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Supporting Students withMental Health Conditionsin Job CorpsDepression and Bipolar Disorders Presenter Information.
Vicki Boyd PhD Region 6 San Francisco Mental Health Specialist Learning Objectives After this presentation participants will be able to articulate applicable changes to titles and diagnostic criteria for depression.
and bipoloar disorders based on DSM 5 recognize how clinical presentations for depression and bipolar disordersmay vary for adolescents and young adults identify at least one evidence based intervention for depression and bipolar Diagnostic and.
Statistical Manual DSM 5 OverviewDepressive and Bipolar Disorders Depressive Disorder in DSM 5 Disruptive Mood Dysregulation Disorder.
Major Depressive Disorder Persistent Depressive Disorder Premenstrual Dysphoric Disorder Substance Medication Induced Depressive Disorder Depressive Disorder due to Another Medical Condition.
Other specified depressive disorder Unspecified depressive disorder DSM 5 Changes To address concerns about potential overdiagnosis and overtreatmentof bipolar disorder in children a new diagnosis disruptive mood.
dysregulation disorder is included for children up to age 18 years whoexhibit persistent irritability and frequent episodes of extremebehavioral dyscontrol Premenstrual dysphoric disorder has been moved from DSM IVAppendix B Criteria Sets and Axes Provided for Further Study to the.
main body of DSM 5 Conceptualizes chronic forms of depression in a somewhat modified Major Depressive Disorder The core criterion symptoms applied to the diagnosis of majordepressive episodes has not changed from DSM IV.
The coexistence within a major depressive episode of at least threemanic symptoms is now acknowledged by the specifier with mixedfeatures Bereavement Exclusion In DSM IV there was an exclusion criterion for a major depressive episode that.
was applied to depressive symptoms lasting less than 2 months following thedeath of a loved one i e the bereavement exclusion Omitted for several reasons Bereavement commonly lasts 1 2 years Bereavement is recognized as a severe psychosocial stressor that can precipitate a major.
depressive episode in a vulnerable individual generally beginning soon after the loss Bereavement related major depression is most likely to occur in individuals with pastpersonal and family histories of major depressive episodes The depressive symptoms associated with bereavement related depression respond tothe same psychosocial and medication treatments as non bereavement related.
depression Specifiers Suicide Risk DSM V provides guidance on assessment of suicidal thinking plans and the presence of other risk factors in order to make adetermination of the prominence of suicide prevention in treatment planning.
for a given individual Mixed Symptoms Added across both the bipolar and the depressivedisorders allowing for the possibility of manic features in individuals with adiagnosis of unipolar depression With Anxious Distress Gives the clinician an opportunity to rate the severity.
of anxious distress in all individuals with bipolar or depressive disorders Differentiating BetweenDepressive Disorders Disruptive Mood Dysregulation Disorder Substance Medication Induced Depressivechronic severe persistent irritability Disorder Symptoms of major depressive.
disorder associated with ingestion of a substance Major Depressive Disorder Symptoms Depressive Disorder due to Another Medicalincluding depressed mood diminishedCondition Period of depressed mood that.
interest or pleasure etc present nearly predominates in the clinical picture directevery day during a 2 week period pathophysiological consequence of another Persistent Depressive Disorder Depressed medical conditionmood that last for at least 2 years in adults Other specified depressive disorder Symptomsor 1 year in children adolescents are characteristic of a depressive disorder but do.
Premenstrual Dysphoric Disorder not fully meet criteriaIrritability dysphoria and anxiety Unspecified depressive disorder Same as above symptoms that occur repeatedly during the Used when clinician chooses not to specifypremenstrual phase of the cycle reason criteria is not met Bipolar and Related Disorders.
Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Substance Medication Induced Bipolar and Related Disorders Bipolar and Related Disorder Due to Another Medical Condition.
Other Specified Bipolar and Related Disorder Unspecified Bipolar and Related Disorders DSM 5 Changes Criterion A for manic and hypomanic episodes now includes anemphasis on changes in activity and energy a well as mood .
Importance of behavioral observations It is no longer necessary to use DSM IV diagnosis of mixed episodebut rather use the specifier with mixed features from DSM 5 tomore accurately support the diagnosis Other Specified Bipolar and.
Related Disorders DSM 5 allows the specification of a specified bipolar condition forindividuals with a documented past history of major depressivedisorder if hypomania is present A second condition constituting an other specified bipolar disorder is.
that too few symptoms of hypomania are present but do last formore than four days Anxious Distress Specifier In the chapter on bipolar and related disorders and the chapter ondepressive disorders a specifier for anxious distress is delineated .
This specifier is intended to identify patients with anxiety symptomsthat are not part of the bipolar diagnostic criteria Differentiating Between Bipolar Bipolar I Disorder Criteria must be met for at Bipolar and Related Disorder Due toleast one manic episode and depressive episode.
Another Medical Condition Bipolar II Disorder One or more major Symptoms of bipolar associated withdepressive episodes and at least one episode ofhypomania with possible periods of level mood another medical conditionbetween episodes Other Specified Bipolar and Related.
Cyclothymic Disorder Chronic fluctuating mood Disorder Symptoms of bipolar do notdisturbance involving numerous periods ofhypomanic symptoms and periods of depressive meet full criteria for any other disordersymptoms Unspecified Bipolar and Related Substance Medication Induced Bipolar and Disorders Same as above Used when.
