NURS 63200 Week 3 Discussion Board

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9. How can you tell the difference between cyclothymic depression and bipolar depression? Cyclothymic depression is characterized by numerous periods of hypomanic symptoms that do not meet symptom or duration criteria for a hypomanic episode and numerous periods of depressive symptoms that do not meet criteria for a major depressive episode (MDE). The depression associated with bipolar II disorder involves the presence of 5 or more symptoms, including depressed mood, anhedonia, psychomotor agitation or retardation, insomnia, fatigue, feelings of worthlessness, and problems with cognition or concentration, that cause clinically significant distress or impairment in social, occupational, or other principal areas of functioning and are not attributable to the effects of a pharmacological substance or medical condition. The diagnosis of cyclothymic disorder is given to adults who experience at least 2 years, and children who experience at least 1 year, of both hypomanic and depressive periods without ever fulfilling the criteria for an episode of mania, hypomania, or major depression. Bipolar II disorder entails the lifetime experience of at least 1 MDE and at least 1 hypomanic episode, however a history of mania is no longer a prerequisite for diagnosis (American Psychiatric Association [APA], 2022). 10. How does grief differ from major depressive disorder? Grief is a universal emotional reaction to death and bereavement that typically resolves over time, but in some instances can persist and progress to major depressive disorder [MDD] (Tsai et al., 2019). It differs from MDD in that the predominant affect is feelings of emptiness and loss rather than persistent depressed mood and anhedonia. Additionally, the dysphoria associated with grief generally decreases in intensity over time and occurs in waves that tend to correlate with thoughts or reminders of the deceased, while a MDE is characterized by pervasive unhappiness and pessimistic ruminations that are not tied to specific preoccupations. Self-esteem is usually preserved in grief as well, whereas in MDD feelings of worthlessness and self-loathing are common (APA, 2022). 11. How does Persistent Depressive Disorder differ from Major Depressive Disorder? Persistent depressive disorder (PDD) is characterized by a depressed mood that occurs for most of the day, for more days than not, for at least 2 years in adults and at least 1 year in children and adolescents. It represents a consolidation of chronic MDD and dysthymic disorder, which were previously distinct diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition (DSM-IV). MDD involves the presence of at least 1 MDE, which is defined as a period of at least 2 weeks in which a depressed mood or loss of interest or pleasure

in activities occurs nearly every day, in the absence of manic or hypomanic episodes (Parker & Malhi, 2019). PDD is also associated with MDEs and is often preceded by MDD and diagnosed in individuals who have met MDD criteria for at least 2 years (APA, 2022). 12. What is Disruptive Mood Dysregulation Disorder? Disruptive mood dysregulation disorder (DMDD) involves chronic, severe, non-episodic and persistent irritability or anger, as well as emotional outbursts or temper tantrums that are disproportionate to their trigger. It is classified as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition (DSM-5) and is only diagnosed in children and adolescents between the ages of 6 and 18 (Bruno et al., 2019). The temper outbursts associated with DMDD are generally developmentally inappropriate and occur 3 or more times per week for a period of at least 1 year across at least 2 different settings such as school and home. Chronic, severe, and persistent irritability or anger that is noticeable to others in the child’s environment and becomes characteristic of the child’s personality is typically present between temper tantrums as well. Treatment for DMDD can include both pharmacological (i.e., risperidone) and nonpharmacological (i.e., psychotherapy) modalities (APA, 2022). 13. What is Premenstrual Dysphoric Disorder? Premenstrual dysphoric disorder (PMDD) is a complex condition that affects women of reproductive age and is characterized by severe physical and psychological symptoms, including anger, irritability, anxiety, depression, impaired concentration, fatigue, insomnia, and mood swings, that are experienced cyclically and remit with the onset of menses (Osborn et al., 2020). The essential feature of PMDD is the expression of mood lability, anxiety, dysphoria, and irritability that occurs regularly (during most menstrual cycles in a 1-year period) in the premenstrual phase of the menstrual cycle and has an adverse impact on professional and/or social functioning. Symptoms typically peak around the time of menses onset and then many individuals experience an asymptomatic period during the follicular phase of the cycle. Risk factors for PMDD include environmental exposure to stress and interpersonal trauma, as well as various sociocultural aspects of female gender roles and sexual behavior. Treatments for PMDD may consist of medications (SSRIs, birth control, NSAIDs), stress management, diet, and exercise (APA, 2022). 14.What are features of major depressive disorder with:

