Psychology chapter 10 and 11

Neurobiological Influences

- Abnormalities in the structure and function of several brain regions that regulate emotional functions - Abnormalities in amygdala, cingulate, prefrontal cortex, hippocampus - Cortical thinking in the right hemisphere - HPA axis dysregulation, sleep abnormalities, variants in BDNF, and neurotransmitters (serotonin, dopamine, and norepinephrine) have also been implicated

Onset, Course, and Outcome

- 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

Depression in Young People

- Almost all young people experience some symptoms of depression - many experience significant depression at some time displayed as a lasting depressed mood with disturbances in thinking, physical functioning, and social behavior - Suicide among teens is a serious concern - 90% of youngsters with depression show significant impairment in daily functions

Psychosocial Interventions

- Behavior therapy - focuses on increasing pleasurable activities and events, and providing the youngster with the skills necessary to obtain more reinforcement - Cognitive therapy - teaches depressed youngsters to identify, challenge, and modify negative thought processes - CBT-- most common form of psychosocial intervention combining behavior and cognitive therapies - IPT-A-- focus is on depressive symptoms and social context in which they occur

Causes of Depression

- Due to the many interacting influences, multiple pathways to depression are likely - Genetic risk influences neurobiological process and is reflected in early temperament characterized by: - Oversensitivity to negative stimuli - High negative emotionality - disposition to feeling negative effect - these early dispositions are shaped by negative experiences in the family

Bipolar Disorder (BD)

- Features a striking period of unusually and persistently elevated, expansive or irritable mood, alternating with or accompanied by one or more major depressive episodes - Elation and euphoria can quickly change to anger and hostility if behavior is impeded - may be experienced simultaneously with depression

Treatment of Depression

- Fewer than half of children with depression receive help for their problem - rayes vary by racial/ethnic background - cognitive-behavioral therapy (CBT) - have shown the most success in treating children and adolescents with depression - Interpersonal Psychotherapy for Adolescent Depression (IPT-A) - Focuses on improving interpersonal communication and has also been effective - Psychopharmacological treatments - with the exception of SSRI's, which have problematic side effects, medications have been less effective than CBT and IPT-A

Comorbidity

- High rates of co-occuring disorders are extremely common - most typical and separation anxiety disorders, generalized anxiety disorders, ADHD, and oppositional and conduct disorders - Substance use disorders - Suicidal thoughts and ideation - Co-occuring medical problems - Cardiovascular and metabolic disorders, epilepsy, and migraine headaches`

Persistent Depressive Disorder (P-DD) (Dysthymia)

- Is characterized by symptoms of depressed mood that occur on most days, and persist for at least one year - Child with P-DD also displays at least two somatic or cognitive symptoms - symptoms are less severe, but more chronic than MDD -characterized by poor emotion regulation - constant feelings of sadness, of being unloved and forlorn, held-deprication, low self-esteem, anxiety, irritability, anger, and temper tantrums - children with both MDD and P-DD are more severely impaired than children with just one disorder

Depression in school aged children and preteens

- May appear extremely somber and tearful, lacking exuberance; may display excessive clinging and whiny behavior around mothers + increasing irritability, disruptive behavior, and tantrums - May appear extremely somber and tearful, lacking exuberance; may display excessive clinging and whiny behavior around mothers + increasing irritability, disruptive behavior, and tantrums + self- blame, low self-esteem, persistent sadness, and social inhibition

Bipolar Disorder Symptoms and Types

- Symptoms include restlessness, agitation, sleeplessness, pressured speech, flight of ideas, racing thoughts, sexual disinhibition, surges of energy, expansive grandiose beliefs - Three subtypes - Bipolar I disorder - Bipolar II disorder - Cyclothymic disorder

Medications

- Tricyclic antidepressants consistently fail to demonstrate any advantage over placebo in treating depression in youth - they have potentially serious cardiovascular side effects - SSRIs (Prozac, Zoloft, 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

