AETC-NMC
   

Introduction

For a brief overview of the characteristics of a mental disorder, as set forth in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 2000), please see the Introduction to this curriculum. This module will discuss the mental disorders that African Americans experience most often:

  • Depression
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder
  • Panic disorder
  • Schizophrenia
  • Schizoaffective disorder

Depression

Major Depressive Disorder vs Normal Sadness

Major depressive disorder differs significantly from normal sadness or grief, which typically are less pervasive and last for a shorter time. In addition, some symptoms of severe depression—eg, anhedonia, hopelessness, loss of mood reactivity—seldom are features of normal sadness or grief. However, many other depressive symptoms can also appear during periods of stress or bereavement, including sleep disturbances, appetite changes, reduced concentration, and feelings of sadness. A skilled diagnostician will be able to differentiate the characteristics of normal sadness or grief from those of clinical depression (DSM-IV).

Symptoms and Diagnosis

An individual with major depressive disorder will experience at least one major depressive episode, lasting at least 2 weeks (DSM-IV). The central symptoms of major depressive disorder are depressed mood and anhedonia (loss of interest or pleasure). Other symptoms can vary widely, depending on an individual’s diagnostic subtype and may include sleep disturbances, weight change, or anxiety.

The DSM-IV criteria for diagnosis of major depressive disorder are:

  • The presence of at least 5 of the following symptoms during the same 2-week period when they represent a change from previous functioning, with one of the symptoms being either depressed mood or loss of interest or pleasure:
    • Depressed mood (eg, feeling sad or empty) most of the day, nearly every day, either reported by the patient or observed by others
    • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day, either reported by the patient or observed by others
    • Significant weight loss when not dieting or weight gain (change of > 5% of body weight in a month) or decrease or increase in appetite nearly every day
    • Insomnia or hypersomnia nearly every day
    • Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings or restlessness or being slowed down)
    • Fatigue or loss of energy nearly every day
    • Feelings of worthlessness or excessive or inappropriate guilt nearly every day (not merely self-reproach or guilt about being sick)
    • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either self-reported or observed by others)
    • 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
  • Moreover, these symptoms should not meet the criteria for a mixed episode, which are:
    • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • The symptoms are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, hypothyroidism).
    • The symptoms are not better accounted for by bereavement; the symptoms persist for > 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Dysthymia

Dysthymia is a chronic form of depression, distinguished from major depressive disorder by onset relatively early in life and it's unrelenting, or “smoldering,” course. Dysthymia affects approximately 2% of adults in a given year and is characterized by at least two of the persistent symptoms required to diagnose a major depressive episode and by duration of at least 2 years. People with dysthymia also are susceptible to development of major depression (DSM-IV, 2000).

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Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center