Running head: DIAGNOSTIC PROTOCOL 1

Diagnostic Protocol:

Depressive Disorders

Sasha Gordon

University of Utah

RECTH 3360

Sandy Negley

October 5, 2016
DIAGNOSTIC PROTOCOL 2

Diagnostic Grouping: Mood Disorders

A category of mental illness that causes serious changes in mood (Mental Health
America, 2016).
o Used to describe all types of depression and bipolar disorders.
Mood is a pervasive and sustained emotion that colors ones view of life (Butterworth,
2016).
o Mood state continuum:
Mania (state of euphoria and frenzied energy)
Hypomania
Normal range
Dysthmia
Depression (low, sad state where everything seems hopeless and
overwhelming)
When people have mood disorders, their emotions and moods are more intense than what
someone might normally feel, and cause distress or impairment in their relationships,
work, and leisure interests (John Hopkins Medicine, n.d.).

Specific Diagnosis: Depressive Disorders

Defining Characteristics:
o Common features of all depressive disorders:
Sad, empty, or irritable mood
Somatic and cognitive changes that impact the individuals ability to
function. (American Psychiatric Association, 2013).
Symptoms:
o Depressed mood
o Loss of interest in almost all activities
o Significant weight loss or weight gain/decrease or increase in appetite
o Insomnia or hypersomnia
o Feelings of worthlessness or excessive guilt
o Fatigue or loss of energy
o Psychomotor retardation or agitation
o Diminished ability to think or concentrate
o Indecisiveness
o Suicidal ideation
Depressive Disorder Diagnoses (from the DSM-5):
o Disruptive mood dysregulation disorder
A new disorder in the DSM-5. It is for children and adolescents between
the ages of 6 and 18. It should not be diagnosed before or after these ages.
Onset must be before age 10.
Characterized primarily by chronic, severe persistent irritability that is
manifested either through frequent temper outbursts or persistent irritable
or angry mood that is clearly noticed by others (American Psychiatric
Association, 2013).
This cannot be diagnosed in conjunction with disorders such as ODD,
intermittent explosive disorder, or bipolar disorder. However, it can
coexist with major depressive disorder, ADHD, and/or anxiety disorder
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o Major depressive disorder

At least five depression symptoms are present for most of the day, nearly
every day during at least two consecutive weeks, and represent a
significant change from previous functioning.
A major depressive episode is mostly characterized by either a depressed
mood or a loss of interest in almost all activities.
In children and adolescents, this mood may be irritable rather than
sad.
Causes significant distress or impairment in social, occupational, and other
important areas of the individuals life. (American Psychiatric
Association, 2013).
o Persistent depressive disorder (dysthymia)
Depressed mood with at least 2 of the symptoms for more days than not
for at least 2 years (or 1 year for children and adolescents).
The criteria for a major depressive disorder may be continuously present
for the two years.
o Premenstrual dysphoric disorder
Mood lability, irritability, dysphoria, and anxiety symptoms that occur
repeatedly during the premenstrual cycle, and stop around the onset of
menses.
The core symptoms are related to mood and anxiety, but there may also be
some somatic symptoms.
o Substance/medication-induced depressive disorder
Presence of the symptoms of a depressive disorder that are associated with
the use of a substance.
The symptoms continue beyond the usual length of intoxication or
withdrawal periods.
The symptoms must have started within a month of using the substance.
o Depressive disorder due to another medical condition
Depressive symptoms that are thought to be directly related to the
physiological effects of another medical condition.
o Other specified/unspecified depressive disorder
Situations where the depressive symptoms are present and cause
significant distress or impairment, but do not meet the full criteria of any
of the depressive disorders.
Specifiers for Depressive Disorders (some of these types can indicate a higher
likelihood of the presence of other disorders, or may lead to a change in diagnosis later):
o With anxious distress
o With mixed features
o With melancholic features
o With atypical features
o With mood-congruent psychotic features
o With mood incongruent psychotic features
o With catatonia
o With peripartum onset
o With seasonal pattern
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Identified Problems (Related to RT):

