according to bowlby, who is at a greater risk for developing a depressive disorder in adulthood? This is a topic that many people are looking for. amritsang.org is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, amritsang.org would like to introduce to you Persistent Depressive Disorder (Dysthymia) | Risk Factors, Symptoms, Diagnosis, Treatment. Following along are instructions in the video below:
Everyone this lesson is on persistent depressive disorder. So in this lesson were going going to talk about what this condition is were also going to talk about of the risk factors for this condition. Were also going to talk about the signs and symptoms of this condition an easy way to remember how to diagnose this condition and were also going to talk about ways to treat this condition so persistent depressive disorder was previously known as dysthymia but in dsm 5 they actually changed dysthymia to the new diagnostic term known as persistent depressive disorder persistent depressive disorder is a chronic mood disorder involving long standing symptoms of depression and long standing is the key term here so it is symptoms of depression for a long period of time.
Were going to talk about how long that time period is later on in this lesson what is the epidemiology of persistent depressive disorder. So we find that the prevalence in the general population is two to three percent. We call this pure dysthymia.
Its only having this long standing low level of depression and theres a higher prevalence with persistent depressive disorder with major depressive episodes so you can have both persistent oppressive disorder this long standing feelings of depression with worsening of depression leading into major depressive episodes. Female to male ratio is actually more skewed to females. So female to male ratio is two to one so twice as many females suffer from persistent depressive disorder than males what are some of the risk or influencing factors for this condition number one is family history of depressive disorders especially a first degree relative so first degree relatives could be your parents could be your children or could be your siblings.
The second risk factor is a past traumatic life experience. This can lead to increased risk of having this condition. Number three is having negative personality traits.
So your personality in general the way you look at the world the way you experience the world can lead to or be a risk factor for getting this condition. And number four is a past history of other psychiatric disorders. So this is tied in with certain other psychiatric disorders.
As well so. It is associated with conditions like anxiety disorders. Somatic disorders.
And increased severity of depression symptoms. So we find that individuals with anxiety disorders and somatic disorders. Are at an increased risk of this condition.
But we also see that having this condition will lead to a more severe depressive episode or more severe depressive symptoms. So what are some of the signs and symptoms and how do we diagnose this condition well we have to look at the dsm 5 criteria so this is all adapted from dsm 5 so the dsm 5 criteria for persistent depressive disorder is as follows the a criteria or criterion a the criteria that we need to have is the following the press move for most of the day for more days than not as indicated either by subjective account or observation by others lasting for at least two years. So.
What is this all telling us. A patient has to have a depressed or low mood for most of the day more days than not so the majority of the time. And whats interesting here is that the individual themselves dont necessarily have to tell you that they are having it it could be from an observation by others so some of their family members could be saying that they have a very low mood majority of the time.
And what is also key here is the time frame you need to have at least two years of depressed mood for most of the day. The majority of the time so its a very very long standing depression and in children. And adolescents.
Theres a caveat here it can be an irritable mood. So it doesnt necessarily have to be a depressed or low mood. It can just be an irritable mood and the duration is different here as well.
Its only at least one year as opposed to adults. Where its at least two years the b criteria. So once you have the a criteria move on to the b criteria.
The b criteria is that while theyre depressed. Theres a presence of at least two of the following. One is that theres poor appetite or overeating.
Two is that theres insomnia or hypersomnia. So insomnia. They cant fall asleep or they have difficulty sleeping.
So they could have difficulty falling asleep or they have early morning awakenings where they cant get back to sleep. Hypersomnia could be the opposite. They could be sleeping way more than they used to the third is low energy or fatigue.
The fourth is low self esteem. The fifth is poor concentration or difficulty making decisions. And the sixth is feelings of hopelessness.
So you need to have at least two of the following you need to have at least two of the b criteria. Poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self esteem poor concentration. Or difficulty making decisions and feelings of helplessness.
So eight criteria and then two or at least two of the b criteria and we move on what is the c criteria. So the c criteria is that during the two year period or one year period in children or adolescence of the disturbance so during this period of disturbance. The person has never been without the symptoms.
In criteria. A or b for more than two months at a time so that kind of excludes this as a persistent depressive disorder. So it could be that if the patient had a long standing level of depression.
But they had a gap of two months in between one episode and another it could be major depressive episodes. It might not necessarily be this condition. So you cant have more than two months of a gap without symptoms in this two year time period.
The d criteria is that they could meet the criteria for a major depressive disorder. That lasts for two years so they would technically have a major depressive disorder and they could also have persistent depressive disorder criteria is that theres never been a manic episode or hypomanic episode and criteria have never met for psychothymic disorder. So this is essentially excluding other psychiatric disorders.
That might be causing this mood episode. So these are separate conditions. If they have a manic episode or a hypomanic episode.
Then we have to talk about bipolar type 1 or bipolar type 2. So in order for a patient to have persistent depressive disorder. They cannot have had a manic episode or a hypomanic episode or meet criteria for a psychothermic disorder.
