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

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

`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 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

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

Clinical guideline Published: 26 September 2005 nice.org.uk/guidance/cg28

Clinical guideline Published: 26 September 2005 nice.org.uk/guidance/cg28 Depression in children young people: identification management Clinical guideline Published: 26 September 2005 nice.org.uk/guidance/cg28 NICE 2005. All rights reserved. Last updated March 2015 Depression

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

Untreated depression leads to concomitant disorders, a chronic course and numerous negative events

Untreated depression leads to concomitant disorders, a chronic course and numerous negative events Dr Androula Ladikos Psychiatrist 28-02-2015 18% of Adolescents have experienced symptoms of depression at least once in their lives. Untreated depression leads to concomitant disorders, a chronic course

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

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

4. Definition and diagnosis of major depression

4. Definition and diagnosis of major depression 4. Definition and diagnosis of major depression Would screening improve the results in major depression? Are there suicide risk factors in patients with major depression? 4.1. Major depression is a syndrome

More information

Mood (affective) disorders. Jana Hořínková Dept. of Psychiatry Masaryk University Brno

Mood (affective) disorders. Jana Hořínková Dept. of Psychiatry Masaryk University Brno Mood (affective) disorders Jana Hořínková Dept. of Psychiatry Masaryk University Brno MOOD DISORDERS Main feature: mood change in sense of decrease (depression) or elevation (mania) Definition of mood:

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

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

E. Classifying Concerns about Children and Adolescents

E. Classifying Concerns about Children and Adolescents PRACTICE NOTES E. Classifying Concerns about Children and Adolescents Deciding how to label a problem, especially related to children and adolescents, is a difficult and controversial matter. The current

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

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

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

BY www.health24.com http://www.health24.com/medical/condition_centres/777-792-807-1647,23534.asp 1 WHAT IS BIPOLAR DISORDER? Bipolar disorder, also known as manic depression, is a mood disorder characterised

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

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

Are Biological Factors Necessary but Not Sufficient in Understanding the Causes of Unipolar Depression? Page. 1. Introduction 3

Are Biological Factors Necessary but Not Sufficient in Understanding the Causes of Unipolar Depression? Page. 1. Introduction 3 Raoul Tawadey 1 Are Biological Factors Necessary but Not Sufficient in Understanding the Causes of Unipolar Depression? Page 1. Introduction 3 1.1. What is unipolar depression? 1.2. Symptoms 1.3. Diagnosis

More information

Deconstructing the DSM-5 By Jason H. King

Deconstructing the DSM-5 By Jason H. King Deconstructing the DSM-5 By Jason H. King Assessment and diagnosis of depressive disorders and bereavement reactions In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),

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. Care for children and young people with depression 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

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

Depression and Bipolar Disorder

Depression and Bipolar Disorder The Canadian Mental Health Association (CMHA) is a nation-wide, charitable organization that promotes the mental health of all and supports the resilience and recovery of people experiencing mental illness.

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

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

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

Depression and the Intellectually/ Developmentally Disabled. Helene Silverblatt MD Professor of Psychiatry UNMHSC/TEASC TEAM March 9, 2012

Depression and the Intellectually/ Developmentally Disabled. Helene Silverblatt MD Professor of Psychiatry UNMHSC/TEASC TEAM March 9, 2012 Depression and the Intellectually/ Developmentally Disabled Helene Silverblatt MD Professor of Psychiatry UNMHSC/TEASC TEAM March 9, 2012 Depression: Some undisputed facts About 1 in 5 adults over age

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

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

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

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

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

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

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

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

Affective Disorders. Depression. Depression. Depression. Aetiology: Aetiology: Epidemiology:

Affective Disorders. Depression. Depression. Depression. Aetiology: Aetiology: Epidemiology: Affective Disorders Affective Disorders Mania / Hypomania Bipolar mood disorder Recurrent depression Persistent mood disorders Others Epidemiology: Lifetime prevalence: 10-20% Mean age of onset: 27 M:F

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

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

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

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

Psychiatric Disorders

Psychiatric Disorders Psychiatric Disorders Learning about the brain from diagnosis to treatment Tedi Asher Harvard Medical School Talk overview Part I: Defining psychiatric disorders Part II: Biological underpinnings of depression

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

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

UNDERSTANDING & TREATING DEPRESSION AND SUICIDE SUPPLEMENTAL HANDBOOK

UNDERSTANDING & TREATING DEPRESSION AND SUICIDE SUPPLEMENTAL HANDBOOK UNDERSTANDING & TREATING DEPRESSION AND SUICIDE SUPPLEMENTAL HANDBOOK I. WHAT IS DEPRESSION? It is normal to feel sad or blue at times. Depression is different from these temporary feelings. Depression

