorbidity Survey Replication. Arch Gen

Psychiatry, 64(5): 543-552.

References Morrison, J. (2014). DSM-5 Made Easy The Clinicians Guide to Diagnosis . Gillford

Press: New York, NY.

National Survey on Drug Use and Health US Dept HHS SAMHSA

2012http://www.samhsa.gov/data/NSDUH/2k12MH_FindingsandDetTables/2K12

MHF/NSDUHmhfr2012.htm#sec3-1

Sadock, B.J., & Sadock, V.A. (2007).Kaplan and Sadocks Synopsis of Psychiatry:

Behavioral

Sciences, Clinical Psychiatry (10th ed.) Baltimore: Lippincott Williams & Wilkins.

Stahl, S. Essessential Psychopharmacology (2nd ed.) Cambridge University Press:

New York, NY. 2004.

Sommers-Flanagan, J. & Sommers-Flanagan, R. (2014). Clinical Interviewing (5th

ed.). Wiley: New Jersey.

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Mood Disorders v 2 Hand Out

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