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COSIG CONFERENCE BROCHURE.pdf - Drexel University College ... COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006 Expression of Mood Disorders According to CFP Hypothesis • Major genetic vulnerability with or without ‘abnormal’ major environmental stress • Predisposing parameters in the absence of genetic or biological vulnerability • Severe traumatic event with minimal vulnerability SEE STRESS DIATHESIS MODEL STRESS-DIATHESIS MODEL Psychobiological vulnerability Protective factors Social support Skill building Transitional programs Medication Socioenvironmental stressors Impairments Dysfunction Disabilities Disability Good Rehabilitation Outcomes Poor (Adapted from Anthony, W.A. & Liberman, R.P., 1994) Major Depressive Episode (DSM-IV): Criterion A • Essential Feature: –A period of at least 2 weeks during which there is either depressed mood or the lost of interest or pleasure in nearly all activities DSM-IV Criteria for Major Depressive Episode: Criterion A •4 or more of: –Appetite changes (usually weight loss) –Insomnia or hypersomnia –Motor agitation or retardation –Fatigue/loss of energy DSM-IV Major Depressive Episode: Criterion A (Cont’d) –Feelings of worthlessness or excessive guilt –Diminished ability to think or concentrate or indecisiveness –Recurrent thoughts of death or suicidal ideation without a plan, or a suicide attempt or a specific plan for committing suicide Physical Symptoms in Depression That Can also be Due to SUDs • Tiredness, fatigue • Sleep disturbance • Headaches • Psychomotor retardation/agitation • GI disturbances • Appetite changes • Body aches and pains 4

COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006 DSM-IV Criterion B & C B. The symptoms do not meet criteria for a Mixed Episode C. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning Differential Diagnosis: DSM-IV Criteria D & E • D- Symptoms not due to direct effects of a substance (drug of abuse, a medication) • Substance –Induced Mood Disorder – or a general medical condition • Mood Disorder Due to a General Medical Condition • E- symptoms not better accounted for by bereavement Rule Out Medications/Drugs That Can Cause Depression • Sedative-hypnotic agents • Antidepressive meds (may worsen depression; increase suicidal ideation/beh. especially in children, adolescents) • Anti-inflammatory agents and analgesics • Steroids/ Hormones • Antihypertensives/Cardiovascular agents • Others, e.g.interpheron Clinical Interview • Start with chief complaint • Explore past history • Explore current symptoms – Look for critical criteria for depression and/or mania • Assess risk of suicide • Assess need for immediate hospitalization Suicidality: Key Points to Assess (CME,Inc.,2003) • Depressed mood, regardless of diagnosis • Hopelessness – Beck Hopelessness Scale • Changes in social supports, finances or health • Family hx or recent exposure to events • Presence of alcohol and/or drug use • Changes in substance abuse Suicidality (Cont’d) – History and seriousness of previous attempts – Presence of suicidal or homicidal ideation, intent, or plans – Access to means for suicide and the lethality of those means – Presence of psychotic symptoms, command hallucinations, or severe anxiety (could be related to drug intoxication or withdrawal) 5

<strong>COSIG</strong> Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006<br />

DSM-IV Criterion B & C<br />

B. The symptoms do not meet criteria<br />

for a Mixed Episode<br />

C. Symptoms cause clinically<br />

significant distress or impairment in<br />

social, occupational, or other<br />

important areas of functioning<br />

Differential Diagnosis: DSM-IV<br />

Criteria D & E<br />

• D- Symptoms not due to direct effects<br />

of a substance (drug of abuse, a<br />

medication)<br />

• Substance –Induced Mood Disorder<br />

– or a general medical condition<br />

• Mood Disorder Due to a General<br />

Medical Condition<br />

• E- symptoms not better accounted for<br />

by bereavement<br />

Rule Out Medications/Drugs That<br />

Can Cause Depression<br />

• Sedative-hypnotic agents<br />

• Antidepressive meds (may worsen<br />

depression; increase suicidal ideation/beh.<br />

especially in children, adolescents)<br />

• Anti-inflammatory agents and analgesics<br />

• Steroids/ Hormones<br />

• Antihypertensives/Cardiovascular agents<br />

• Others, e.g.interpheron<br />

Clinical Interview<br />

• Start with chief complaint<br />

• Explore past history<br />

• Explore current symptoms<br />

– Look for critical criteria for depression<br />

and/or mania<br />

• Assess risk of suicide<br />

• Assess need for immediate<br />

hospitalization<br />

Suicidality: Key Points to Assess<br />

(CME,Inc.,2003)<br />

• Depressed mood, regardless of diagnosis<br />

• Hopelessness<br />

– Beck Hopelessness Scale<br />

• Changes in social supports, finances or<br />

health<br />

• Family hx or recent exposure to events<br />

• Presence of alcohol and/or drug use<br />

• Changes in substance abuse<br />

Suicidality (Cont’d)<br />

– History and seriousness of previous<br />

attempts<br />

– Presence of suicidal or homicidal ideation,<br />

intent, or plans<br />

– Access to means for suicide and the<br />

lethality of those means<br />

– Presence of psychotic symptoms, command<br />

hallucinations, or severe anxiety (could be<br />

related to drug intoxication or withdrawal)<br />

5

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