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

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

PSYCHIATRY OBJECTIVES

PSYCHIATRY OBJECTIVES 1 P a g e PSYCHIATRY OBJECTIVES Phase II Introductory clinical appointment 1. Ability to take a brief psychiatric history, do a mental state examination and relevant physical examination in a patient with

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

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

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

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

1. Various attempts have been made to formally classify psychiatric disorders, the two major systems being:

1. Various attempts have been made to formally classify psychiatric disorders, the two major systems being: ADJUSTMENT DISORDERS MEDICAL APPENDIX 1. Various attempts have been made to formally classify psychiatric disorders, the two major systems being: 1.1. The ICD-10 Classification of Mental and Behavioural

More information

Title: Protocol for Depression Screening Adults with Stroke Manual: Patient Care Policy and Procedure Type: Protocol

Title: Protocol for Depression Screening Adults with Stroke Manual: Patient Care Policy and Procedure Type: Protocol Title: Protocol for Depression Screening Adults with Stroke Manual: Patient Care Policy and Procedure Type: Protocol Section: Stroke Additional Sections (if indicated): Developed by: Stroke Quality Committee

More information

m~íüï~óë=íç=êéåçîéêó=~åç=üé~äíü aê=píééüéå=t~êêéå `çåëìäí~åí=`üáäç=~åç=^ççäéëåéåí=mëóåüá~íêáëí dêééåïáåü

m~íüï~óë=íç=êéåçîéêó=~åç=üé~äíü aê=píééüéå=t~êêéå `çåëìäí~åí=`üáäç=~åç=^ççäéëåéåí=mëóåüá~íêáëí dêééåïáåü m~íüï~óë=íç=êéåçîéêó=~åç=üé~äíü aê=píééüéå=t~êêéå `çåëìäí~åí=`üáäç=~åç=^ççäéëåéåí=mëóåüá~íêáëí dêééåïáåü Outline Definitions and prevalence Age of onset and duration of untreated psychosis Costs of psychosis

More information

Since the 1960s there has been a steady increase of youths being referred for mental health

Since the 1960s there has been a steady increase of youths being referred for mental health ODD AND MDD 1 Since the 1960s there has been a steady increase of youths being referred for mental health services due to aggressive, acting out, and disruptive behavior patterns (Achenback & Howell, 1993,

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

Assessing for Depression

Assessing for Depression Assessing for Depression in your clinical counseling practice Deborah Legge PhD CRC LMHC http://www.influentialtherapist.com Poll Question Who are you? Clinical counselor in Private Practice Clinical Counselor

More information

Summary of guideline for the. treatment of depression RANZCP CLINICAL PRACTICE GUIDELINES ASSESSMENT

Summary of guideline for the. treatment of depression RANZCP CLINICAL PRACTICE GUIDELINES ASSESSMENT RANZCP CLINICAL PRACTICE GUIDELINES Summary of guideline for the RANZCP CLINICAL PRACTICE GUIDELINES treatment of depression Pete M. Ellis, Ian B. Hickie and Don A. R. Smith for the RANZCP Clinical Practice

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

Psychological treatments for Anxiety and Depression

Psychological treatments for Anxiety and Depression Psychological treatments for Anxiety and Depression Katy Grazebrook Clinical Lead, Greenwich Time To Talk Consultant Clinical Psychologist Wednesday 18 March 2015 Plan of the presentation Summary of NICE

More information

Bipolar Disorder: Fact Sheet and Criteria for Diagnosis

Bipolar Disorder: Fact Sheet and Criteria for Diagnosis Bipolar Disorder: Fact Sheet and Criteria for Diagnosis Formerly known as manic-depressive disorder, bipolar disorder is a brain disorder that results in extreme fluctuations in mood, energy, and activity

More information

FASD and Depression. Depression

FASD and Depression. Depression FASD and Depression Jacqueline Pei, R.Psych., Ph.D. Depression Depression is a serious mood disorder that can take the joy from a child s life. 1 Depression Depression isn't just bad moods and occasional

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

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

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

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

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

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

Management of Depression in Primary Care

Management of Depression in Primary Care Management of Depression in Primary Care Introduction Neil Micklewood, owner of Neil Micklewood Psychology Registered Clinical Psychologist 5 yrs experience in: Mental Health Forensic Mental Health Correctional

