Some helpful reminders on depression in children and young people. Maria Moldavsky Consultant Child and Adolescent Psychiatrist

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Some helpful reminders on depression in children and young people. Maria Moldavsky Consultant Child and Adolescent Psychiatrist"

Transcription

1 Some helpful reminders on depression in children and young people Maria Moldavsky Consultant Child and Adolescent Psychiatrist

2 The clinical picture What art and my patients taught me

3 Albert Durer ( ) Melancholia

4 Lucas Cranach ( ) Melancholy

5 Moretto da Brescia ( ) Portrait of a young man

6 The broad picture Is the low mood related to a physical illness? another mental health problem? substance use? family/social circumstances? Is the young person suicidal? psychotic? a risk to others/at risk from others?

7 Long-term factors Depression in CYP usually starts and is maintained for a reason However, we frequently get Nothing or I don t know as an answer CYP not aware of factors that play their role insidiously: early trauma lack of contact with one parent emotional needs not being met

8 Depression in YP with traits of an emergent Emotional Unstable PD Many different areas of difficulty, like a mosaic Poor sense of identity Changeable opinions about other people All areas of their life are chaotic Emotional dysregulation Psychotic symptoms but not clinically psychotic

9 Increasing degrees of suicidal risk There s no point in life I don t care what happens to me I wish I were dead I ll kill myself Making plans; setting a time Doing things to put the plans into action Being close to doing it Having tried

10 Beware of protective factors Family When in distress, young people think that they are a burden to their family they will be better off without me they will be upset for a while, then they will be fine Friends A disappointment or argument may increase suicidal risk Plans for the future Hopelessness makes YP think that they will never achieve them

11 Possible diagnoses What the international classifications taught me

12 Why is this important? It tells us all what questions to ask It helps you decide whether to refer to CAMHS what to include in your referral

13 ICD 10 diagnoses including symptoms of depression Depressive episode Recurrent depressive episode Persistent mood (affective) disorder Mixed disorder of conduct and emotions Adjustment disorder M&BD due to psychoactive substance use Organic mental disorder Schizoaffective disorder, depressive type

14 Depressive episode At least two of these symptoms: Depressed mood for 2 weeks, most of the day almost every day Loss of interest of pleasure in activities Decreased energy or increased fatigability Additional symptoms: Loss of confidence/self esteem Self-reproach/guilt Suicidal thoughts/ behaviour Less ability to concentrate/think Agitation/motor retardation

15 Depressive Episode: Diagnostic Criteria for Research Should last for at least 2 weeks No hypomanic or manic episode (lifetime) Episode not attributable to: Psychoactive substance use Organic mental disorder

16 Severity of Depressive Episode Mild: total of 4 symptoms With/without somatic syndrome Moderate: total of 6 symptoms With/without somatic syndrome Severe: all three main symptoms present; total of 8 symptoms With/without psychotic symptoms

17 Somatic syndrome At least four of these: Loss of interest/pleasure in activities Lack of emotional reactions Waking 2 hours before usual Depression worse in the morning Psychomotor retardation/agitation Loss of appetite Loss of weight: 5% in last month Loss of libido

18 Psychotic symptoms One of these: Delusions or hallucinations other than those typically schizophrenic Most frequent mood-congruent content: worthlessness, guilt, hypochondriacal, nihilistic Most frequent mood-incongruent content: selfreferential, persecutory Depressive stupor

19 Typically schizophrenic Delusions of control, influence or passivity clearly referred to body/limb movements or to thoughts/actions/perceptions Hallucinatory voices giving running commentary of patient s behaviour discussing the patient between themselves coming from some part of the body Persistent delusions that are culturally inappropriate and completely impossible

20 Persistent mood (affective) disorder: Dysthymia At least 2 years of constant depressed mood Periods of normal mood rarely longer than a few weeks Episodes not severe enough to be recurrent depressive episode At least 3 symptoms: Reduced energy Insomnia Loss of self-confidence Poor concentration Tearfulness Anhedonia Hopelessness Inability to cope Pessimism/brooding Social withdrawal Being less talkative

21 Adjustment Disorder Onset of symptoms occur within 1 month of exposure to a psychosocial stressor Affecting social network/wider system of social support Major developmental transition or crisis Individual vulnerability plays a role

22 Types of Adjustment Disorder Brief depressive reaction: mild depressive state, < 1 month Prolonged depressive reaction: mild depressive state, < 2 years Mixed anxiety and depressive reaction With predominant disturbance of other emotions; e.g. regressive behaviour in children of conduct; e.g. aggressive/dissocial behaviour in adolescents

