It's no secret that Anxiety conditions and Depression co-occur. In fact, most researchers agree they co-occur at least 60% of the time. They're so interrelated that most antidepressants are also often effective for anxiety; both conditions are highly associated with decreased serotonin. With these facts in mind, it's no surprise that some people, when they experience an MDD episode, there is an onset of some specific anxiety that is congruent to the depression.
Yesterday, we got reacquainted with Major Depressive Disorder (MDD) in general. Today, we will start looking at the subtypes, or specifiers, beginning with Psychotic Features. Estimates vary, but psychotic depression seems to be present in upwards of 20% of MDD patients and bring new challenges to treatment.
Sure, you know Major Depressive Disorder (MDD) when you see it: at least two weeks of depressed mood or anhedonia, yada, yada, yada. But! There are many masks to MDD, each with their own treatment implications. Are you assessing for subtypes/specifiers? MDD is not MDD is not MDD.
The last item we’ll examine in this series, for now, is the precision point of recognizing when something in one disorder evolves to require a concurrent diagnosis. It may seem like splitting hairs, but a particular symptom’s severity in one diagnosis can escalate to the point of needing to be recognized as its own condition.
Unspecified. What an ambiguous term for something as bent on categorization as psychiatric diagnosis! As readers learned in Part 1, there is more than meets the eye to boring-sounding classification categories. While Unspecified and Other may ostensibly appear synonymous, there is quite a distinction in terms of diagnostic application.
May 18, 2013: “Other” and “Unspecified” enter the diagnostic language of mental health professionals. Perhaps the two most boring headings in the DSM-5, they compensate for their austerity with beautiful utility.
It might seem convenient, as discussed in part 1, for a patient to come to us pre-diagnosed. This doesn't give a clinician license, however, to blindly accept the inherited diagnosis.
Edgar Allan Poe suggested that we should believe none of what we hear and only half of what we see. While it is wise to not be gullible or naive, his suggestion seems a little extreme. Perhaps “Believe half of what you hear and most of what you see” is more, well, believable. Afterall, 27. 14% of all facts are made up on the spot (I think), and, especially if you have a forensic background, you know that some of what we witness can be feigned.
In Medical Mimicry, Parts 1 and 2, we began exploring how medical conditions affect mental health and the importance of evaluating for them as symptom sources. This included two of three crucial items to keep in mind when thinking about medical contributions. Today, we examine the third:
In part 1 of Medical Mimicry, readers were reminded about how psychiatric symptoms can be brought on by general medical conditions, requiring physician intervention. Now, in Part 2, let's turn our attention to the evaluation process.
Many people are referred...
Many people are referred...