Genetic and Family Risk

- Twin and other genetic studies suggest moderate genetic influence, with heritability estimates ranging from 30-40% - Children of parents with depression have about three times the risk of having depression - what is inherited is likely a vulnerability to depression and anxiety - with certain environmental stressors needed for these disorders to be expressed

Bipolar disorder in Young People

- Young people with BP display: - significant impairment in functioning, including previous hospitalization, MDD, medication treatment, co-occurring disruptive behavior and anxiety disorders - History of psychotic symptoms, and suicidal ideation/ attempts are common

BD Mania in Young People

- Youngsters with mania may present with atypical symptoms- volatile and erratic changes in mood, psychomotor agitation, and mental excitation - irritability, belligerence, and mixed manic-depressive features occur more frequently than euphoria - Classic symptoms for children with mania include pressured speech, racing thoughts, and flight of ideas

Causes

- few studies have looked at the causes of BP in children and adolescents - Research with adults suggests that BP is the result of a genetic vulnerability in combination with environmental factors (life stress and family disturbances) - Multiple genes may be involved - Genetic predisposition does not necessarily mean a person will develop BP - Brain imaging studies suggest mood fluctuations are related to abnormalities in areas of the brain related to: - Emotion regulation prefrontal and anterior cingulate cortex, hippocampus, amygdala, thalamus, and basal ganglia.

History of Depression

- mistakenly believed that depression did not exist in children in a form comparable to that in adults -Now Children do experience recurrent depression and Depression in children is not masked, but rather may be overlooked - frequently co-occurs with other more visible disorders

Other Theories

- self control theories - interpersonal models - socioenvironmental models (Diathesis-stress model) - Neurobiological models

Treatment

- there is no cure for BP - A mulitmodal plan includes: - monitoring symptoms closely - educating the patient and the family - matching treatments to individuals - administering medication - addressing symptoms and related psychosocial impairments with psychotherapeutic interventions

Stressful life events

- triggers for depression may involve: - interpersonal stress and actual or perceived personal losses - life changes - violent family environment - daily hassles and other nonsecure stressful life events

Depression

-A pervasive unhappy mood disorder - more severe than the occasional blues or mood swings everyone experiences - Children who are depressed cannot shake their sadness- interferes with their daily routines, social relationships, school performance, and overall functioning - often accompanied by anxiety or conduct disorders - often goes unrecognized and untreated

Comorbidity of 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 (GAD), specific phobias and separation anxiety disorders - Depression and anxiety are more visible as separate, co-occuring disorders: - as severity of the disorder increases and the child gets older - Other common comorbid disorders are: Dysthymia, conduct problems, ADHD, and substance-use disorder - 60% of adolescents with MDD have comorbid personality disorders, especially borderline personality disorder - Pathways to comorbid conditions may differ by disorder/sex

Cognitive theories

-Focus on relationship between negative thinking and mood - Emphasize "depressogenic" cognitions - negative perceptual and attributional styles and beliefs associated with depressive symptoms - Hopelessness theory - Depression-prone individuals have a negative attributional style (Blame themselves for negative events in their lives) -Beck's cognitive model: depressed individuals make negative interpretations about the events - three areas of cognitive problems - information-processing biases - negative outlook regarding oneself, the world, and the future (Negative cognitive triad) - Negative cognitive schemata

Associated Characteristics of Depression Disorders

-Intellectual and academic functioning - difficulty concentrating, loss of interest and slowness of thought and movement may have a harmful effect on intellectual and academic functioning - lower scores on tests, poor teacher ratings, and lower levels of grade attainment - interference with academic performance but not necessarily related to intellectual deficits - may have problems on tasks requiring attention, coordination, and speed

Prevalence

-Lifetime estimates of BP range from 0.5-2.5% of youths 7-21 years old - it is difficult to make an accurate diagnosis - in youngsters, milder bipolar II and cyclothymic disorder are more likely than bipolar I - Rapid cycling episodes are common - Extremely rare in young children - rate increases (nearly as high as that for adults) after puberty

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 high risk for developing other disorders: MDD, anxiety disorders, conduct disorder - Adolescents with P-DD receive less social support than those with MDD