Emotional:
o Difficulty regulating emotions
o Feelings of worthlessness or excessive guilt
Focusing on past failures or mistakes
Placing unnecessary blame on self for things out of ones control
o Loss of interest in activities
Not finding enjoyment in activities that once brought pleasure
Social:
o Social withdrawal or neglect of social roles
o Relationship problems
Cognitive:
o Difficulty thinking clearly or concentrating
o Difficulty making even small decisions
Physical:
o Difficulty maintaining a balanced and healthy lifestyle
Due to loss of energy and fatigue as well as appetite changes
Exercise and eating habits

Related Factors or Etiologies:

Related Factors/Diagnoses:
o Anxiety disorders
Most people with depression show some signs of anxiety.
According to Mental Health America (2016), about 15-30% of people
with depression have panic attacks.
People with anxiety might also try to cope with drugs or alcohol, which
can cause depression.
o Personality disorders
There is often evidence of coexisting personality behaviors, such as
borderline personality disorder, with depressive disorders.
o Substance use disorders
The dual diagnosis of substance use disorders and mood disorders is an
increasingly serious psychiatric problem (Mental Health America, 2016).
o Bipolar disorders
Many bipolar illnesses begin with one or more depressive episodes
many who are initially diagnosed with major depressive disorder are later
found to actually have a bipolar disorder (American Psychiatric
Association, 2013).
o Obsessive Compulsive disorder
o Eating disorders
o Self-harm
o Suicide
The possibility of suicidal behavior exists at all times during major
depressive episodes.
Half of teen suicides are linked to depression, low self-esteem, and
hopelessness (Butterworth, 2016).
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Etiology (possible causes):

o Adverse childhood experiences
o Trauma or abuse
o Stress
Death or loss
Serious illness
Major life events
Conflict with family members or friends
o Sociocultural influences
Low social class/income
Lack of social support
o Seasonal changes
o Negative thinking (neuroticism)
o Genetics
Evidence suggests that some people inherit a biological predisposition for
depression (Butterworth, 2016).
o Substance abuse
o Biological causes
Imbalances in brain chemicals and neurotransmitters
o Essentially all major nonmood disorders increase the risk of an individual
developing depression (American Psychiatric Association, 2003, p. 166).

Process Criteria:
Emotional:
o Emotion regulation
o Self-esteem training
o Coping skills
o Power of positivity
o Leisure education
o Resilience
Social:
o Social skills training
Cognitive:
o Stress management
o Problem solving
o Decision making
o Concentration
o Mindfulness
Physical:
o Healthy living

Outcome Criteria:
Emotional:
o Clients will be able to identify strategies for regulating emotions.
o Clients will demonstrate an understanding of positive thinking.
o Clients will demonstrate strategies to implement positive thinking techniques.
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o Clients will demonstrate reframing as a positive thinking technique.

o Clients will demonstrate the ability to use positive self-talk messages.
o Clients will be able to identify new positive leisure activities that can be used as
coping strategies for depressive symptoms and negative thinking.
Social:
o Clients will identify a positive support system.
o Clients will demonstrate techniques to improve family and peer relationships.
o Clients will identify personal social roles and responsibilities.
Cognitive:
o Clients will identify personal stressors.
o Clients will demonstrate coping skills to manage personal stressors.
o Clients will demonstrate mindfulness techniques.
o Clients will demonstrate concentration strategies.
o Clients will demonstrate decision-making strategies.
Physical:
o Clients will identify an understanding of a healthy and balanced life.
o Clients will determine goals for living a healthy and balanced life.

S. Gordon TRS, CTRS

10/5/2016 (Student)
DIAGNOSTIC PROTOCOL 7

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: American Psychiatric Publishing.

Butterworth, M. (2016). Mood disorders & treatment [PowerPoint slides]. Retrieved from

University of Utah, Abnormal Psychology. Canvas: utah.instructure.com.

John Hopkins Medicine. (n.d.). Overview of Mood Disorders. Retrieved from

http://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/overvi

ew_of_mood_disorders_85,P00759/.

Mental Health America. (2016). Mood Disorders. Retrieved from

http://www.mentalhealthamerica.net/conditions/mood-disorders.