More information

Depression in Children and Adolescents

Depression in Children and Adolescents Depression in Children and Adolescents Karen Dineen Wagner, MD, PhD Marie B. Gale Centennial Professor & Vice Chair Department of Psychiatry & Behavioral Sciences Director, Division of Child & Adolescent

More information

LP Psy Disorders BC:Psydisorder mood 1 03/23/09. Mood disorders

LP Psy Disorders BC:Psydisorder mood 1 03/23/09. Mood disorders Mood disorders LP Psy Disorders BC:Psydisorder mood 1 Mood disorders: A category of mental disorders in which significant and chronic disruption in mood is the predominant symptom, causing impaired cognitive,

More information

Diagnosis and Treatment of Bipolar Disorder. Marissa Mariano-Mejia, M.D. Adult Psychiatrist July 2, 2016

Diagnosis and Treatment of Bipolar Disorder. Marissa Mariano-Mejia, M.D. Adult Psychiatrist July 2, 2016 Diagnosis and Treatment of Bipolar Disorder Marissa Mariano-Mejia, M.D. Adult Psychiatrist July 2, 2016 Points to Cover What is the defining characteristic of Bipolar Disorder? Bipolar I vs. Bipolar II

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

Screening for Mental Illnesses at DOCS Health Fairs

Screening for Mental Illnesses at DOCS Health Fairs Screening for Mental Illnesses at DOCS Health Fairs Depression, Anxiety & Substance Abuse Screening Presented by: Stefania Prendes-Alvarez Mental Health The World Health Organization defines 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

BIPOLAR DISORDER. Dr. Norman Costigan Department of Psychiatry Alberta Health Services

BIPOLAR DISORDER. Dr. Norman Costigan Department of Psychiatry Alberta Health Services BIPOLAR DISORDER Dr. Norman Costigan Department of Psychiatry Alberta Health Services Clinical Professor Faculties of Family Medicine and Psychiatry The University of Alberta 1 1 DSM 5 - Modified Major

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

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

Schizoaffective disorder

Schizoaffective disorder Schizoaffective disorder Schizoaffective disorder is a mental illness that affects your moods and thoughts. This factsheet explains the condition, possible causes and treatments. This guide is for people

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

Axis II: Long standing chronic conditions that may affect the clinical syndromes listed in Axis I

Axis II: Long standing chronic conditions that may affect the clinical syndromes listed in Axis I The Axes of a Diagnosis Psychiatrists and psychologists use criteria in the DSM-IV, or Diagnostic and Statistical Manual, to diagnose a patient. If you are not familiar with this manual, check this out

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

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

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

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

Bipolar Disorder in Adults Evidence Based Practice

Bipolar Disorder in Adults Evidence Based Practice Bipolar Disorder in Adults Evidence Based Practice Questions from Module A 1) To diagnose a hypomanic episode, the period of persistently elevated, expansive, or irritable mood must last at least days.

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

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

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

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

About Mental Illness. Clinical Definitions

About Mental Illness. Clinical Definitions About Mental Illness This section includes some facts and statistics about mental illness as well as short descriptions of the more common illnesses. Comprehensive facts and statistics are available from

More information

Guidelines for School Nurse Role in the. Management of Depression in Children and. Young People

Guidelines for School Nurse Role in the. Management of Depression in Children and. Young People Guidelines for School Nurse Role in the Management of Depression in Children and Young People Reference No: G_CS_45 Version 1.2 Ratified by: LCHS Trust Board Date ratified: 26 th August 2014 Name of originator

More information

Depression and antidepressant drugs. By Vincent van Gogh

Depression and antidepressant drugs. By Vincent van Gogh Depression and antidepressant drugs By Vincent van Gogh Depression - according to DSM-IV Five (or more) of the following symptoms have been present during the same 2-week period and represent a change

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

What is Depression? Class Objectives 3/22/2011. Mood Disorders Chapter 8. THINK on your own What are some everyday moods people can experience?

What is Depression? Class Objectives 3/22/2011. Mood Disorders Chapter 8. THINK on your own What are some everyday moods people can experience? What is Depression? Mood Disorders Chapter 8 Class Objectives Depressive Disorders What are Mood Disorders? What is Major Depressive Disorder? What is Post Partum Disorder? Next class: What are Unipolar

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

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. Step 3: Persistent subthreshold depressive symptoms or mild to moderate depression with inadequate response to initial interventions, entions, and moderate and bring together all NICE guidance, quality

More information

Screening and suicide risk factors in the major depression of adults

Screening and suicide risk factors in the major depression of adults Screening and suicide risk factors in the major depression of adults B Screening of depression is not generally recommended, given that there are reasonable doubts about its effectiveness for modifying

More information