psyc 4176 exam 3
DSM5 for PDD
Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
cognitive (cause of depression)
Depressive mindset; distorted or maladaptive cognitive structures, processes, and products; negative view of self, world, and future; poor problem-solving ability; hopelessness
DSM5 for bipolar ||
For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode
DSM5 for cyclothymic disorder
For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. (Criteria for a major depressive, manic, or hypomanic episode have never been met.)
attachment (cause of depression)
Insecure early attachments; distorted internal working models of self and others
behavioral (cause of depression)
Lack or loss of reinforcement or quality of reinforcement; deficits in skills needed to obtain reinforcement
treatment for eating disorders: hospitalization
(usually brief) is necessary for those who: - Have serious complications due to comorbid diagnosis or - Are at high physical and/or psychiatric risk
treatment for eating disorders: psychosocial interventions
- Comprehensive treatment plans with an internist, a psychotherapist, a nutritionist, and a psychopharmacologist are more effective than medications alone - Resolution of family and interpersonal problems is crucial to recovery from an eating disorder
Depression and Development: preteens
- self-blame, low self-esteem, persistent sadness, and social inhibition - May appear extremely somber and tearful, lacking exuberance; may display excessive clinging and whiny behavior - increasing irritability, disruptive behavior, and tantrums
At least how many symptoms must be present for a diagnosis of major depressive disorder?
5
What is the chance that MDD will reoccur within 5 years of the initial episode?
70%
Around what age to girls tend to become more anxious than boys about losing weight?
9
Characteristics of Children Who Suffer Maltreatment: sex
- 80% of sexual abuse victims are female, but with that exception, boys and girls are victims of maltreatment almost equally
behavior therapy
- Aims to increase behaviors that elicit positive reinforcement and to reduce punishment from the environment. This may involve teaching social and other coping skills, and using anxiety management and relaxation training - Focuses on increasing pleasurable activities and events, and providing the youngster with the skills necessary to obtain more reinforcement
ITP-A
- Explores family and interpersonal interactions that maintain depression. Family sessions are supplemented with individual sessions in which youngsters with depression are encouraged to understand their own negative cognitive style and the effects of their depression on others and to increase pleasant activities with family members and peers - Focus is on depressive symptoms and social context in which they occur
cognitive therapy
- Focuses on helping the youngster with depression become more aware of pessimistic and negative thoughts, depressogenic beliefs and biases, and causal attributions of self-blame for failure. Once these self-defeating thought patterns are recognized, the child is taught to change from a negative, pessimistic view to a more positive, optimistic one. - Teaches depressed youngsters to identify, challenge, and modify negative thought processes
emotional regulation with trauma (Individual: Poor Emotion Regulation)
- Have difficulty understanding, labeling, and regulating internal emotional states - Learn to inhibit emotional expression and regulation, remaining more fearful and on alert
Depression and Development: school-age children
- May appear extremely somber and tearful, lacking exuberance; may display excessive clinging and whiny behavior - increasing irritability, disruptive behavior, and tantrums
Child care along a continuum: positive, middle, and negative end
- Positive end: appropriate and healthy forms of childrearing actions that promote child development - Middle range: poor/dysfunctional actions represent irresponsible and harmful child care - Negative end: parents who violate their children's basic needs and dependency status in a physically, sexually, or emotionally intrusive or abusive manner, or by neglect
Depression and Development In children under age 7 (as young as 3-5)
- Tends to be diffuse and less easily identified - Anaclitic depression (Spitz)
Abused or neglected children face paradoxical dilemmas
- The victim wants to stop the violence but also longs to belong to the family in which they are being abused - Affection and attention may coexist with violence and abuse - Violence intensity tends to increase over time, but in some cases, physical violence may decrease or be replaced with other forms
Characteristics of Children Who Suffer Maltreatment: age
- Younger children are more at risk for abuse and neglect, while sexual abuse is more common among older age groups (over 12) - Except for sexual abuse, the victimization rate is inversely related to the child's age
Studies have shown that up to ______ of male adolescents have shown some symptoms of disordered eating.