Related Disorders Symptoms of bipolarassociated with substance intoxication orclinician chooses not to specify reasonwithdrawal criteria is not met Disruptive Mood Dysregulation.
Because of the newness of this diagnostic category there are fewstudies available for the Job Corps age group It is wise to considerthis for JC students in spite of its newness Multiple studies exist on children ranging in age from 8 to 16 with thecautionary note to avoid diagnosing children with bipolar disorder .
This diagnosis is not given to adolescents over 18 therefore thefollowing example is reflective of minor students in Job Corps Scenario for Disruptive MoodDysregulation Disorder Seventeen year old female is referred from academics because of unruliness in.
the classroom disrespectful language towards to staff verbal rants socialdifficulties with peers no one wants to room with her unstable datingrelationships and generalized lack of responsibility for her own actions In orderto pursue the above diagnosis the following must be ruled out a ADHD.
b Substance abuse c Other medical conditions IACAPAP e textbook of Child and Adolescent Mental Health Geneva InternationalAssociation for Child and Adolescent Psychiatry and Allied Professions 2012 Major Depressive Disorder.
Definition A period of two weeks or longer during which there iseither depressed mood or loss of interest or pleasure and at leastfour other symptoms that reflect a change in functioning such asproblems with sleep eating energy concentration and self image While there are not precise statistics covering Job Corps 16 to 24 age.
group NIMH www nimh gov suggests that major depressivedisorders are common among these groups roughly 12 to 18 Major Depressive DisorderStatistics An estimated 15 to 18 of Job Corps students seeking mental health assistance will present.
with depression symptoms based on the prevalence in the general population Because Job Corps is a work training program it is of interest to note that an estimated cost ofjob productivity and related health care issues due to depression is approximately 80 trillion 50 of the general population with major depression do not seek treatment Since JC is aresidential program the likelihood of early detection and diagnosis is probably much lower for.
JC students Suicide death statistics vary depending upon the age group and occupation group e g veterans The national rate in 2014 for suicide death in age group 15 24 was 11 5 per 100 000 overall rate in general population was 13 4 per 100 000 Most important the Job Corps ratewas 2 0 per 100 000 .
Treatment Considerations forDepression Most treatments will include collaboration with the utilization of medical andmedication interventions Separate slide Psychosocial Non Pharmacologic... interventions include psycho education .
cognitive behavior therapies and group supports Center wide educational presentations are excellent venues for staff andstudents to participate in early detection and peer support Early detection of psychosocial stressors through the use of the SIF can aid staffin assessing stressors and risks .
Supportive mood elevating activities can be achieved by collaborating with JobCorps own recreation department its music programs and HEALs programs Additional TreatmentConsiderations Job Corps provides a variety of group programs through its Counseling.
department These groups are frequently provided in collaboration with acenter mental health consultant Utilization of programs outside of the Job Corps center are typicallydetermined by the availability in each geographical area For example urbancenters may have access to support programs that are free or of low cost .
Rural centers may rely on their county mental health programs in their areas Utilization of Self Help programs HelpGuide org Utilization of Job Corps own Youth 2 Youth Program www JobCorps Y2Y com Pharmacological Treatments Antidepressants .
Most if not all major depressive disorders will require some form of medicationsupport in order to achieve success in treatment It is important to assist students in obtaining an adequate medication evaluation andfor you to maintain support especially through the initial portion of medicationtreatment Remember the PRH requires that the center MD nursing staff and CMHC.
must collaborate on monitoring students on psychotropic medications Some centersuse a group format to monitor students As a non prescriber CHMC it is strongly encouraged to establish a relationship withthe student s medication provider so that you may coordinate treatment for optimal Pharmacological treatments will be covered in other webinars .
Major Depression Scenario A twenty year old female refers herself to the CMHC because she isnot eating and sleeping well has recognized a definite change forthe worse in her overall mood and lack of energy She reports thatthe feelings are only getting worse and that she has felt this way for.
nearly a month Her thoughts are dark and of wishing she weredead She has withdrawn from her family and friends and can barelyfunction at her trade which she loves Her increased thoughts ofsuicide initiated her self referral Her dorm mates were also Working with a Student with.
Depression Take a thorough history to rule out Extenuating circumstances such as a recent loss Dampened mood because of recent social debacle Substance abuse and its consequences consult with TEAP .
Consult with center MD regarding medication trials Establish a collaborative treatment plan for the student Bipolar I and Bipolar II Bipolar I The Individual has experienced one or more episodes ofmania Most will have depression as well but not all Episode must.
last at least 7 days and present most of each day nearly every day orcan be any duration if hospitalization is necessary Bipolar II A subset of bipolar I during which individuals experiencedepressive episodes shifting back and forth with hypomanicepisodes but never a full manic episode more likely to be observed.
in the JC population than bipolar I Teens and Young Adults withBipolar Disorder Less than 5 of children and young adults experience bipolar disorderbut its symptoms include an ongoing combination of highs and lows that.
The coexistence within a major depressive episode of at least three manic symptoms is now acknowledged by the specifier “with mixed features.” Bereavement Exclusion In DSM-IV, there was an exclusion criterion for a major depressive episode that was applied to depressive symptoms lasting less than 2 months following the death of a loved one ...

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