Gender, Ethnicity, and Culture of Depression

-No gender differences until puberty; then, Females are two to three times more likely to suffer from depression -Symptom presentation is similar for both sexes although correlates of depression differ for the sexes - Physical, psychological, and social changes are related to the emergence of sex differences in adolescence

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 13-15 years -Average episode lasts 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 - outcome is NOT optimistic

Prevalence of PDD and MDD

-Rates of P-DD are lower than MDD - approximately 1% of children and 5% of adolescents display P-DD - Most common comorbid disorder is MDD - 70% of children with DD may have an episode of major depression - About 50% of children with P-DD - also have one or more noneffective disorders that preceded dysthymia,.. anxiety disorders, conduct disorder, or ADHD

Cognitive Biases and Distortions

-Selective attentional biases - feelings of worthlessness, negative beliefs, attributions of failure, self-critical and automatic thoughts - depressive ruminative style; pessimistic outlook; and negative self-esteem - negative thinking and faulty conclusions generalized across situations, hopelessness, and suicidal ideation

Social, Peer, and Family Problems

-Social and peer problems - few close friendships, feelings of loneliness and isolation - social withdrawal and ineffective styles of coping in social situations - Family Problems- child with depression: - has less supportive and more conflicted relationships with parents and siblings - feels socially isolated from families and prefer to be alone

Family Influences

-When children are depressed - Families display more critical and punitive behavior toward the depressed child than toward other children - when parents are depressed - depression interferes with the parent's ability to meet the needs of the child - Child experiences higher rates of depression phobias, panic disorder, and alcohol dependence as adolescents and adults

Depression In Preschoolers

May appear extremely somber and tearful, lacking exuberance; may display excessive clinging and whiny behavior around mothers

Depression and suicide

Most youngsters and depression think about suicide, and as many as one-third who think about it, attempt it - most common methods for those who complete suicide are firearms, hanging, suffocation, poisoning, and overdose - worldwide, the strongest risk factors are having a mood disorder and being a young female - Ages 13 and 14 are peak periods for a first suicide attempt by those with depression

Anatomy of Depression

Symptom: feeling sad or miserable -- occurs without existence of serious problem, and is common at all ages 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 Disorder: Major Depressive Disorder (MDD) - has minimum duration of two weeks - is associated with depressed mood, loss of interest, and other symptoms; and significant impairment in functioning

Prevalence of Depression

Between 2% and 8% of children ages 4-18 experience MDD Depression is rare among preschool and school-aged children (1-2%)-- increases two- to threefold by teen - The sharp increase in adolescence may result from biological maturation at puberty interacting with developmental changes

Prevention

CBT and interpersonal psychotherapy are most effective at lowering risk for depression and for preventing recurrences School-based initiatives may provide a comprehensive program to enhance protective factors in the environment and to develop young people's individual resiliency skills - recent studies did not yield significant results

Emotion Regulation

Children who experience prolonged periods of emotional distress and sadness, or who are exposed to maternal negative moods - may have problems regulating negative emotional states and may be prone to depression - may use avoidance or negative behavior regulate dishes, rather than problem-focused and adaptive coping strategies

Psychodynamic Theories

Depression is viewed as the conversion of aggressive instinct into depressive affect - results from the actual or symbolic loss of a love object Children and adolescents were believed to have inadequate development of the superego or conscience - therefore, they do not become depressed

Major Depressive Disorder

Diagnosis in Children: same criteria for school-aged children and adolescents - depression is easily overlooked because other behaviors attract more attention - some features (irritable mood) are more common in children and adolescents than in adults

Behavioral Theories

Emphasize the importance of learning, environmental consequences, and skills and deficits during the onset and maintenance of depression - Depression is related to a lack of response-contingent positive reinforcement

Depression and Development

Experience and expression of depression change with age - In children under age 7 (as young as 3-5) - tends to be diffuse and less easily identified - anaclitic depression (Spitz)- infants - infants raised in a clean but emotionally cold institutional environment showed depression-like reactions, sometimes resulting in death - similar symptoms can occur in infants raised in severely disturbed families