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Sep

21

Depression and African-American

Posted By: wbhazel1 on September 21, 2011 at 12:37 pm

Depression is one of the most misunderstood, maligned and unreported/over reported diagnoses in the Diagnostic and Statistical Manual Fourth Edition Text Revised (DSM IV-TR). Many have misconceptions of what it is, what it looks like and how it is treated. I have respectfully enclosed the criteria upon which this is diagnosed and attached several very relevant articles from authorities in the field about the need for increased awareness, and action to improve universally community quality of life. The DSM IV-TR describes this diagnosis as follows:

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
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 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.

Recurrent

A. Presence of two or more Major Depressive Episodes.

Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode.
B. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are 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 the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition.
Specify (for current or most recent episode):

Severity/Psychotic/Remission Specifiers
Chronic
With Catatonic Features
With Atypical Features
With Postpartum Onset

Specify

Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern

This is the working definition for nearly all helping professionals responsible for diagnosis, treatment and other care of clients, consumers or patients. It is extremely workable and provides a common language, in fact a snapshot of what we therapist will probably observe when we assess the patient. Is it all inclusive however? Well any time we work clinically (with people) nothing is ever absolute is it? People will surprise you as they often do not display all of the exact characteristics that scientist (or treatment professionals) will come to expect.

Depression in African-Americans

African-Americans often do not display the same criteria in terms of cognitive or mood symptoms instead displaying more neurovegatative and somatic complaints. This is to say they don’t complain of sadness as much as physical aches, pains and maladies. Often depressive symptoms are displayed as anger, irritability and aggression. Treatment historically until current time has been noticeably different and unequal in terms of medications prescribed, therapy vs community supports i.e. church, extended family, friends etc.

http://www.pbs.org/thisemotionallife/blogs/black-and-depressed-two-african-american-women-break-silence

http://www.nytimes.com/2001/08/27/us/disparities-seen-in-mental-care-for-minorities.html?pagewanted=print&src=pm

http://thefreshxpress.com/2010/05/trouble-man-black-men-depression-and-suicide/

Ialongo Koenig Suicide

    Filed Under: Abuse , Anger , Anger Management , Anxiety / Stress , Anxiety Therapy , Bereavement-Grief , Depression , Depression Therapy , Difficult Emotions , Family Treatment , Group Treatment , Identity Issues , Individual Treatment , Insomnia Therapy , Low Self Esteem , Marriage & Relationship , Marriage and Family Therapist , Mood Fluctuation , Panic Attack Therapy , Parenting , Pre-Marital Counseling , Psychiatry , Psychology , PTSD / Trauma , Relationship Problems , Social Phobia Treatment , Social Work , Trust Issues , Unresolved Childhood Issues , Violence , Work Related Issues
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