Differential 4

”I just read your Differential 3 and wanted to explain your grade. It is lacking specificity. The diagnosis was not
specific. Perhaps there was a miscommunication that I wanted you to give me a disorder rather than just the classification of disorders. For the next case, please include specifics of the disorder, your rule-outs, and why your diagnosis seems best.

This PAPER: There is only ONE disorder to be diagnosed, and it’s definitely a mood disorder. The symptoms should lead you in the right direction. Let’s add something new… On this one, make sure to include the appropriate specifier for the disorder.

Definitions: Differentials. Students will complete differentials. Differentials will actually be case studies provided by the instructor. Cases will be relevant to the disorder category of the week. Students will read the case materials, consider the symptoms, and make a “best-guess” of what diagnosis the case describes using a series of questions provided by the instructor. The diagnosis is not intended to be perfect using all possible specifiers, etc., but rather to allow students to begin thinking through the complexities and inter-relatedness of many disorders, and recognizing symptoms and the disorders they represent.

Tips: This is your LAST differential! So, make it count. There is only ONE disorder to be diagnosed, and it’s definitely a mood disorder. The symptoms should lead you in the right direction. Let’s add something new… On this one, make sure to include the appropriate specifier for the disorder. See your text for more…

Notes:
GENERAL: Read the case materials, consider the symptoms, and make a “best-guess” of what diagnosis the case describes. The diagnosis is not intended to be perfect using all possible specifiers, etc., but rather to allow students to begin thinking through the complexities and inter-relatedness of many disorders, and recognizing symptoms and the disorders they represent.
FORMAT: Use 12-point font, 1-inch margins, single-spaced, Times New Roman font. This shoud take NO MORE than one page. You can use more of an outline form if you like instead of a narrative. As long as you convey what you are thinking to lead you to your diagnosis, you should be alright. These are the things you should address: 1) What are the symptoms presented in the case? 2) Which disorders do these symptoms seem to match? Here you will note your differentials (rule-outs) of disorders whose DSM criteria presented in the text seem to match – there will be only one disorder. . 3) What is your diagnosis? This should be the disorder whose diagnostic criteria best matches the symptoms. 4) Why is this the best match?

EXAMPLES:
MOOD DISORDERS AND SUICIDE
WHAT ARE MOOD DISORDERS?
There are two moods involved in mood disorders:
Mania – intense and unrealistic feeling of excitement and euphoria
Depression – involves feelings of extraordinary sadness and dejection
Some people with mood disorder experience each of these at different times and some only experience depression. Some may experience a MIXED EPISODE in which they have some manic symptoms and some depression symptoms such as feeling sad, euphoric, and irritable.
Unipolar disorders – the person experiences only depressive episodes
Bipolar disorders – person experiences at least manic episodes, and usually depressive episodes as well.
PREVALENCE
Lifetime prevalence rates of unipolar major depression – about 17 percent – higher in women than in men
Lifetime prevalence rate of bipolar disorder – .4 to 1.6 percent – no difference between the sexes
The gender differences, or lack thereof, may indicate that like schizophrenia, bipolar disorder is very biologically determined compared to many other disorders.
UNIPOLAR MOOD DISORDERS
Most people experience some feelings of discouragement, pessimism, and hopelessness. Some mild depression is “normal” and may even be good for us – it slows us down and forces us to deal with some painful things that we may otherwise avoid dealing with.
DPRESSIONS THAT ARE NOT MOOD DISORDERS
I. Grief – seems to be more difficult for men than for women.
Major Depressive disorder is not diagnosed for the first 2 months after a loss. Some have even suggested that it take a year to get out of the grieving state.
Some people are truly resilient and have very symptoms and bounce back quickly. It doesn’t mean they were not attached, but they just move on faster.
II. Postpartum “blues” – emotional lability, crying easily, and irritability. About 50-70 percent of women may have postpartum symptoms most likely due to hormonal readjustments. More likely to occur if she doesn’t have a strong social support system.
DYSTHYMIC DISORDER
Must have a persistently depressed mood most of the day, for more days than not, for at last 2 years (1 year for children and adolescents).
Must have at least 2 of 6 additional symptoms from the criteria list on page 230.
May have a normal mood for a few days, but not more than 2 months.
Dysthymia lasts on the average about 5 years, but can last more than 20 years.
Usually worse with chronic stress
Usually begins during adolescence
Dysthymia is essentially a low-grade, yet more chronic depression.
MAJOR DEPRESSIVE DISORDER
Must experience a markedly depressed mood or loss of interest in pleasurable activities most of every day, nearly every day, for at least 2 consecutive weeks.
Must have five or more of the symptoms noted in textbook.
These include cognitive symptoms, behavioral symptoms, and physical symptoms.
They have NEVER had a manic or mixed episode.
People also often experience anxiety. There is a very high comorbidity rate.
Depression can begin at any time in the life cycle – from early childhood (even infants) to old age.
With psychotic features – loss of contact with reality and delusions (false beliefs) or hallucinations; also feel worthless and guilty
-Have a poorer long-term prognosis
-Often given antipsychotic medication as well as antidepressants
With a diagnosis of major depression, it is specified whether this is a first and single episode or a recurrent episode. The average duration of untreated depression is usually 6 months.
If the depression does not remit for over 2 years, it is chronic major depressive disorder.
Depression usually remits (no symptoms for 2 months). But it usually comes back.
Relapse – often occurs when medication is stopped.
CAUSES OF UNIPOLAR MOOD DISORDERS
BIOLOGICAL CAUSES
Genetic influences –
Family studies show that the prevalence of mood disorders is about 3 times higher in blood relatives of persons with clinical unipolar depression.
Overall, there is a moderate genetic contribution for major depression. For dysthymia, there doesn’t seem to be much evidence of a genetic contribution.
3 neurotransmitters involved in depression:
Norepinephrine, dopamine, and serotonin
Only some depressed patients have lowered serotonin activity – often those who are suicidal.
Some have elevated cortisol levels (human stress hormone released by the adrenal glands) – depressed patients with elevated cortisol have memory impairments which can cause cell death in the hippocampus (involved in making new memories).
Another possibility is that people with low thyroid levels (hypothyroidism) often become depressed.
Stroke damage to the left prefrontal cortex often leads to depression. Or if they haven’t had a stroke, they may still have lower levels of brain activity in that region.
Sleep. Depressed patients typically have some type of sleep difficulty. They go into REM sleep 15-20 minutes sooner and have more intense REM sleep.
PSYCHOSOCIAL CAUSES
Stressful events can precipitate depression – loss of a loved one, threats to close relationships, or occupation, economic troubles, or health problems. The depression is worse is there is a sense of humiliation.
Chronic stress can be as important as major life events.
If the individual already has a genetic predisposition to depression and they experience stressful life events, they are even more likely to experience depression.
Personality vulnerability factors:
Neuroticism (especially in conjunction with being sensitive to negative stimuli)
High levels of introversion
Beck’s Cognitive Theory:
Underlying dysfunctional beliefs – rigid, extreme, and counterproductive – “If everyone doesn’t love me, then my life is worthless.”
Negative automatic thoughts:
Beck’s Cognitive Triad for Depression:
Negative thoughts about the self: “I’m a failure.”
Negative thoughts about the world in general:…