23 Bereavement Normal bereavement reactions (<6months): No diagnosis; Z code Grief reactions considered to be abnormal because of their form, content or duration: diagnosed as Adjustment Disorder

24 DSM 5 Depressive Disorders A new diagnosis: Disruptive Mood Dysregulation Disorder (DMDD) Persistent irritability and frequent episodes of temper outbursts that are inconsistent with developmental level Symptoms present > 12 months, in at least 2 of 3 settings and are severe in at least one setting Onset before 10 years

25 Disruptive Mood Dysregulation Disorder Never had hypomanic or manic episode Symptoms do not only occur during an episode of major depressive disorder This diagnosis cannot coexist with Oppositional Defiant Disorder (DMDD overrides it) The term Bipolar Disorder is reserved for episodic presentations of irritability

26 Persistent Depressive Disorder (Dysthymia) In CYP: Irritability may be more obvious than low mood Only 1 year of low mood needed to make the diagnosis

27 How to treat depression in CYP What NICE and research taught me

28 NICE guideline Depression in CYP (Sept 2005): Risk factors for depression age gender family discord bullying physical, sexual or emotional abuse history of parental depression comorbid disorders, including drug and alcohol use homelessness refugee status living in institutional settings

29 Referral Management can remain at Tier 1 if: Exposure to a recent undesirable life event and: absence of other risk factors for depression Some risk factors (in the YP or family members) with no evidence of depression and/or self-harm in the YP mild depression without comorbidity

30 Criteria for referral to tier 2 or 3 CAMHS Depression with 2/more risk factors for depression Depression where 1/more family members (parents/children) have multiple risk factors Mild depression + no response to interventions in tier 1 after 2 3 months Moderate/severe depression (including psychotic depression) Recurrence of depression after recovery from moderate/severe depression Unexplained self-neglect >1 month Active suicidal ideas/plans Referral requested by YP/parent

31 Criteria for referral to tier 4 services High recurrent risk of acts of self-harm or suicide Significant ongoing self-neglect (e.g. poor personal hygiene or significant reduction in eating that could be harmful to physical health) Requirement for intensity of assessment/treatment and/or level of supervision that is not available in tier 2 or 3

32 NICE: the stepped-care model Focus Action Responsibility Mild depression, incl. Dysthymia Moderate to severe depression Depression unresponsive to treatment/recurrent/ psychotic Watchful waiting Non-directive psychotherapy/group CBT/guided self-help Brief psychological therapy +/- Fluoxetine Intensive psychological therapy +/- Fluoxetine, Sertraline or Citalopram; augmentation with an antipsychotic Tier1 Tier 1 or 2 Tier 2 or 3 Tier 3 or 4

33 Main RCTs since 2005 The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. March et al, Arch Gen Psych 2007 A randomised controlled trial of cognitive behaviour therapy in adolescents with major depression treated by selective serotonin reuptake inhibitors. The ADAPT trial. Goodyer et al, Health Technol Assess 2008 Treatment of Resistant Depression in Adolescents (TORDIA): week 24 outcomes. Emslie et al, AM J Psychiatry 2010

34 USA The Treatment for Adolescents With Depression Study (TADS), 2007 N=327, age Mayor Depressive episode Compared CBT, Fluoxetine and their combination 36 weeks, 12 were blind

35 TADS: Conclusions In adolescents with moderate to severe depression, treatment with fluoxetine alone or in combination with CBT accelerates the response. Adding CBT to medication enhances the safety of medication. Combined treatment appears superior to either monotherapy as a treatment for major depression in adolescents.

36 The ADAPT trial, 2008 UK N=208, age Severely depressed Compared SSRI+CBT to SSRI alone 12 w treatment, 16 w maintenance No difference in treatment effectiveness for SSRI + CBT over SSRI only for the primary or secondary outcome measures at any time point

37 Treatment of Resistant Depression in USA Adolescents (TORDIA), 2010 N=334, age SSRI-resistant depression Compared medication switch alone with medication switch + CBT 24 w (non-responders had open treatment after 12 w)

38 TORDIA: conclusions Continued treatment for depression among treatment-resistant adolescents results in remission in approximately one-third of patients, similar to adults. Eventual remission is evident within the first 6 weeks in many, suggesting that earlier intervention among non-responders could be important.

