DSM-5 contains several new depressive disorders, including dysphoric mood dysregulation disorder and premenstrual dysphoric disorder. To address concerns about potential over-diagnosis and overtreatment of bipolar disorder in children, disruptive mood dysregulation disorder, is included for children up to age 12 years who exhibit persistent irritability and frequent episodes of extreme behavioral dyscontrol. What was referred to as dysthymia in DSM-IV now falls under the category of persistent depressive disorder, which includes both persistent major depression and what was previously labeled dysthymia.
In DSM-IV there was an exclusion criterion for a major depressive episode that was applied to depressive symptoms lasting less than two months following the death of a loved one (i.e., the bereavement exclusion). This exclusion is omitted in DSM-5 and reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode in a vulnerable individual, generally beginning soon after the loss.
Finally, the clinician is asked to inquire about suicidal thinking and plans and to rate the severity of suicide risk in order to make an explicit determination of the proportion of treatment planning that should be devoted to prevention of suicide in a given patient.
These questions are from DSM-5 Self-Exam Questions: Test Questions for the Diagnostic Criteria, which may be preordered at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62467 from American Psychiatric Publishing. The answers and rationales are posted at http://www.psychnews.org/pdfs/DSM-5_Self_Examination_QandA_6.pdf. The questions were developed under the leadership of Philip Muskin, M.D., a professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. The book, available in August, contains 500 questions for all the categories of psychiatric disorders and includes Section III.
1. If a patient does not have depressed mood, which of the following symptoms is required to diagnose a major depressive episode?
a) suicidal ideation
b) guilt or worthlessness
e) weight loss.
2. A 6-year-old girl presenting with a chronic negative mood and frequent and severe verbal and behavioral outbursts to common stressors is most likely to go on to develop which disorder in adulthood?
a) bipolar I disorder
b) bipolar II disorder
c) schizoaffective disorder
d) generalized anxiety disorder
e) major depressive disorder.
3. What is the most consistently described risk factor for suicidal behavior?
a) history of suicide attempt(s)
b) female sex
c) family history of suicide
d) presence of a major depressive episode
e) active substance use. ■