1/3
How long do symptoms need to be present for a diagnosis of major depressive disorder?
2 weeks
Dissociative reactions, such as flashbacks, in which someone feels or acts as if the event is recurring may present in children:
as reenactment during play
Why might boys be less likely to be diagnosed with PTSD than girls?
because they are less likely to experience certain traumatic events
Cindy has experienced hypomanic symptoms on and off over the past 2 years. Last year, she was in treatment for a major depressive episode. Her symptoms still cause her significant distress. Which is the most appropriate diagnosis for Cindy?
bipolar || disorder
Alterations in the HPA axis and norepinephrine symptoms:
can cause hyperreactivity to stress
Learning of the accidental death of a friend:
could meet criteria for a traumatic event in PTSD regardless of repeated exposure
PSTD is one of the few disorders in the DSM where ______ is necessary for the diagnosis.
etiology
Depressive disorders
excessive unhappiness (dysphoria) and loss of interest in activities (anhedonia)
What is a key difference between anorexia nervosa binge-eating purging type and bulimia nervosa?
in order to receive a diagnosis of anorexia nervosa, one must have significantly low weight
treatment for eating disorders: psychological interventions
individual and/or family-based psychotherapy, sometimes accompanied by medical interventions - Cognitive approaches have limited evidence, focus on distorted cognitions around body image - Efficacy of cognitive-behavioral approaches focusing on modifying abnormal eating behaviors - Family-based treatment has generally been more effective
A diagnosis of bulimia nervosa requires the presence of symptoms at least:
once per week for three months
Hypersonmia means:
sleeping too much
prevalence of bipolar disorder
• Lifetime estimates of BP range from 0.5 to 2.5% of youths 7-21 years old - It is difficult to make an accurate diagnosis - These numbers are hotly debated • In adolescents, bipolar II and cyclothymic disorder are more likely than bipolar I - Rapid cycling episodes are common • Extremely rare in young children
Bulimia Nervosa
• More common than anorexia • Primary feature is recurrent binge eating • Binges are followed by compensatory behaviors (intended to prevent weight gain)
Onset, Course, and Outcome of PDD
• Most common age of onset 11-12 years • Childhood-onset dysthymia has a prolonged duration, generally 2-5 years • Most recover, but are at a high risk for developing other disorders: - MDD, anxiety disorders, and conduct disorder • Adolescents with P-DD receive less social support than those with MDD.
treatment for eating disorders
• Psychological interventions • Hospitalization • Pharmacological antidepressants • Psychosocial interventions • Individual or family-oriented CBT - Interpersonal therapy
Binge Eating Disorder
• Similar to bulimia without the compensatory behaviors - Involves periods of eating more than other people would, accompanied by feeling of loss of control - Affects 1.5-3% of adolescents - Has negative health correlates
interpersonal (cause of depression)
Impaired interpersonal functioning related to grief over loss; role dispute and conflict; role transition; interpersonal deficit; single parenting; social withdrawal; interaction between mood and interpersonal events
Depression and Development: preschoolers
May appear extremely somber and tearful, lacking exuberance; may display excessive clinging and whiny behavior
depression and suicide
Most youngsters with depression think about suicide, and as many as one-third who think about it, attempt it ▪ "Gender paradox" - Men die more by suicide than women, but women attempt suicide more frequently. Gender does indeed shape suicidal ideas and behaviors. Due to differences in the way men express their suffering, men's depression may be underdiagnosed and undertreated. Furthermore, regarding suicidal behaviors, men use more lethal suicide methods than women.