39 Thank you very much for your attention Dr. Maria Moldavsky

Management of depression in young people

Management of depression in young people Management of depression in young people A guide for primary care health professionals For young people not in immediate danger of suicidal behaviour, management of major depressive disorder is likely

More information

Depression in children and young people. Identification and management in primary, community and secondary care

Depression in children and young people. Identification and management in primary, community and secondary care NICE guideline May 2005 Issue date: September 2005 Depression in children and young people Identification and management in primary, community and secondary care Clinical Guideline 28 Developed by the

More information

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí=

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= `çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect

More information

Depression Assessment & Treatment

Depression Assessment & Treatment Depressive Symptoms? Administer depression screening tool: PSC Depression Assessment & Treatment Yes Positive screen Safety Screen (see Appendix): Administer every visit Neglect/Abuse? Thoughts of hurting

More information

Major Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions

Major Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions Major Depressive Disorder Major Depressive Disorder (MDD) Guideline Diagnostic omenclature for Clinical Depressive Conditions Conditions Diagnostic Criteria Duration Major Depression 5 of the following

More information

Depression Flow Chart

Depression Flow Chart Depression Flow Chart SCREEN FOR DEPRESSION ANNUALLY Assess for depression annually with the PHQ-9. Maintain a high index of suspicion in high risk older adults. Consider suicide risk and contributing

More information

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1 What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated

More information

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999 Feeling Moody? Is it just a bad mood or is it a disorder? Major Depressive Disorder Prevalence: 7%; 18-29 years old; Female>Male DDx: Manic episodes with irritable mood or mixed episodes, mood disorder

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. Management of moderate to severe ere (including psychotic) depression in children and young people tiers 2 4 bring together all NICE guidance, quality standards and other NICE information on a specific

More information

Depression Treatment Guide

Depression Treatment Guide Depression Treatment Guide DSM V Criteria for Major Depressive Disorders A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous

More information

CHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014. 2014 MVP Health Care, Inc.

CHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014. 2014 MVP Health Care, Inc. CHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014 2014 MVP Health Care, Inc. CHAPTER 5 CHAPTER SPECIFIC CATEGORY CODE BLOCKS F01-F09 Mental disorders due to known physiological

More information

MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION

MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION Executive summary of recommendations Details of recommendations can be found in the main text at the pages indicated. Clinical evaluation D The basic

More information

Step 4: Complex and severe depression in adults

Step 4: Complex and severe depression in adults Step 4: Complex and severe depression in adults A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

More information

Mental Health Needs Assessment Personality Disorder Prevalence and models of care

Mental Health Needs Assessment Personality Disorder Prevalence and models of care Mental Health Needs Assessment Personality Disorder Prevalence and models of care Introduction and definitions Personality disorders are a complex group of conditions identified through how an individual

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. Using antidepressants in children and young people bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They

More information

Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome

Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome Dr. May Lam Assistant Professor, Department of Psychiatry, The University of Hong Kong Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome a mental state in

More information

Depression in children and young people. Quick reference guide. Issue date: September 2005

Depression in children and young people. Quick reference guide. Issue date: September 2005 Quick reference guide Issue date: September 2005 Depression in children and young people Identification and management in primary, community and secondary care Clinical Guideline 28 Developed by the National

More information

Depre r s e sio i n o i n i a dults Yousuf Al Farsi

Depre r s e sio i n o i n i a dults Yousuf Al Farsi Depression in adults Yousuf Al Farsi Objectives 1. Aetiology 2. Classification 3. Major depression 4. Screening 5. Differential diagnosis 6. Treatment approach 7. When to refer 8. Complication 9. Prognosis

More information

Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders

Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders Welcome New Employees Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders After this presentation, you will be able to: Understand the term Serious

More information

Behavioral Health Best Practice Documentation

Behavioral Health Best Practice Documentation Behavioral Health Best Practice Documentation Click on the desired Diagnoses link or press Enter to view all information. Diagnoses: DSM-5 and ICD-10 Codes Major Depressive Disorder Bipolar Disorder Eating

More information

Clinical features - Depression

Clinical features - Depression Mood CRS Formulation Depression The word depression is used to describe a variety of states ranging from normal unhappiness after a loss up to severe major depressive illness with physical and psychotic

More information

ENTITLEMENT ELIGIBILITY GUIDELINE

ENTITLEMENT ELIGIBILITY GUIDELINE ENTITLEMENT ELIGIBILITY GUIDELINE BIPOLAR DISORDERS MPC 00608 ICD-9 296.0, 296.1, 296.4, 296.5, 296.6, 296.7, 296.8, 301.13 ICD-10 F30, F31, F34.0 DEFINITION BIPOLAR DISORDERS Bipolar Disorders include:

More information

in young people Management of depression in primary care Key recommendations: 1 Management

in young people Management of depression in primary care Key recommendations: 1 Management Management of depression in young people in primary care Key recommendations: 1 Management A young person with mild or moderate depression should typically be managed within primary care services A strength-based

More information

DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D.

DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D. DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D. GOALS Learn DSM 5 criteria for DMDD Understand the theoretical background of DMDD Discuss background, pathophysiology and treatment

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

Bipolar disorders: Changes from DSM IV TR to DSM 5

Bipolar disorders: Changes from DSM IV TR to DSM 5 Bipolar disorders: Changes from DSM IV TR to DSM 5 M. Amin Esmaeili, MD, MPH Iranian Research Center for HIV/AIDS (IRCHA) Iranian National Center for Addiction Studies (INCAS) Mood disorders committee

More information

Managing depression after stroke. Presented by Maree Hackett

Managing depression after stroke. Presented by Maree Hackett Managing depression after stroke Presented by Maree Hackett After stroke Physical changes We can see these Depression Emotionalism Anxiety Confusion Communication problems What is depression? Category

More information

Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT

Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Please fax with CCHP prior authorization form to 608-252-0853

More information

309.28 F43.22 Adjustment disorder with mixed anxiety and depressed mood Adjustment disorder with disturbance of conduct

309.28 F43.22 Adjustment disorder with mixed anxiety and depressed mood Adjustment disorder with disturbance of conduct Description ICD-9-CM Code ICD-10-CM Code Adjustment reaction with adjustment disorder with depressed mood 309.0 F43.21 Adjustment disorder with depressed mood Adjustment disorder with anxiety 309.24 F43.22

More information

Schizoaffective disorder

Schizoaffective disorder Schizoaffective disorder Dr.Varunee Mekareeya,M.D.,FRCPsychT Schizoaffective disorder is a psychiatric disorder that affects about 0.5 to 0.8 percent of the population. It is characterized by disordered

More information

Depression Signs & Symptoms

Depression Signs & Symptoms Depression Signs & Symptoms Contents What Is Depression? What Are The Signs And Symptoms Of Depression? How Do The Signs And Symptoms Of Depression Differ In Different Groups? What Are The Different Types

More information

Depressive Disorder in DSM-5

Depressive Disorder in DSM-5 Depressive Disorder in DSM-5 Gary G. Gintner, Ph.D., LPC Louisiana State University Baton Rouge, LA gintner@lsu.edu Who are you? Poll Question Clinical counselor in Private Practice Clinical Counselor

More information

Abnormal Psychology PSY-350-TE

Abnormal Psychology PSY-350-TE Abnormal Psychology PSY-350-TE This TECEP tests the material usually taught in a one-semester course in abnormal psychology. It focuses on the causes of abnormality, the different forms of abnormal behavior,

More information

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller School of Medicine/University of Miami Question 1 You

More information

MENTAL HEALTH PROBLEMS

MENTAL HEALTH PROBLEMS 2 MENTAL HEALTH PROBLEMS Just as we can develop problems with our physical health, mental health problems will be experienced by many of us over the course of our lives. Mental health problems range from

More information

Chapter 7. Mood Disorders. An Overview of Mood Disorders

Chapter 7. Mood Disorders. An Overview of Mood Disorders Chapter 7 Mood Disorders An Overview of Mood Disorders Gross Deviations in Mood 2 Fundamental states: & Mania : The Low Major Depressive Episode The most commonly diagnosed & most severe depression Depressed

More information

Mohammad Amjad ullah Khan, M.D. Child, Adolescent and Adult Psychiatry Texas A & M University Scott & White Healthcare System Temple and Killeen

Mohammad Amjad ullah Khan, M.D. Child, Adolescent and Adult Psychiatry Texas A & M University Scott & White Healthcare System Temple and Killeen Mohammad Amjad ullah Khan, M.D. Child, Adolescent and Adult Psychiatry Texas A & M University Scott & White Healthcare System Temple and Killeen Sadness of mood for most of the day, nearly every day, and/or

More information

POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm

POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm E-Resource March, 2014 POST-TRAUMATIC STRESS DISORDER PTSD Diagnostic Criteria PTSD Detection and Diagnosis PC-PTSD Screen PCL-C Screen PTSD Treatment Treatment Algorithm Post-traumatic Stress Disorder

More information

Washington State Regional Support Network (RSN)

Washington State Regional Support Network (RSN) Access to Care Standards 11/25/03 Eligibility Requirements for Authorization of Services for Medicaid Adults & Medicaid Older Adults Please note: The following standards reflect the most restrictive authorization

