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296.2x
Major Depressive Disorder, Single Episode

Updated June 14, 2010

Major Depressive Disorder, Single Episode

A. Presence of a single Major Depressive Episode

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.

Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

If the full criteria are currently met for a Major Depressive Episode, specify its current clinical status and/or features:

Mild, Moderate, Severe Without Psychotic Features/With Psychotic Features

Criteria for Severity .x3 Severe without Psychotic Features: Several symptoms in excess of those required to make the diagnosis, and symptoms markedly interfere with occupational functioning or with usual social activities or relationships with others. 

Criteria for Severity .x4 With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent.

Mood-Congruent Psychotic Features: The content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism or deserved punishment.

Mood-Incongruent Psychotic Features: Delusions or hallucinations whose content does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism or deserved punishment are present with or without mood-congruent psychotic features.

Chronic (The group is proposing the elimination of this specifier. Please see the criteria for Chronic Depressive Disorder, formerly DSM-IV Dysthymia)

With Catatonic Features

With Melancholic Features

With Atypical Features

With Postpartum Onset (can be applied to the current or most recent Major Depressive, Manic, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder, or Bipolar II Disorder; or to Brief Psychotic Disorder). Onset of episode within 6 months postpartum. (Read more here.)

If the full criteria are not currently met for a Major Depressive Episode, specify the current clinical status of the Major Depressive Disorder or features of the most recent episode:

With Mixed Features

In Partial Remission, In Full Remission With Catatonic Features

With Melancholic Features

With Atypical Features

 

Rationale for Major Depressive Episode, Single Episode:

1. For removal of "Severe" in "With Psychotic Features": Separate severity rating from subtyping for presence or absence of psychotic features. MDD with psychotic features is not severe in all cases

Maj M, Pirozzi R, Magliano L, Fiorillo A, Bartoli L. Phenomenology and prognostic significance of delusions in major depressive disorder: a 10-year prospective follow-up study. Journal of Clinical Psychiatry 68: 1411-1417, 2007.

2. For mood-congruent and mood-incongruent change: A hierarchy giving precedence to mood-incongruent features is being introduced to allow classification of cases in which mood-congruent and mood-incongruent psychotic features co-exist.

For Postpartum Specifier: The window for the postpartum onset specifier is being extended because studies conducted subsequent to DSM-IV have shown that the period of elevated risk following delivery extends to 6 months in unipolar depression.

3. Forty, L., Jones, L., Macgregor S., Caesar, S., Cooper, C., Hough A., Dean, L., Dave, S., Farmer, A., McGuffin, P., Brewster, S., Craddock, N., Jones, I.,: Familiality of postpartum depression in unipolar disorder: results of a family study.  American Journal of Psychiatry,163(9):1549-53, 2006

 

 

The Work Group is proposing several options for severity:

-PHQ-9 (see also PHQ-9 scoring)

-CGI

Severity of Illness Rating (applied to previous week)

 Considering your total clinical experience with this particular population, how mentally ill

is the patient at this time?

0 = Not Assessed

1 = Normal, not at all ill

2 = Borderline mentally ill

3 = Mildly ill

4 = Moderately ill

5 = Markedly ill

6 = Severely ill

7 = Among the most extremely ill patients

 

 

 

 

Major Depressive Disorder, Single Episode

A. Presence of a single Major Depressive Episode

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.

Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

If the full criteria are currently met for a Major Depressive Episode, specify its current clinical status and/or features:

Mild, Moderate, Severe Without Psychotic Features/Severe With Psychotic Features

Chronic

With Catatonic Features

With Melancholic Features

With Atypical Features

With Postpartum Onset

If the full criteria are not currently met for a Major Depressive Episode, specify the current clinical status of the Major Depressive Disorder or features of the most recent episode:

In Partial Remission, In Full Remission

Chronic

With Catatonic Features

With Melancholic Features

With Atypical Features

With Postpartum Onset

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