neurobiological (cause of depression)
Neurochemical and receptor abnormalities; neurophysiological abnormalities; neuroendocrine abnormalities; genetic variants; abnormalities in brain structure and function; effects of early experience on the developing brain
Gender and Depression
No gender differences until puberty; then, females are two to three times more likely to suffer from depression
How Eating Patterns Develop
Normal development - Problematic eating habits and picky eating are common in early childhood - Societal norms and expectations affect girls more than boys - Beginning around age 9, girls are more anxious than boys about losing weight - Most important impact on fundamental biological processes is early parent-child relationship - Entering school comes with pressure to conform to perceptions of desirable body type
Four primary acts of child maltreatment
Physical abuse, neglect, sexual abuse, and emotional abuse (In North America, it is estimated that 1 in 10 children experience some form of sexual victimization by an adult or a peer)
socio-environmental (cause of depression)
Stressful life circumstances and daily hassles as vulnerability factors; social support, coping, and appraisal as protective factors
CBT
The most common form of psychosocial intervention. Combines elements of behavioral and cognitive therapies in an integrated approach. Attribution retraining may also be used to challenge the youngster's pessimistic beliefs.
Colin has had quite the day. He came home upset and broke his diet, eating the whole rest of the box of girl scout cookies. Select the most appropriate statement.
This is not likely to be viewed as abnormal/atypical behavior
medication for depression
Treats mood disturbances and other symptoms of depression using antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). • SSRIs (e.g., Prozac, Zoloft, and Celexa) are the most commonly prescribed medications for treating childhood depression - Despite support for their efficacy, side effects include suicidal thoughts and self-harm as well as a lack of information about long-term effects on the developing brain • Up to 60% of depressed youngsters respond to placebo
Depression (syndrome):
a group of symptoms that occur together more often than by chance - Mixed symptoms of anxiety and depression that tend to cluster on a single dimension of negative affect
Treatment of Depression
behavior therapy, cognitive therapy, CBT, Interpersonal Psychotherapy for Adolescent Depression (ITP-A), medication
The likelihood of PTSD developing:
can increase when asked to recount the event immediately afterwards
Which of the following is NOT considered a compensatory behavior in bulimia nervosa?
cutting
DSM-5 divides mood disorders into two general categories
depressive disorders and bipolar disorders
People with anorexia nervosa often _______their current low body weight.
do not recognize the seriousness of
Which of the following characterizes an episode of binge eating?
eating a lot more food than a normal person would in a specific amount of time combined with a feeling of lack of control
Trauma is now defined as
exposure to actual or threatened death, serious injury or sexual violence in one or more of four ways: (a) directly experiencing the event; (b) witnessing, in person, the event occurring to others; (c) learning that such an event happened to a close family member or friend; and (d) experiencing repeated or extreme exposure to aversive details of such events, such as with first responders. Actual or threatened death must have occurred in a violent or accidental manner.
In children, "significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day" may also manifest as ______.
failure to make expected weight gain
Depression (symptom):
feeling sad or miserable - Occurs without existence of serious problem, and is common at all ages
treatment for eating disorders: Pharmacological antidepressants
for comorbid depressive disorders - Should be used in conjunction with CBT, not just medication by itself
Dysthymic disorder depressed mood is
generally less severe but with longer-lasting symptoms (a year or more) and significant impairment in functioning
Shame and self-blame are more common in maltreated ____, whereas verbal and physical aggression are more common in maltreated ______.
girls; boys
Which of the following is NOT evidence of negative alterations in cognitions?
inappropriate behavior
Which of the following is a symptom of a hypomanic episode?
increase in goal directed activity
Which of the following is NOT true about psychomotor agitation or retardation
it is a subjective feeling of restless or of being slowed down
Which of the following is NOT true concerning the prevalence of major depressive disorder?
it occurs in 50% of all teenagers
Bipolar disorders
mood swings from deep sadness to high elation (euphoria) and expansive mood (mania)
In hopelessness theory, negative events are seen as:
permanent, global, and characteristic of one's self
Ever since the accident, Sam has to close their eyes the instant they see a car. This is likely an example of?