More information

Mood Disorders. 1. Major Depressive Disorders 2. Dysthymic Disorder 3. Bipolar Disorder Bipolar I disorder Bipolar II disorder 4. Cyclothymic Disorder

Mood Disorders. 1. Major Depressive Disorders 2. Dysthymic Disorder 3. Bipolar Disorder Bipolar I disorder Bipolar II disorder 4. Cyclothymic Disorder Mood Disorders 1. Major Depressive Disorders 2. Dysthymic Disorder 3. Bipolar Disorder Bipolar I disorder Bipolar II disorder 4. Cyclothymic Disorder 1. Major Depressive Disorders Introduction Major depressive

More information

Recognizing and Treating Depression in Children and Adolescents.

Recognizing and Treating Depression in Children and Adolescents. Recognizing and Treating Depression in Children and Adolescents. KAREN KANDO, MD Division of Child and Adolescent Psychiatry Center for Neuroscience and Behavioral Medicine Phoenix Children s Hospital

More information

Depression, Mental Health and Native American Youth

Depression, Mental Health and Native American Youth Depression, Mental Health and Native American Youth Aisha Mays, MD UCSF Department of Family And Community Medicine Native American Health Center Oakland, CA July 8, 2015 Presenter Disclosures No relationships

More information

Depression in the Elderly: Recognition, Diagnosis, and Treatment

Depression in the Elderly: Recognition, Diagnosis, and Treatment Depression in the Elderly: Recognition, Diagnosis, and Treatment LOUIS A. CANCELLARO, PhD, MD, EFAC Psych Professor Emeritus and Interim Chair ETSU Department of Psychiatry & Behavioral Sciences Diagnosis

More information

POSTPARTUM DEPRESSION: A Guide for Patients and Families

POSTPARTUM DEPRESSION: A Guide for Patients and Families POSTPARTUM DEPRESSION: A Guide for Patients and Families Margaret L. Moline, PhD, David A. Kahn, MD, Ruth W. Ross, MA, Lori L. Altshuler, MD, and Lee S. Cohen, MD www.womensmentalhealth.org The birth of

More information

Post-traumatic stress disorder overview

Post-traumatic stress disorder overview Post-traumatic stress disorder overview A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

More information

DSM-5 to ICD-9 Crosswalk for Psychiatric Disorders

DSM-5 to ICD-9 Crosswalk for Psychiatric Disorders DSM-5 to ICD-9 Crosswalk for Psychiatric s The crosswalk found on the pages below contains codes or descriptions that have changed in the DSM-5 from the DSM-IV TR. DSM-5 to ICD-9 crosswalk is available

More information

Bipolar and related disorders and depressive disorders in DSM-5

Bipolar and related disorders and depressive disorders in DSM-5 Should be cited as: Psychiatr. Pol. 2014; 48(2): 245 260 PL ISSN 0033-2674 www.psychiatriapolska.pl Bipolar and related disorders and depressive disorders in DSM-5 Dorota Łojko, Aleksandra Suwalska, Janusz

More information

Amendments to recommendations concerning venlafaxine

Amendments to recommendations concerning venlafaxine Amendments to recommendations concerning venlafaxine On 31 May 2006 the MHRA issued revised prescribing advice for venlafaxine*. This amendment brings the guideline into line with the new advice but does

More information

Mood disorders. Unlike emotions that are intense and short-lived, moods are relatively long-lasting, nonspecific emotional states.

Mood disorders. Unlike emotions that are intense and short-lived, moods are relatively long-lasting, nonspecific emotional states. LP 14BC: mood disorders 1 Mood disorders Unlike emotions that are intense and short-lived, moods are relatively long-lasting, nonspecific emotional states. Mood disorders: Mental disorders that have mood

More information

Guideline scope Depression in adults: treatment and management

Guideline scope Depression in adults: treatment and management Topic NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Depression in adults: treatment and management This guideline will update the NICE guideline on depression in adults (CG90) as set

More information

Update on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice

Update on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice Update on guidelines on biological treatment of depressive disorder Dr. Henry CHEUNG Psychiatrist in private practice 2013 update International Task Force of World Federation of Societies of Biological

More information

Borderline personality disorder

Borderline personality disorder Issue date: January 2009 Borderline personality disorder Borderline personality disorder: treatment and management NICE clinical guideline 78 Developed by the National Collaborating Centre for Mental Health

More information

Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care

Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care CLINICAL ASSESSMENT AND DIAGNOSIS (ADULTS) Obsessive-Compulsive Disorder (OCD) is categorized by recurrent obsessions,