 Seasonal Pattern? The specifier ‘with seasonal pattern’ applies to recurrent MDD in which there is a temporal relationship between both the onset and remission of MDEs and a particular time of year. Seasonal MDEs are characterized by hypersomnia, loss of energy, overeating, weight gain, and carbohydrate cravings, and generally begin in fall or winter and remit in spring (APA, 2022). This cyclical pattern of symptoms must occur at least twice within a 2-year period and in the absence of any nonseasonal MDEs for the specifier to be considered. Treatments for MDD with seasonal pattern include light therapy, antidepressant medications, vitamin D supplementation, and psychotherapy (Johns Hopkins University, 2022).  Peripartum Onset? The specifier ‘with peripartum onset’ is applied to a MDE if the onset of mood symptoms occurs during pregnancy or within 4 weeks following delivery. These symptoms generally include depressed mood, anhedonia, weight loss/decreased appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of excessive guilt, impaired concentration, and thoughts of death or suicide (Narlesky et al., 2020). Peripartum-onset mood episodes may present with or without psychotic features, which can involve command hallucinations and infanticide in their most severe manifestations. In the United States, approximately 9% of women will experience a MDE between conception and birth and 50% of those women will have their first postpartum MDE prior to delivery (APA, 2022). 15. What is the difference in treatment for mild, moderate, and severe depression? A formal diagnosis of MDD requires the presence of at least 1 of the core symptoms of persistent low mood/feelings of sadness or anhedonia and, to a lesser degree, the associated symptoms of fatigue, impaired concentration, sleep pattern and appetite disturbances, psychomotor agitation or retardation, and feelings of guilt and/or worthlessness. MDD is classified according to quantity of symptoms and degree of functional impairment and is typically graded as mild, moderate, or severe. Mild depression denotes the occurrence of 1 core symptom and no more than 4 associated symptoms, while moderate depression indicates the presence of both core symptoms and four or more related symptoms. Severe depression is characterized by the presence of all core and associated symptoms, as well as recurrent thoughts of death and/or suicide (Tolentino & Schmidt, 2018).

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Treatment options for mild depression are generally nonpharmacological and consist of cognitive behavioral therapy (CBT), diet, exercise, and stress reduction and mindfulness-based techniques. Therapeutic interventions for moderate depression frequently involve psychotherapy and lifestyle alterations as well, often with the addition of pharmacological agents such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). Finally, treatment modalities for severe depression include antidepressant therapy and, in the most extreme cases, inpatient admission and interventions like and electroconvulsive therapy [ECT] (Kennard, 2020). References American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5 th ed., text revision). American Psychiatric Association Publishing. Bruno, A., Celebre, L., Torre, G., Pandolfo, G., Mento, C., Cedro, C., Zoccali, R.A., & Muscatello, M.R. (2019). Focus on disruptive mood dysregulation disorder: A review of the literature. Psychiatry Research, 279 , 323-330. https://doi.org/10.1016/j.psyres.2019.05.043 Johns Hopkins University. (2022). Health: Seasonal affective disorder . Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/seasonal-affective- disorder Kennard, J. (2020, June 14). The difference between mild, moderate, and severe depression . HealthCentral. https://www.healthcentral.com/article/mild-moderate-or-severe- depression-how-to-tell-the-difference Narlesky, M., Lemp, A., Braaten, S., Wooten, R.G., & Powell, A. (2020). A case of major depressive disorder with peripartum onset with heralding symptoms. Cureus, 12 (6), 1-5. https://doi.org/10.7759/cureus.8393 Osborn, E., Wittkowski, A., Brooks, J, Briggs, P.E., & Shaughn O’Brien, P.M. (2020). Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: A qualitative investigation. BMC Women’s Health, 242 (20), 1-15. https://doi.org/10.1186/s12905-020- 01100-8 Parker, G., & Malhi, G.S. (2019). Persistent depression: Should such a DSM-5 diagnostic category persist? Canadian Journal of Psychiatry, 64 (3), 177-179. https://doi.org/10.1177/0706743718814

