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| DSM IV Criteria for Major Depressive Episode |
A. Five (or more) of the
following symptoms have been present during the same
2-week period and represent a change from previous
functioning; at least one of the symptoms is either
(1) depressed mood or
(2) loss of interest or pleasure.
(1) depressed mood most of
the day, nearly every day, as indicated by
either subjective report (e.g., feels sad or
empty) or observation made by others (e.g.,
appears tearful). Note: In children and
adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in
all, or almost all, activities most of the day,
nearly every day (as indicated by either
subjective account or observation made by
others)
(3) significant weight
loss when not dieting or weight gain
(e.g., a change of more than 5% of body weight
in a month), or decrease or increase in appetite
nearly every day. Note: In children,
consider failure to make expected weight gains.
(4) Insomnia or
Hypersomnia nearly every day
(5) psychomotor agitation
or retardation nearly every day
(observable by others, not merely subjective
feelings of restlessness or being slowed down)
(6) fatigue or loss of
energy nearly every day
(7) feelings of
worthlessness or excessive or inappropriate
guilt (which may be delusional) nearly
every day (not merely self-reproach or guilt
about being sick)
(8) diminished ability to think or
concentrate, or
indecisiveness,
nearly every day (either by subjective account
or as observed by others)
(9) recurrent thoughts of
death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a
suicide attempt or a specific plan for
committing suicide
B. The symptoms do not meet
criteria for a Mixed Episode (see p. 335).
C. The symptoms cause
clinically significant distress or impairment in
social, occupational, or other important areas of
functioning.
D. The symptoms are not due to
the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general
medical condition (e.g.,
hypothyroidism).
E. The symptoms are not better
accounted for by Bereavement,
i.e., after the loss of a loved one, the symptoms
persist for longer than 2 months or are
characterized by marked functional impairment,
morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms, or psychomotor
retardation. |
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| ICD-10 Criteria |
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In typical depressive episodes of all three
varieties described below (mild, moderate, and
severe), the individual usually suffers from
depressed mood, loss of
interest and enjoyment, and reduced energy
leading to increased fatiguability and
diminished activity. Marked tiredness after only
slight effort is common. Other common symptoms
are:
(a) reduced concentration and attention;
(b) reduced self-esteem and self-confidence;
(c) ideas of guilt and unworthiness (even in a
mild type of episode);
(d) bleak and pessimistic views of the future;
(e) ideas or acts of self-harm or suicide;
(f) disturbed sleep;
(g) diminished appetite. |
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Depressed mood, loss of interest and
enjoyment, and increased fatiguability are
usually regarded as the most typical symptoms of
depression, and at least
two of these, plus
at least two of the other symptoms
described above should usually be present for a
definite diagnosis. None of the symptoms should
be present to an intense degree. Minimum
duration of the whole episode is about 2 weeks.
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At least two of
the three most typical symptoms noted for mild
depressive episode should be present, plus
at least three (and
preferably four) of the other symptoms. Several
symptoms are likely to be present to a marked
degree, but this is not essential if a
particularly wide variety of symptoms is present
overall. Minimum duration of the whole episode
is about 2 weeks. |
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All three of the
typical symptoms noted for mild and moderate
depressive episodes should be present, plus
at least four other
symptoms, some of which should be of severe
intensity. However, if important symptoms such
as agitation or retardation are marked, the
patient may be unwilling or unable to describe
many symptoms in detail. An overall grading of
severe episode may still be justified in such
instances. The depressive episode should usually
last at least 2 weeks, but if the symptoms are
particularly severe and of very rapid onset, it
may be justified to make this diagnosis after
less than 2 weeks. |
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| Etiology of Mood Disorders |
�@ 1.Genetic
��Bipolar MZ concordance rate: 74%, 1st deg. relative: 30%
2.Physique and personality
3.Early environment
��Parental deprivation
��Parental caring style
4.Precipitating factors
��Life events: long-term difficulties/ vulnerability factor
��Physical Illness
5.Psychological theories
��Psychoanalytic: Freud "loss of an object", "Ambivalence",
"self-reproach", Klein "depressive position"
��"Learned helplessness" (Seligman,
1975)
��Cognitive theories (Beck, 1967)
(1)Automatic thoughts that reveal negative views of the self, the
world, and the future
(2)Cognitive distorsions:
arbitrary inference
selective abstraction
overgeneralization
personalization
(3)Dysfunctional beliefs:
eg. all-or-none thinking
6.Biochemical theories
(1)Monoamine hypothesis
��5-HT: Plasma Typtophan��, Prolactin release��, Cortical 5-HT2
receptor binding��, CSF 5-HIAA��
��Noradrenaline: GH release��
��Dopamin: CSF HVA��
(2)Endocrine
��HPA axis: Cushing syndrome(50%), Addison's disease
��Hyper/Hypo-thyroidism
��Melatonin��
7.Physiological studies
��REM sleep latency ��
��Cerebral flow��: dorsolateral prefrontal cortex, cingulate cortex,
basal ganglion
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