persistent avoidance of stimuli
Anorexia nervosa restricting type is when:
the person has not had recurrent purging episodes in the past 3 months
Which of the following are more likely to be effective in treating PSTD in children and adolescents:
treatments which focus most specifically on the traumatic event
Which of the following is NOT true about eating disorders in boys:
young men often place emphasis on being muscular so they generally don't develop eating disorders
Onset, Course, and Outcome of bipolar disorder
• About 60% of patients with BP have a first episode prior to age 19 - Onset before age 10 is extremely rare • Adolescents with mania typically have: - Psychotic symptoms, unstable moods, and severe deterioration in behavior • Early onset and course is chronic and resistant to treatment - Long-term prognosis is poor
Ethnic and Cross-Cultural Considerations of eating disorders
• Anorexia occurs around the world, although it may manifest differently • Bulimia is a culture-bound syndrome - Arising predominately in Western regions of the world
comorbidity associated with depression
• As many as 90% of young people with depression have one or more other disorders; 50% have two or more • Most common comorbid disorders include: - Anxiety disorders (especially GAD), specific phobias, and separation anxiety disorders • Other common comorbid disorders are: - Dysthymia, conduct problems, ADHD, and substanceuse disorder
prevalence of depression
• Between 2% and 8% of children age 4-18 experience MDD • Depression is rare among preschool and school-age children (1-2%) - Increases two- to threefold by adolescence
Anorexia Nervosa
• Characterized by refusal to maintain minimally normal body weight, intense fear of gaining weight, and significant disturbance in perception and experiences of body size • DSM-5 subtypes - Restricting type: individual loses weight through diet, fasting, or excessive exercise - Binge-eating/purging type
long-term alterations in child abuse (Biological: Neurobiological Development)
• Children and adults with a history of child abuse show long-term alterations in the hypothalamic- pituitary-adrenal (HPA) axis and norepinephrine systems - These alterations have a significant affect on responsiveness to stress - Hyperreactivity to stress
assessment for ptsd
• Clinical interview - UCLA PTSD Reaction Index for DSM-5 - Other PTSD symptom scales - Diagnostic interviews • Multiple informants - gathering information from both a caregiver and directly from the child - Avoidance of distressing thoughts/memories is a symptom of PTSD.
Assessment of Bipolar Disorder
• Clinical interview/diagnostic interview • Rating scales • Multiple informants • Discussion point: How do we distinguish hypomanic episodes from typical behavior, in the context of MDD or P-DD.
Assessment of Depression
• Clinical interview/diagnostic interview (DISC-5, KSADS) paired with rating scales • Primary informant is the child, with parent as a secondary informant • Useful Scales: Reynolds Adolescent Depression Scale, Beck Hopelessness Scale, Columbia-Suicide Severity Rating Scale, GAD-7
treatment for ptsd
• Cognitive-Behavioral Therapies - Frequently include a combination of: ▪ Skills learning (emotion regulation, coping skills, etc.) ▪ Enhancing support ▪ Trauma processing/trauma narratives ▪ Enhancing safety - Examples: ▪ Trauma-focused cognitive-behavioral therapy (TF-CBT) ▪ Trauma and grief component therapy (TGCT) • Skills: - Emotion regulation (identifying emotions, psychoeducation, coping) - Support building - Trauma narratives ▪ Combine exposure and cognitive therapy
self view with trauma (Individual: Emerging View of Self and Others)
• Feelings of powerlessness and betrayal are internalized as part of the child's self-identity • Maltreated girls show internalizing signs of distress, such as shame and self-blame, while maltreated boys show heightened levels of verbal and physical aggression
comorbidity associated with bipolar disorder
• High rates of co-occurring disorders are extremely common - Most typical are separation anxiety disorders, generalized anxiety disorders, ADHD, and oppositional and conduct disorders - Substance use disorders - Suicidal thoughts and ideation
Avoiding Re-traumatization
• In the immediate aftermath of a trauma, asking individuals to recount the traumatic event can actually, increase the likelihood that an individual will develop PTSD. - Mental Health First Aid teaches emergency personnel and behavioral responders to provide support WITHOUT increasing risk/asking directly about trauma.