Because if they have had those things this mood episode could be related to that condition the f criteria. Is that the disturbance is not better explained by a persistent schizoaffective disorder schizophrenia delusional disorder or other specified or unspecified schizophrenia spectrum and other psychotic disorder. So this is another exclusion criteria.
So if theres another psychiatric disorder. That better explains. This current mood episode then we have to go with that other psychiatric diagnosis criteria g is that symptoms are not due to the direct physiological effects of a substance or another medical condition.
So again this is another exclusion criteria. If theres some kind of substance that might be causing these symptoms or if theres another medical condition thats causing these symptoms this is not persistent depressive disorder in criteria h the last criteria a lot of criteria here criteria h states that the symptoms cause clinically significant stress or impairment in social occupational or other important areas of functioning. So this is always key to psychiatric diagnoses.
There has to be some significant distress or impairment in order for this to be a disorder. So criteria. H.
Meets that if the symptoms that the patient is experiencing with this disorder. Causes clinically significant distress or impairment in social occupational or other important areas of functioning. So say if they have ruined relationships or lost relationships or lost their job or have lost something in their life due to these symptoms that can meet this criteria.
So that was a lot of diagnostic criteria. So how can we remember all of those diagnostic criteria. We can use the mnemonic.
Hes too sad and we need two years of a time frame with at least two of the following. So hes too sad. What does that mean so h.
For hopelessness e for energy loss. Or fatigue s. For self esteem.
That is low two is for the time frame two years minimum duration depressed mood. Most of the day more days than not s is for sleep disturbances a is for appetite increased or decreased and d. Is for decision making or concentration impairment.
So this mnemonic. Hes too sad can actually wrap up criteria. A and criteria b for us to help us.
Remember criteria. A and criteria b. So criteria.
A remember is a depressed mood. Most of the day more days than not for at least two years. It can be an irritable mood or at least one year in children.
But at least two years here and then the rest of them are actually criteria b. And we need at least two of these so this actually helps us remember criteria. A and criteria b.
Very. Well and all we have to remember. After that is that there has to be clinically significant impairment or distress from these symptoms.
And we have to have excluded other psychiatric disorders. And other medical conditions or substances. That might be causing.
These symptoms. Once we have that that makes this diagnosis very easy to remember so before i move on i want to talk about some specifiers with regards to this condition. There are certain specifiers that come with a lot of other psychiatric conditions and theyre very similar here as well one of them is with anxious distress.
So they have a lot of anxiety with this condition it can be persistent depressive disorder with anxious distress. There can be with mixed features with melancholic features with atypical features with mood. Congruent or incongruent.
Psychotic. Features. So they can have hallucinations and delusions.
And these can be moot. Congruent or incongruent. Which means that there are hallucinations like things that they hear and see that other people dont hear and see they could be in line with their mood or the depressed mood or they could be incongruent with their mood.
They could be seeing very happy and fun and very nice things that dont match with their low mood. So thats really what that means other specifiers include with peripartum onset. So it can occur after pregnancy or after delivery of a baby and in partial or full remission is another specifier you could use early onset is another one which means that it started before the age of 21 late onset is something that occurs after the age of 21.
It can be with pure dysthymic syndrome. So really what that means is that mdd or major depressive disorder. Full criteria not met in past two years so if we see that theres just persistent depressive disorder and no really full criteria of major depressive disorder that has been met over those two years this is just persistent depressive disorder with pure dysthymic syndrome theres something with persistent depressive disorder with persistent depressive episode so major depressive disorder full criteria meant throughout the preceding two year period.
So we saw that as criteria d that we could have this and then theres another specifier persistent depressive disorder with intermittent major depressive episodes with current episode and without a current episode so with current episode means that they have a major depressive disorder episode right now on top of their persistent depressive disorder and without current episode means that theyve had in the past two years but theyre not having a major depressive disorder. Right now so a lot of things there too dont worry too much about all of that information so how do we treat this condition so treatment of persistent depressive disorder starts with psychoeducation you want to teach the patient about their condition theres also psychological treatment. So this can be cognitive behavioral therapy.
Interpersonal therapy and then we move on to pharmacological therapies. These include ssri so selective serotonin reuptake inhibitors like sertraline and paroxetine. These are the first line therapy.
You can also use tcas so imipramine is also used for this condition. And you can also use mertazapine as well so remaron and as we see with most psychiatric disorders. A combination therapy is almost always superior to an individual.
One which means that its always better to have one pharmacological therapy. Plus a psychological therapy. And when we see that combination it always beats a single individual therapy.
So again psychoeducation is always important but psychological. So you can use cognitive behavioral therapy or interpersonal therapy and then pharmacological therapies ssris like circulating and proxying our first line therapy. And if the ssris dont work you can always move on to tcas like imipramine or mertazapine.
So i hope you found this lesson helpful that was a lesson on persistent depressive disorder. If you havent already please consider liking subscribing and clicking the notification bell to help support the channel and stay up to date on future lessons and as always thank you so much for watching. And i hope to see you next time .
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