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!!! Allgemein zu D. in Elderly
Oft unerkannt und die Symptome als sommatische Krankheiten gesehen.
Incidence of MDD declines with age, but MINOR D. is much more common
15-20% have D. Symptoms without meeting the criteria for D.
Fewer than half of depressed seniors are recognized as being depressed!
Mood congruent vs. Mood incongruent psychotic features
Diagnose und differential Diagnose of late-life mood Disorders
•Bipolar and related disorders
•Major depressive disorder
•Major Depressive Disorder with Mood congruent or Mood incongruent psychotic features
•Persistent Depressive Disorder (Dysthymia)
•Depressive Episode with insufficient symptoms (minor or subsyndromal Depression)
•Depression Disorder Due to another medical condition
•Adjustment disorder with depressed mood
Differential Diagnoses: Bipolar and related disorders:
•To meet criteria for a MANIC episode, an individual must exhibit three or more of the following symptoms:
1)Inflated self-esteem / grandiosity
2)Decreased need for sleep
4)Fight of ideas
6)Increased goal-directed activity or psychomotor agitation
7)Excessive involvement in pleasurable activities with potential adverse consequences (e.g. unrestricted buying episodes)
•Bipolar disorder varies with aging:
•Post (1978) found that most elderly individuals with bipolar disorder exhibited a depressive mixture with manic symptomatology
•Spar (1979) reported that manic elderly individuals are atypical in presentation, with dysphoric mood and denial of classic manic symptoms
•Shulman (1986) described the special problem of manic delirium. Manic episodes must be distinguished (but often with difficulty from neuro- cognitive disorders such as delirium characterized by hallucinations, delusion, agitation.
•Late onset psychotic depression:
•(Smith et al. 2011): Depressed patients with illness onset at age 60 or later had delusions more frequently than did those with earlier onset
•Smith et al. 2011: Individuals with delusional depression tended to be older and respond to Electroconvulsive therapy (ECT), as opposed to tricyclic anti- depressants
•Delusions of persecution or of having an incurable illness are more common than delusions with guilt. If guilt predominates in the delusional picture, it usually involves a relatively trivial episode that occurred many years before the onset of the depressive episode and was forgotten over time, but is currently viewed as a major problem (Bridges, 1986)
•Depressive Episode with insufficient symptoms (minor or subsyndromal depression)
!!! –> IN DSM-V: Is coded “other specified depressive disorder”
•This diagnosis can be assigned when an individual who has never met criteria for a mood disorder, experiences depressed affect and at least one other symptom of a major depressive episode that persist for at least 2 weeks
•Associations with impaired physical functioning, disability, poorer self-rated health low social support, female gender and unmarried status (Beckman et al. 1995)
•Depressive Disorder Due to another medical condition
•Depressive disorders have been associated with a variety of physical illnesses including cardiovascular disease, endocrine disturbances, Parkinsons disease, stroke, cancer etc.
•Controversy continues over the degree to which acute or chronic medical illnesses cause depression because of direct physiological effects on the brain or because of a psychological reaction to the disability and other life changes evoked by these illnesses.
•To meet criteria for “due to another medical condition” there must be evidence that the mood disturbance is a direct pathophysiological consequence of another medical condition.
•Otherwise a diagnosis of adjustment disorder with depressed mood