Prevalence of PTSD
• Most children exposed to traumatic events do NOT develop PTSD - Many will show PTS symptoms for a period of time - But these symptoms wane • The rate at which children develop PTSD depends on the trauma experienced - Example: after a natural disaster, only about 5% develop PTSD - This may be much higher (1 in 3) among those exposed to war
Onset, Course, and Outcome of depression
• Onset may be gradual or sudden - Usually a history of milder episodes that do not meet diagnostic criteria • Age of onset usually between 13 and 15 years • Average episode lasts approx. eight months • Most children eventually recover from initial episode, but the disorder does not go away - Chance of recurrence is 25% within one year, 40% within two years, and 70% within five years - About one-third develop bipolar disorder within five years after onset of depression
Developmental Course of eating disorders
• Onset of anorexia is usually between ages 14 and 18 - Often begins with dieting and gradually leads to life-threatening starvation (5% mortality rate) - Fewer than one-half show full recovery, one-third show fair improvement, and one-fifth continue on a chronic course • Worse outcomes are correlated with: - Longer illness duration, bingeing and purging, and comorbid affective or anxiety disorders • Onset of bulimia is in late adolescence and young adulthood • Binge eating often develops during or after a period of restrictive dieting • May follow a chronic course or occur intermittently • Between 50 and 75% of patients with bulimia show full recovery over several years • Disordered eating tends to decline in early adulthood - Body dissatisfaction remains an issue for many young adults
Prevalence and Development of eating disorders
• Prevalence of anorexia nervosa and bulimia among adolescents is 0.3% and 0.9%, respectively • Eating disorders among boys - More common than originally believed - Young men place emphasis on being muscular • Sexual orientation and eating disorders - Gay men are at greater risk for behavioral symptoms of eating disorders compared to heterosexual men
prevalence of persistent depressive disorder
• Rates of P-DD are lower than those of MDD - Approximately 1% of children and 5% of adolescents display P-DD • Most common comorbid disorder is MDD - Nearly 70% of children with DD may have an episode of major depression
sexual abuse and trauma (Individual: Sexual Adjustment)
• Sexual abuse, in particular, can lead to traumatic sexualization, in which a child's sexual knowledge and behavior is shaped in developmentally inappropriate ways - E.g., leading to age-inappropriate sexual behaviors
mood and affects of ptsd and trauma (Individual: Mood and Affect Disturbances)
• Symptoms of depression, emotional distress, and suicidal ideation are common among children with histories of physical, emotional, and sexual abuse • Teens with histories of maltreatment have a much greater risk of substance abuse • Childhood sexual abuse also can lead to eating disorders, such as anorexia nervosa and bulimia nervosa
Treatment for Bipolar Disorder
• There is no cure for BP • A multimodal plan includes: - Monitoring symptoms closely - Educating the patient and the family - Matching treatments to individuals - Administering medication, e.g., lithium - Addressing symptoms and related psychosocial impairments with psychotherapeutic interventions
Depression (disorder) Major depressive disorder (MDD):
▪ Has a minimum duration of two weeks ▪ Is associated with depressed mood, loss of interest, and other symptoms; significant impairment in functioning
Anaclitic depression (Spitz) - infants:
▪ Infants raised in a clean but emotionally cold institutional environment show depression-like reactions, sometimes resulting in death ▪ Similar symptoms can occur in infants raised in severely disturbed families
What causes depression?
Attachment Behavioral Cognitive Interpersonal Socio-environmental Neurobiological
DSM5 for MDD
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.
DSM5 for bipolar |
For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.