Tolentino, J.C., & Schmidt, S.L. (2018). DSM-5 criteria and depression severity: Implications for clinical practice. Frontiers in Psychiatry, 9 , 1-9. https://doi.org/10.3389/fpsyt.2018.00450 Tsai, W.I., Wen, F.H., Kuo, S.C., Prigerson, H.G., Chou, W.C., Shen, W.C., & Tang, S.T. (2019). Symptoms of prolonged grief and major depressive disorders: Distinctiveness and temporal relationship in the first 2 years of bereavement for family caregivers of terminally ill cancer patients. Psycho-Oncology, 29 (4), 751-758. https://doi.org/10.1002/pon.5333 How can you tell the difference between cyclothymic depression and bipolar depression? According to the DSM-5 cyclothymic disorder is often looked at as a mild form of bipolar disorder, cyclothymic disorder has lower grade high periods (hypomanias) as well as fleeting periods of depression that don't last as long. It states that if an individual with this disorder subsequently after the initial 2 years in adults and 1 year in children or adolescents, experiences a major depressive, manic, or hypomanic episode they change the diagnosis from cyclothymic disorder to Bipolar 1 disorder, major depressive disorder, or unspecified bipolar and related disorder. Also to note as this writer has read that bipolar 1 with rapid cycling and bipolar 2 with rapid cycling can resemble cyclothymic disorder due to the frequently marked shifts in mood (DSM-5-TR), 2022). How does grief differ from major depressive disorder? Grief is recognized as a variable mood between anger, sadness, and normal states in one day. A person can also be preoccupied with a loss, will respond to warmth and reassurance from others, and stays connected with family and friends (Tusaie & Fitzpatrick, 2023). On the other hand, a major depressive disorder episode is a period of at least 2 weeks during which there is either a depressed mood or a loss of interest or pleasure in nearly all activities. In children and adolescents, the mood may be irritable rather than sad. The individual must also experience at least four additional symptoms drawn from a list that includes changes in appetite, weight, sleep, and psychomotor activity, decreased energy, feelings of worthlessness or guilt, difficulty thinking, concentrating or making decisions, or recurrent thoughts of death or suicidal ideations or attempts. These symptoms must persist for most of the day, nearly every day for at least 2 consecutive weeks (DSM-5-TR), 2022). How does Persistent Depressive Disorder differ from Major Depressive Disorder?

PDD or Persistent depressive disorder is defined as a 2-year long or longer period of depressed mood, most of the day for more days than not. Either by subjective account or observation by others. MDD or Major depressive disorder experiences depressive episodes that are separated by at least 2 months. According to the DSM-5 differential diagnosis states that if MDD has persisted for at least a 2-year duration and remains persistent that a diagnosis of a persistent major depressive episode is given. It seems to be that the major difference between the two disorders is the duration of the symptoms (DSM-5-TR), 2022). What is Disruptive Mood Dysregulation Disorder? DMDD or Disruptive mood dysregulation disorder is a childhood and adolescent experience of ongoing irritability, anger, and frequent, intense temper outburst. The severe irritability has two prominent clinical manifestations, the frequent temper outburst. The outburst occurs in response to frustration and can be verbal or behavioral. The second part is chronic, persistent irritable or angry mood that is present between the severe temper outburst. The presence is being most of the day, nearly every day, and noticeable by others in the child's environment. These outbursts need to be ongoing for at least 12 months. The diagnosis is usually made between 6 and 10 years of age. Over time, as a child grows and develops the DMDD may change, and they may experience fewer tantrums but will exhibit symptoms of depression and or anxiety (DSM-5-TR), 2022). What is Premenstrual Dysphoric Disorder? Premenstrual Dysphoric Disorder is an expression of mood lability, irritability, dysphoria, and anxiety symptoms that occur repeatedly during the premenstrual phase of the cycle and stop around the onset of menses or shortly after. Symptoms must have occurred in most of the menstrual cycles during the past year and must have an adverse effect on work and or social functioning (DSM-5-TR), 2022). What are the features of major depressive disorder with:  seasonal pattern?  peripartum onset? The seasonal pattern of major depressive disorder is characterized by a regular temporal relationship between particular periods of the year and the onset and remission of symptoms. The most common presentation in the northern hemisphere is the regular appearance of symptoms between early October and late November and regular remission from mid-

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February to Mid April. Episodes have atypical features such as hypersomnia and overeating. Some of them experience manic or hypomanic symptoms (DSM-5-TR), 2022). Peripartum onset is right after or typically 4 weeks after delivery (DSM-5-TR), 2022). What is the difference in treatment for mild, moderate, and severe depression? The symptoms can be used to classify depression as mild, moderate, and severe. In mild depression one of the core symptoms must be present and usually no more than four related symptoms. People with mild depression can get by without any medication and may find their symptoms begin to subside without treatment over time. Moderate depression would suggest that both core symptoms are present as well as four or more related symptoms. With this level of depression, there is a far higher chance that daily work and social activities are affected. The ability to concentrate and solve problems becomes more significantly impaired. These patients will prepare or exhibit behavior that shows the way they feel. Severe depression is almost certain to include both core symptoms and most if not all the related symptoms. Daily Functioning ceases beyond the most rudimentary activities. The person can also experience psychotic features in the form of delusions or hallucinations. Typically these are consistent with themes of depression involving death, disease, guilt, or some sense of deserved punishment. The patient may or may not need inpatient and will definitely need medication or antidepressants (DSM-5-TR), 2022). Reference American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Tusaie, K.R. & Fitzpatrick, J. J. (2023). Advanced practice psychiatric nursing: Integrating psychotherapy, psychopharmacology, and complementary and alternative approaches (3rd ed). Springer Publishing Company.

NURS 63200 Week 3 Discussion Board

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