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Dépression : Évaluation et diagnostic

 

Notions essentielles

 

  • L'évaluation juge que la dépression est légère, modérée ou sévère selon la gravité et l'incidence des symptômes et le degré de déficience fonctionnelle ou d'invalidité qui en résulte. Cette évaluation détermine le niveau de traitement à administrer.
  • Les critères du DSM IV-TR ou DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) sont utilisés pour poser un diagnostic formel.

Évaluation

 

La dépression est jugée légère, modérée ou sévère selon la gravité et l'incidence des symptômes et le degré de déficience fonctionnelle ou d'invalidité qui en résulte.

Voici les éléments relatifs à l'évaluation de la dépression :

  • Inclure les antécédents et un examen exhaustifs, y compris l'examen de l'état mental (Télécharger le fichier PDF de l'examen (en anglais) Mental Status Examination).
  • Explorer les problèmes d'ordre fonctionnel, interpersonnel et social.
  • Consigner les antécédents psychiatriques illustrant les épisodes de dépression ou de stimulation de l'humeur, la réponse aux traitements antérieurs et l'existence de comorbidités en matière de santé mentale.
  • Évaluer la sécurité du client et le risque pour les autres. Les intentions suicidaires devraient être évaluées régulièrement.
  • Recueillir les antécédents auprès des membres de la famille ou d'autres soignants avec le consentement du client et si cela est indiqué.

Diagnostic

[translator: don't translate the DSM criteria. We are clearing permission from the French language rights holder to reproduce the criteria]

DSM-IV-TR criteria for 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.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Copyright 2000 American Psychiatric Association.

Sommaire des données probantes

 

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4e éd., texte rév.). Washington (DC).

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5e édition). Washington (DC).

Kennedy, S.H., Lam, R.W., Parikh, S.V., Patten, S.B. et Ravindran, A.V. (2009). Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical Guidelines for the Management of Major Depressive Disorder in AdultsJournal of Affective Disorders, 117(Suppl. 1). S44–53.

Lam, R.W. (2011). Dans D. Goldbloom et J. Davine (réd.), Psychiatry in Primary Care: A Concise Canadian Pocket Guide (pp. 13–26). Toronto (Ontario) : Centre de toxicomanie et de santé mentale.

National Institute for Health and Care Excellence. (2009). Depression in Adults: The Treatment and Management of Depression in Adults (Clinical Guideline 90). Londres (Royaume-Uni).


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