Ch. 10 || Depressive and Bipolar Disorders

Section Summary: Persistent Depressive Disorder [P-DD] (Dysthymia)

- children with P-DD display a depressive or irritable mood for most of the day, on most days for at least one year. While depressed, they also experience a number of somatic and cognitive symptoms. - about 5% of children and adolescents have an episode of P-DD by the end of adolescence. - the most common disorders accompanying P-DD are superimposed MDD, anxiety disorders, CD, and ADHD. - the most common age at onset for P-DD is between 11 and 12 years, with an average episode length of between 2 and 5 years. - almost all young people eventually recover from their P-DD, but many will develop MDD. - children who recover from their P-DD differ from other children mainly on measures of psychosocial functioning. - P-DD is a revised category in DSM-5 that combines the previous DSM-IV categories of Dysthymic Disorder and MDD--Chronic. This was done because of the lack of differences between youths and dysthymic disorder and those with a chronic type of major depression.

Section Summary: Overview of Mood Disorders

- children with mood disorders suffer from extreme, persistent, or poorly regulated emotional states - for example, excessive unhappiness irritability, or swings in mood from deep sadness to high elation. - mood disorders are common and are among the most persistent and disabling illnesses in young people. - there are two major types of mood disorders: depressive disorders and bipolar disorders (BP).

Section Summary: Depressive Disorders

- depression in young people involves numerous and persistent symptoms, including impairments in mood, behavior, attitudes, thinking, and physical functioning. - for a long time, it was mistakenly believed that depression did not exist in children in a form comparable to depression in adults. - it is now known that depression in young people is prevalent, disabling, and often under-referred. - the way in which children express depression changes with age. - it is important to distinguish between depression as a symptom, a syndrome, and a disorder. - three types of DSM-5 depressive disorders are major depressive disorder (MDD), persistent depressive disorder (P-DD), or dysthymia, and disruptive mood dysregulation disorder (DMDD).

Depressive Rumination Style

A style thinking displayed by depressive individuals; it is characterized by a narrow and passive focus on negative events for long periods of time.

Why is depression in young people a quality of life issue?

Depression makes it harder for them to think clearly and function in every aspect of their day-to-day existence.

An adolescent diagnosed with disruptive mood dysregulation disorder (DMDD) cannot also be diagnosed with simultaneous ___________.

ODD

Section Summary: Disruptive Mood Dysregulation Disorder (DMDD)

- disruptive mood dysregulation disorder (DMDD) is characterized by frequent and severe temper outbursts and chronic, persistently irritable or angry mood. - DMDD is a new disorder in DSM-5, and it is the one we know the least about. - the development of the DMDD category was a response to increasing rates of bipolar disorder (BP) diagnoses in young children; it was intended to provide an alternative to diagnosing BP in young children too frequently. - further research and clinical data are needed to determine whether the DMDD diagnosis will provide to be reliable, valid, and useful in clinical practice.

Section Summary: Major Depressive Disorder (MDD)

- the key features of MDD are sadness, loss of interest or pleasure in nearly all activities, plus many specific symptoms that are present for at least two weeks. - the overall prevalence of MDD annually for youths 4 to 18 years of age is between 2% and 8%, with rates that are low during childhood but increase dramatically during adolescence. The likelihood that a youth has ever had MDD is higher, from 10% to 20% or more. - the most frequent accompanying disorders in young people with MDD are anxiety disorder, P-DD, conduct problems, ADHD, and substance-use disorder. - almost all young people recover from their initial depressive episode, but about 70% have another episode within 5 years and many develop bipolar disorder. - depression in preadolescent children is equally common in boys and girls, but the ratio of girls to boys is about 2:1 to 3:1 after puberty. - the relationship between depression and race/ethnicity during childhood and adolescence is an understudied area.

