Depressive disorders diagnosis

Kleinman (1986) claimed that neurasthenia was a cultural form of chronic somatization that outlined several different types of psychopathological disorders, the major depressive disorder included in western classifications being the one that best accounted for this disorder. This would explain the lower rate of prevalence of the diagnosis of depressive disorder among the Chinese population. 

The classic symptoms of depression are listed in Table 12.1, which is based on DSM-IV criteria. For a diagnosis of major depressive disorder, most of these symptoms must be present, including the first two (APA, 2000). These symptoms should be of sufficient intensity and chronic duration (at least 2 weeks) to cause clinically significant distress and impairment in social or economic functioning. However, they should not be a result of another psychiatric or somatic illness, nor of drug misuse or bereavement. For a diagnosis of mania, the symptoms are a mirror image of those for depression (Table... 

The essential feature of major depressive disorder is a clinical course that is characterized by one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes. Dysthymic disorder is a chronic disturbance of mood involving depressed mood and at least two other symptoms, and it is generally less severe than major depressive disorder. This chapter focuses exclusively on the diagnosis and treatment of major depressive disorder. 

Appropriate management of AN also requires the early detection and treatment of any comorbid psychiatric disorders. The most common comorbid conditions associated with AN are major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and substance use disorders. At the time of presentation, over 50% of AN patients also fulfill criteria for MDD however, accurate diagnosis of depression in these patients is complicated by the fact that prolonged starvation often produces a mood disturbance and neurovegetative symptoms identical to MDD. If MDD appears to be comorbid with AN at the time of presentation, there is debate as to whether it is more prudent to withhold treatment of the depression until weight restoration has been initiated. If the depression persists despite refeeding, then treatment of the depression is likely warranted. 

These patients will often present with complaints of depressed mood or anxiety. The depression frequently takes the form of dysthymic disorder although these patients are at increased risk for major depressive disorder as well. Anxiety is often a symptom of the personality disorder itself, though comorbid Axis 1 anxiety disorders are occasionally present. Similar to the other personality disorders, there is a differential diagnosis that should be considered in patients who have a Cluster C personality disorder. 

Agor, agoraphobia Dep, depression Dx, diagnosis MDD, major depressive disorder OCD, obsessive-compulsive disorder Not eval, not evaluated. 

A normal response is an increase in plasma TSH of 5 to 15 pU/mL above baseline. A response of less than 5 pU/mL above baseline is generally considered to be blunted (some laboratories consider a response below 7 pU/mL to be blunted) and may be consistent with a major depression. An abnormal test is found in approximately 25% of patients with depression. A blunted TSH response (especially in conjunction with an abnormal DST) may help in confirming the differential diagnosis of a major depressive episode and support continued antidepressant treatment. An increased baseline TSH or an augmented TSH response (higher than 30 pU/mL), in conjunction with other thyroid indices, might identify patients with hypothyroidism, mimicking a depressive disorder. These patients may benefit most from thyroid replacement therapy. 

Some data indicate that those who make multiple attempts (i.e., greater than five) are different from those who will die from suicide. Multiple suicide attempters tend to be younger and to have a diagnosis other than a depressive disorder (e.g., antisocial, histrionic, or borderline personality). Although they are likely to make future attempts, they do not constitute a substantial proportion of those who die of suicide. 

An analysis of data from the 1993 HCUP, consisting of 6.5 million computerized medical records in 913 community hospitals across 17 states, found that ECT use was greater in older patients, Caucasians, those who were privately insured, and those who lived in more affluent areas (15). In 1993, an estimated 249,600 patients were discharged from general hospitals with a principal diagnosis of a depressive disorder. Of these patients... 

Major depressive disorder (MDD) can occur in children as young as 6 years of age. The diagnosis is based on the same criteria as in adults. These patients typically have a high familial loading for psychiatric disorders (110), with more than 70% of mothers having MDD, either pure or complicated by the presence of other psychiatric syndromes. Fathers, however, are more likely to have alcohol abuse or dependence, as opposed to MDD. Given this familial pattern, it is not surprising that many children and adolescents with MDD frequently also meet criteria for other psychiatric syndromes, particularly conduct and oppositional disorder ( 110). 

The diagnosis of depression still rests primarily on the clinical interview. Major depressive disorder (MDD) is characterized by depressed mood most of the time for at least 2 weeks and/or loss of interest or pleasure in most activities. In addition, depression is characterized by disturbances in sleep and appetite as well as deficits in cognition and energy. Thoughts of guilt, worthlessness, and suicide are common. Coronary artery disease, diabetes, and stroke appear to be more common in depressed patients, and depression may considerably worsen the prognosis for patients with a variety of comorbid medical conditions. 

Clinical descriptions and criteria for diagnosis of disorders of mood will only be mentioned in passing. The reader should consult standard reference sources for this material. Here we will discuss how discoveries of various antidepressants have impacted the diagnostic criteria for depression and how they may have modified the natural history and course of this illness. The goal of this chapter is to acquaint the reader with current ideas about the clinical and biological aspects of mood disorders in order to be prepared to understand how the various antidepressants and mood stabilizers work. 

Q1 The swings of mood from depression Lo mania suggest a diagnosis of manic depressive disorder (bipolar affective disorder). In this condition, the cycle of manic and depressive periods can take place over months or years, but may occur rapidly over weeks or days this varies between patients. On the other hand, there may be several episodes of depression which follow each other, or the patient may experience several episodes of mania in succession. 

If symptoms of despair and hopelessness are sufficiently severe, an additional diagnosis of major depressive disorder may be warranted. If the symptom pattern does not meet criteria for ASD, however, a diagnosis of adjustment disorder should be considered in lieu of PTSD. 

For the diagnosis of major depressive disorder, a person must have either symptom 1 or 2, plus five out of nine symptoms, and these symptoms must occur most of the day, nearly every day, for at least two weeks. Major depressive disorder is differentiated from other depressive disorders, including minor depression (dysthymia), recurrent brief depression, and adjustment disorder with depressed mood. 

Nevertheless, this is an area of intensive research, with the potential for improved diagnosis and heatment. The best estimates are that several genes are involved (5-15). The environmental influence in bipolar disorder is less than that for major depressive disorder. Some risk factors have been identified, including negative stressful life events. 

For a diagnosis of a major depressive disorder the patient must have experienced for at least two weeks of either a sustained low or depressed mood and/or... 

In a prospective study, 50 patients with chronic hepatitis B or C who received 18-30 MU/week of natural or recombinant interferon alfa were followed for 12 months (144). The SCID before starting interferon alfa identified 16 patients with a current psychiatric diagnosis and eight with a previous psychiatric disorder 26 patients free of any psychiatric history constituted the control group. Psychiatric manifestations during treatment occurred in 11 patients (five from the control group), major depression in five, depressive disorders in three, severe dysphoria in two, and generalized... 

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