More information

DSM-5: A Comprehensive Overview

DSM-5: A Comprehensive Overview 1) The original DSM was published in a) 1942 b) 1952 c) 1962 d) 1972 DSM-5: A Comprehensive Overview 2) The DSM provides all the following EXCEPT a) Guidelines for the treatment of identified disorders

More information

EXHIBIT D, COVERED BEHAVIORAL HEALTH DIAGNOSES

EXHIBIT D, COVERED BEHAVIORAL HEALTH DIAGNOSES EXHIBIT D, COVERED BEHAVIORAL HEALTH DIAGNOSES Part I- Mental Health Covered Diagnoses 295-298.9 295 Schizophrenic s (the following fifth-digit sub-classification is for use with category 295) 0 unspecified

More information

B i p o l a r D i s o r d e r

B i p o l a r D i s o r d e r B i p o l a r D i s o r d e r Professor Ian Jones Director National Centre for Mental Health www.ncmh.info @ncmh_wales /WalesMentalHealth 029 2074 4392 info@ncmh.info Robert Schumann 1810-1856 Schumann's

More information

Child and Adolescent Mental Health Service (CAMHs) in Luton

Child and Adolescent Mental Health Service (CAMHs) in Luton Child and Adolescent Mental Health Service (CAMHs) in Luton CAMHS in Luton delivers services for young people experiencing moderate to severe mental health problems and the new CAMHS MALT (Multi Agency

More information

Step 2: Recognised depression in adults persistent subthreshold depressive symptoms or mild to moderate depression

Step 2: Recognised depression in adults persistent subthreshold depressive symptoms or mild to moderate depression Step 2: Recognised depression in adults persistent subthreshold depressive symptoms or mild to moderate depression A NICE pathway brings together all NICE guidance, quality standards and materials to support

More information

Mood Disorders. What Are Mood Disorders? Unipolar vs. Bipolar

Mood Disorders. What Are Mood Disorders? Unipolar vs. Bipolar Mood Disorders What Are Mood Disorders? In mood disorders, disturbances of mood are intense and persistent enough to be clearly maladaptive Key moods involved are mania and depression Encompasses both

More information

Borderline personality disorder

Borderline personality disorder Understanding NICE guidance Information for people who use NHS services Borderline personality disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases

More information

Eating Disorder Treatment Protocol

Eating Disorder Treatment Protocol Eating Disorder Treatment Protocol All Team Members: Patient Self-Management Education & Support Eating Disorders are incredibly debilitating and are associated with significant medical and psychosocial

More information

Mental health issues in the elderly. January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca

Mental health issues in the elderly. January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca Mental health issues in the elderly January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca Cognitive Disorders Outline Dementia (294.xx) Dementia of the Alzheimer's Type (early and late

More information

Borderline personality disorder

Borderline personality disorder Borderline personality disorder Treatment and management Issued: January 2009 NICE clinical guideline 78 guidance.nice.org.uk/cg78 NICE 2009 Contents Introduction... 3 Person-centred care... 5 Key priorities

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

Personality Disorders (PD) Summary (print version)

Personality Disorders (PD) Summary (print version) Personality Disorders (PD) Summary (print version) 1/ Definition A Personality Disorder is an abnormal, extreme and persistent variation from the normal (statistical) range of one or more personality attributes

More information

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 This document is intended to be used with the Somerset Dual Diagnosis Operational Working guide. This document provides principles governing joint working

More information

3/17/2014. Pediatric Bipolar Disorder

3/17/2014. Pediatric Bipolar Disorder Pediatric Bipolar Disorder 1 Highlighted Topics 1. Review the current DSM-5 definition and criteria for bipolar disorder 2. Highlight major historical developments in the scientific understanding of bipolar

More information

MOLINA HEALTHCARE OF CALIFORNIA

MOLINA HEALTHCARE OF CALIFORNIA MOLINA HEALTHCARE OF CALIFORNIA MAJOR DEPRESSION IN ADULTS IN PRIMARY CARE HEALTH CARE GUIDELINE (ICSI) Health Care Guideline Twelfth Edition May 2009. The guideline was reviewed and adopted by the Molina

More information

The treatment of depression in children and young people. Issue date: September 2005

The treatment of depression in children and young people. Issue date: September 2005 Issue date: September 2005 The treatment of depression in children and Understanding NICE guidance information for children and young with depression, their families and carers, and the public Information

More information

MAJOR DEPRESSION DURING CONCEPTION AND PREGNANCY: A Guide for Patients and Families

