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Diagnosing MDD

Diagnosing Major Depressive Disorder

Although there will be no question asking you to describe the symptoms of Major Depressive Disorder, it is important that you understand the nature of the disorder before we get into the etiologies or potential explanations for the disorder. You should know the affective, behavioural, cognitive, and physiological (somatic) symptoms of the disorder as well as the difficulties in obtaining a valid diagnosis.

Key concepts

  • Affective symptoms: symptoms linked to emotional health
  • Anhedonia - the inability to experience pleasure
  • Avolition - a lack of motivation or ability to carry out daily tasks
  • Comorbidity - when a person has more than one psychological disorder at the same time - e.g. anxiety and depression.
  • Dysthymia - depressed mood most of the time for at least two years, along with at least two of the following symptoms: poor appetite or overeating; insomnia or excessive sleep; low energy or fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness
  • Somatic symptoms: physical symptoms

MDD and the DSM 5

Read through the following presentation.  At the end of the presentation, you should be able to explain the key symptoms of Major Depressive Disorder and why it is often difficult to diagnose.

Living with clinical depression

The following two videos look at the effects of having depression.  After watching the videos, what are the effects of the disorder on the individual?  On others around them?

Checking for understanding

Comorbidity occurs when:

Comorbidity is one of the factors that makes diagnosing MDD difficult; many people with depression may suffer from anxiety, OCD, or eating disorders.

 

Which of the following is not a symptom of Major Depressive Disorder according to the DSM 5?

Although MDD may lead to a person not being able to keep a job or maintain relationships, it is not an effect, not a symptom of depression.

 

Which of the following statements is not true about the prevalence of depression?

While major depressive disorder can develop at any age, the median age at onset is 32.5 years old.

 

When diagnosing MDD, which two factors are the most important to consider when assessing the symptoms?

Although all of the responses may be part of a clinical interview, the two most important factors in diagnosis is how severe the symptoms are (intensity) and how long they have lasted (duration). 

 

In a study of people suffering from MDD, the researchers used a questionnaire to obtain self-reported data about their level of fatigue.  What is the most likely problem with this study?

Remember, construct validity is about how we operationalize and measure a variable.  Asking people to discuss their level of fatigue by asking them to fill in a questionnaire means that it will be difficult to say that when participant one says that his level of fatigue is an "8" out of 10, that is actually the same as someone else who fills in the questionnaire with the same response.

 

Which of the following is not a symptom of Major Depressive Disorder?

Although grief is associated with sadness, it is not a symptom of Major Depressive Disorder. Although bereavement-related grief and major depression share some features, they are distinct and distinguishable conditions.  However, an individual may develop depression after the loss of a loved one.  This is why it is important that the other criteria for diagnosis are followed to avoid giving medication, for example, to someone who is just going through the normal grieving process.

 

Which of the following is not true about diagnosing MDD?

Although there is some evidence that depression may have an effect on the hippocampus, this is not part of the diagnostic process.

 

Which of the following statements is true with regard to cultural differences in MDD according to Parker et al (2001)?

It is most likely due to the collectivistic nature of Chinese culture that they are less likely to focus on their own emotions when interacting with a psychiatrist than Australians, who have an individualistic culture.

 

Dysthymia is characterized by

Persistent depressive disorder, also called dysthymia (dis-THIE-me-uh), is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years.

 

Which of the following would be an indicator of avolition?

Avolition is a decrease in the motivation to initiate and perform self-directed purposeful activities.  The most common form is to pull out of social activities.  The student who cries every morning may be experiencing anxiety; there may be many reasons that an athlete drops off of the football team.  Although this could be an example of avolition, the social friend who has withdrawn from all social activity is the most likely case.  As for a friend who does not enjoy going to parties - if this is not a change in behaviour, it is not a problem.

 

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