-Depression-

Morshed Mahamid

1.12.2020
When we hear the term depression, several
unanswered questions come to mind...

• Normal and abnormal?

• What is depression?
• Prevalence?
• symptoms?
• Causes?
• Risk factors?
• Types of depression?
• Diagnosis?
• Scales tools?
• Theories?
• Treatment?
https://youtu.be/z-IR48Mb3W0
Sadness and depression… What is the
difference?
A serious psychological problem that causes a constant
feeling of sadness and loss of interest in activities
accompanied by low self-esteem, loss of pleasure or
slackness. It affects the way of thinking, feelings and
behavior, and it can cause emotional, functional and
physical problems (anger, drug use, talking about death or
suicide). Although depression can occur at any age, the
symptoms may differ between children, adolescents and
adults.
Prevalence:

Arab current
society
countries year
• 10-12% Minimum. • In the past three
• children 1 - 2%. years, the
percentage has
40%
• teenagers 5 - 8%.
increased by 20%. • China 52%.
• Males are more
than females • Japan38%
before adultness, • Iraq (43%).
but then the • Tunisia (40%).
• Pakistan 42%.
females be more
• Palestine (37%).
after adultness.
• Jordan (34%)
• Lebanon (30%).
Does the child suffer from changes at
the following levels?
 Mood
 Appearance and movement
 Sleeping
 Eating
 Activity
 Thinking
 Physical
 Sexual
 Mental Capacities
 Autistic symptoms
Symptoms:

✓Sadness and lethargy.

✓Lack of attention and resentment.
✓Nervousness and tension.
✓Confusion.
✓The guilt complex and self-harm.
✓Weakness and vulnerability.
✓Isolation.
✓Changes in weight or eating habits.
✓Sleep disturbances
✓Withdrawal .
✓Adolescent suicidal ideation.
 What is the reason? causes and factors..

Genetic and biological Environmental factors Risk factors

factors
• brain chemistry • parents’ divorce • Addiction to alcohol,
• Hormones • excessive stress nicotine, or other drugs.
• chronic diseases, such as • abuse or neglect • Constant pain or chronic
diabetes • Trauma physical diseases.
• other psychiatric • loss of a parent, • personality traits.
disorders caregiver or other loved • Problems and accidents.
• other developmental, one • Family.
learning or conduct • loss of a relationship, • mental disorders.
disorders such as moving away or
• family history of loss of
depression boyfriend/girlfriend
• Side effects of some • failure to accomplish
medications tasks such as learning to
read, or keeping up with
peers in other activities.
• School stress.

Note: In adolescents, peer pressure, academic expectations, physical changes,

and the inability to be independent may cause many mood swings in them.
Types of depression:

According - Disruptive Mood Dysregulation Disorder 296.99 (F34.8).

to DSM5:
- Major Depressive Disorder.

- Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1).

- Premenstrual Dysphoric Disorder 625.4 (N94.3).

- Substance/Medication-Induced Depressive Disorder.

- Depressive Disorder -Due to Another Medical Condition.

- Other Specified Depressive Disorder 311 (F32.8).

- Unspecified Depressive Disorder 311 (F32.9).

 1- Disruptive Mood Dysregulation
Disorder 296.99 (F34.8).
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or
Diagnostic behaviorally (e.g., physical aggression toward people or property) that are grossly out of
proportion in intensity or duration to the situation or provocation.
Criteria:
B. The temper outbursts are inconsistent with developmental
level.

C. The temper outbursts occur, on average, three or more times

per week.

2.5- D. The mood between temper outbursts is persistently irritable or

5%
angry most of the day,nearly every day, and is observable by
others (e.g., parents, teachers, peers).
 E. Criteria A–D have been present for 12 or more months. Throughout that time,
the individual has not had a period lasting 3 or more consecutive months
without all of the symptoms in Criteria A–D.
F. Criteria A and D are present in at least two of three settings (i.e., at home, at
school, with peers) and are severe in at least one of these.

G. The diagnosis should not be made for the first time before age 6 years or
after age 18 years.

H. By history or observation, the age at onset of Criteria A–E is before 10 years.

I. There has never been a distinct period lasting more than 1 day during which
the full symptom criteria, except duration, for a manic or hypomanic episode
have been met.

Note (I): Developmentally appropriate mood elevation, such as occurs in the context of a highly positive
event or its anticipation, should not be considered as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively during an episode of major depressive
disorder and are not better explained by another mental disorder (e.g., autism
spectrum disorder, posttraumatic stress disorder, separation anxiety disorder,
persistent depressive
disorder [dysthymia]).

Note (J): This diagnosis cannot coexist with OD, intermittent explosive disorder,
or bipolar disorder, although it can coexist with others, including the primary
disorder. Depressive disorder, attention deficit / hyperactivity disorder, conduct
disorder, and Substance use disorders.

K. The symptoms are not attributable to the physiological effects of a substance

or to another medical or neurological condition.
 2- Major Depressive Disorder
Diagnostic A. Five (or more from 9) of the following symptoms have been present during the same 2-
week period and represent a change from previous functioning; at least one of the

Criteria: symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note (A): Do not include symptoms that are clearly attributable to another
medical condition.

B. The symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another

7%
medical condition.
Note : Criteria A–C represent a major depressive episode.

D. The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and
unspecified schizophrenia spectrum and other psychotic disorders

E. There has never been a manic episode or a hypomanic episode.

Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are
substance-induced or are attributable to the physiological effects of another medical
condition.

Note!!
 3- Persistent Depressive Disorder
(Dysthymia) 300.4 (F34.1).
Diagnostic A. Depressed mood for most of the day, for more days than not, as indicated by
either subjective account or observation by others, for at least 2 years. Note: In
Criteria: children and adolescents, mood can be irritable and duration must be at least 1 year.

B. Presence, while depressed, of two (or more) of the following:

C. During the 2-year period (1 year for children or adolescents) of the disturbance, the
individual has never been without the symptoms in Criteria A and B for more than 2
months at a time.

D. Criteria for a major depressive disorder may be continuously present for 2 years.

%0.5 E. There has never been a manic episode or a hypomanic episode, and criteria have
never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.

G. The symptoms are not attributable to the physiological effects of a

substance (e.g., a drug of abuse, a medication) or another medical condition
(e.g. hypothyroidism).

H. The symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning.

Note…

Specify if…
Scale Tool:
 Treatment

Guidance for
Psychotherapy Pharmacologic
family members
therapy
and school staff

Complications protection
Any questions