MAJOR DEPRESSION DURING CONCEPTION AND PREGNANCY: A Guide for Patients and Families MAJOR DEPRESSION DURING CONCEPTION AND PREGNANCY: A Guide for Patients and Families David A. Kahn, MD, Margaret L. Moline, PhD, Ruth W. Ross, MA, Lee S. Cohen, MD, and Lori L. Altshuler, MD www.womensmentalhealth.org

More information

DSM-5 Do Not Use ICD -10 Codes

DSM-5 Do Not Use ICD -10 Codes DSM-5 Do Not Use ICD -10 Codes There are ICD-10 codes that DSM 5 is not compatible with. This spreadsheet details the ICD-10 codes that are NOT compatible with DSM 5. ICD10_DX_CD ICD10_DX_DESC F03.90 Unspecified

More information

Assessment of depression in adults in primary care

Assessment of depression in adults in primary care Assessment of depression in adults in primary care Adapted from: Identification of Common Mental Disorders and Management of Depression in Primary care. New Zealand Guidelines Group 1 The questions and

More information

Bipolar Disorder. When people with bipolar disorder feel very happy and "up," they are also much more active than usual. This is called mania.

Bipolar Disorder. When people with bipolar disorder feel very happy and up, they are also much more active than usual. This is called mania. Bipolar Disorder Introduction Bipolar disorder is a serious mental disorder. People who have bipolar disorder feel very happy and energized some days, and very sad and depressed on other days. Abnormal

More information

Definition of Terms. nn Mental Illness Facts and Statistics

Definition of Terms. nn Mental Illness Facts and Statistics nn Mental Illness Facts and Statistics This section contains a brief overview of facts and statistics about mental illness in Australia as well as information that may be useful in countering common myths.

More information

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

More information

Symptoms of mania can include: 3

Symptoms of mania can include: 3 Bipolar Disorder This factsheet gives information on bipolar disorder. It explains the symptoms of bipolar disorder, treatments and ways to manage symptoms. It also covers what treatment the National Institute

More information

ICD- 9 Source Description ICD- 10 Source Description

ICD- 9 Source Description ICD- 10 Source Description 291.0 Alcohol withdrawal delirium F10.121 Alcohol abuse with intoxication delirium 291.0 Alcohol withdrawal delirium F10.221 Alcohol dependence with intoxication delirium 291.0 Alcohol withdrawal delirium

More information

information for service providers Schizophrenia & Substance Use

information for service providers Schizophrenia & Substance Use information for service providers Schizophrenia & Substance Use Schizophrenia and Substance Use Index 2 2 3 5 6 7 8 9 How prevalent are substance use disorders among people with schizophrenia? How prevalent

More information

Introduction to bipolar disorder

Introduction to bipolar disorder Introduction to bipolar disorder Bipolar I is when the individual experiences manic episodes when high as well as episodes of depression Bipolar II is when the individual experiences hypomanic episodes

More information

Adolescent Depression. Danielle Bradshaw, DO Diplomate of the American Board of Psychiatry and Neurology Adult and Child/Adolescent Psychiatry

Adolescent Depression. Danielle Bradshaw, DO Diplomate of the American Board of Psychiatry and Neurology Adult and Child/Adolescent Psychiatry Adolescent Depression Danielle Bradshaw, DO Diplomate of the American Board of Psychiatry and Neurology Adult and Child/Adolescent Psychiatry Adolescence When does it start? When does it end? Characteristics:

More information

Depression in adults with a chronic physical health problem

Depression in adults with a chronic physical health problem Depression in adults with a chronic physical health problem Treatment and management Issued: October 2009 NICE clinical guideline 91 guidance.nice.org.uk/cg91 NICE has accredited the process used by the

More information

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe,

More information

Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls

Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls Satellite Conference and Live Webcast Thursday, August 25, 2011 5:30 7:00 p.m. Central Time Faculty David J. Schonfeld,

More information

Supporting children in the aftermath of a crisis

Supporting children in the aftermath of a crisis Supporting children in the aftermath of a crisis David J. Schonfeld, MD Thelma and Jack Rubinstein Professor of Pediatrics Director, National Center for School Crisis and Bereavement Division of Developmental

More information

NICE Clinical guideline 23

NICE Clinical guideline 23 NICE Clinical guideline 23 Depression Management of depression in primary and secondary care Consultation on amendments to recommendations concerning venlafaxine On 31 May 2006 the MHRA issued revised

More information

It is distressing for parents to see their child or

It is distressing for parents to see their child or MOOD DISORDERS: DEPRESSIVE AND BIPOLAR DISORDERS MOOD DISORDERS KEY FACTS The prevalence of mood disorders in children and adolescents ages 9 17 years is approximately 6 percent (U.S. Department of Health

More information

See also www.thiswayup.org.au/clinic for an online treatment course.

See also www.thiswayup.org.au/clinic for an online treatment course. Depression What is depression? Depression is one of the common human emotional states. It is common to experience feelings of sadness and tiredness in response to life events, such as losses or disappointments.

More information

Referral Criteria for Berkshire Specialist CAMHs

Referral Criteria for Berkshire Specialist CAMHs Referral Criteria for Berkshire Specialist CAMHs Berkshire CAMHs is a specialist child and adolescent mental health service that provides support, advice, guidance and treatment for children and young

More information

Clinical guideline Published: 29 November 2005 nice.org.uk/guidance/cg31

Clinical guideline Published: 29 November 2005 nice.org.uk/guidance/cg31 Obsessive-compulsive e disorder and body dysmorphic disorder: treatment Clinical guideline Published: 29 November 2005 nice.org.uk/guidance/cg31 NICE 2005. All rights reserved. Contents Introduction...

More information

Mental Health ICD-10 Codes Department of Health and Mental Hygiene

Mental Health ICD-10 Codes Department of Health and Mental Hygiene Mental Health ICD-10 Codes Department of Health and Mental Hygiene (2) For dates of service on or after October 1, 2015: F200 F201 F202 F203 F205 F2081 F2089 F209 F21 F22 F23 F24 F250 F251 F258 F259 F28

More information

More than just feelings of unhappiness, clinical or major depression is a mood disorder a medical illness that involves both the body and mind.

More than just feelings of unhappiness, clinical or major depression is a mood disorder a medical illness that involves both the body and mind. What is depression? More than just feelings of unhappiness, clinical or major depression is a mood disorder a medical illness that involves both the body and mind. 1,2 The difference between clinical depression

More information

The DSM-5 and the Depressive Disorders

The DSM-5 and the Depressive Disorders This image cannot currently be displayed. The DSM-5 and the Depressive Disorders Marcelo T. Berlim, MD, MSc, Assistant Professor, Department of Psychiatry, McGill University Clinical Research Scholar,

More information

The Clinical Presentation of Mood Disorders. Bob Boland MD

The Clinical Presentation of Mood Disorders. Bob Boland MD The Clinical Presentation of Mood Disorders. Bob Boland MD 1 The Clinical Presentation of Mood Disorders 2 Concentrating On Depression Major Depression Mania Bipolar Disorder (Manic-Depression) For the

More information

Post traumatic Stress Associated with Cancer

Post traumatic Stress Associated with Cancer Post traumatic Stress Associated with Cancer BCCA Survivorship Forum June 8, 2016 Alan Bates, MD, PhD, FRCPC Provincial Practice Leader for Psychiatry BC Cancer Agency None Disclosures Acknowledgments

More information

Depression: management of depression in primary and secondary care

Depression: management of depression in primary and secondary care Issue date: December 2004 Quick reference guide Depression: management of depression in primary and secondary care Clinical Guideline 23 Developed by the National Collaborating Centre for Mental Health

More information

Depression Pathway. Patient Education Box 4. Guided self help Box 18. pg 11

Depression Pathway. Patient Education Box 4. Guided self help Box 18. pg 11 LCFT localised Map pathway June 2009 Depression Pathway Instructions: Throughout this pathway if you click on the Bookmarks tab to the left of the screen and then click on the various documents you will

More information

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include: Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic

More information

Specific issues for child and youth primary mental health care

Specific issues for child and youth primary mental health care Guides to specific issues 1 Specific issues for child and youth primary mental health care This issues guide is linked to the vignette Children should be seen and heard Consideration of Child and Youth

More information

Psychosocial Risk Factors. Women s Mental Health. Prevalence of Mood Disorders by Gender. Depression in Women: Contributing Factors

Psychosocial Risk Factors. Women s Mental Health. Prevalence of Mood Disorders by Gender. Depression in Women: Contributing Factors Women s Mental Health Linda S. Mullen, MD Director, Women s Mental Health Assistant Professor of Clinical Psychiatry in OB/GYN Columbia University & NewYork Presbyterian Hospital Departments of Psychiatry

More information

Disruptive Mood Dysregulation Disorder

Disruptive Mood Dysregulation Disorder The Center for Counseling Practice, Policy, and Research counseling.org/practice_briefs 703-823-9800 x324 Disruptive Mood Dysregulation Disorder Brandy L. Gilea Ph.D. and Rachel M. O Neill Ph.D., Walden

More information