Section Summary: Associated Characteristics of Depressive Disorders

- youths with depression have normal intelligence, although certain symptoms such as difficulty concentrating, loss of interest, and slowness of thought may negatively affect intellectual functioning. -they perform more poorly than others in school, score lower on standard achievement tests, and have lower levels of grade attainment. - they often experience deficits and distortions in their thinking, including negative beliefs, attributions of failure, and self-critical automatic negative thoughts. - almost all youths with depression experience low or unstable self-esteem. - youths with depression have few friends and close relationships, feel lonely and isolated, and feel that others do not like them. - they experience poor relationships and conflict with their parents and siblings, who in turn may respond in a negative, dismissing, or harsh manner. - most youths with depression report suicidal thinking, and about 30% who think about killing themselves actually attempt it.

The prevalence of P-DD among adolescents is approximately __________.

5 percent.

Disruptive Mood Dysregulation Disorder (DMDD)

A DSM-5 depressive disorder characterized by: (1) frequent and severe temper outbursts that are extreme over-reactions to the situation or provocation; and (2) chronic, persistently irritable or angry mood that is present between the severe temper outbursts.

Irritability

A common symptom of major depressive disorder and disruptive mood dysregulation disorder characterized by easy annoyance and touchiness, an angry mood, and temper outbursts.

Persistent Depressive Disorder (P-DD) or Dysthymia

A depressive disorder associated with depressed or irritable mood; generally fewer, less severe, but longer-lasting symptoms (a year or more in children) than seen in major depressive disorder (MDD); and significant impairment in functioning.

Mood Disorders

A disorder in which the subject suffers from extreme, persistent, or poorly regulated emotional states. DSM-5 mood disorders include disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder, and bipolar disorder.

Major Depressive Disorder (MDD)

A form of depressive disorder characterized by five or more mood, cognitive (ex: indecisiveness, inability to think or concentrate), psychomotor (ex: agitation or retardation), or somatic (ex: weight loss, sleep disturbances) symptoms that have been present during the same 2-week period; at least one of the symptoms is either depressed mood, or markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

Co-Rumination

A negative form of self-disclosure and discussion between peers focused narrowly on problems or emotions to the exclusion of other activities or dialogue.

Anhedonia

A negative mood state characterized by a lack of enjoyment in anything one does and a loss of interest in nearly all activities.

Dysphoria

A negative mood state characterized by prolonged bouts of sadness.

Mania

An abnormally elevated or expansive mood.

Euphoria

An exaggerated sense of well-being.

Double Depression

An instance in which a major depressive episode is superimposed on the individual's previous persistent depressive disorder, causing the individual to present with both disorders.

Despite the differences in the nature of the symptoms and duration, P-DD ___________.

Can occur before a diagnosis of MDD later in life.

When can depression be detected in a child?

Children as young as 3 can be identified with age-adjusted diagnostic criteria.

What is the primary difference between children diagnosed with persistent depressive disorder (P-DD) and other depressive disorders, such as MDD?

Children with P-DD have symptoms that are less severe than MDD.

Vincente, 13, admits to this therapist Dean that, as a Hispanic, he always feels "cheated compared to the other kids and that's why I feel bad all the time." Since Vincente comes from a middle-class home, albeit both parents have to work more than one job, what Vincente says supports current research about a child's depression vis-á-vis his or her ethnicity and socioeconomic background?

For Vincente, that part of the brain that senses reward doesn't connect in a way that makes him feel good about himself.

Maggie cannot stand to see herself in the swimming pool with others looking at her, who many see her as "so fat" despite the fact that she is over 5 feet tall and has a normal body weight for her body type. What role does her self-image play in depression?

Maggie's perception of herself may heighten her risk for depression.

For several days, sometimes only a month apart, Mega, 15, felt depressed, bloated, irritable, took no pleasure in cheerleading, could not sleep, and felt tired for days. Her doctor assured her that she likely did not have major depressive disorder. Why?

Megan's symptoms did not occur in the same 2-week period.

Which of the following is not one of the recognized forms of depressive disorder?

Minor depressive disorder (mDD)

Dean, Monique's therapist, attributes her low-test scores for a college entrance exam to the P-DD that impacted her grade and middle school years. What research does he rely on for this observation?

Research that associates the long-lasting effects of P-DD on cognitive development.

The most salient feature of DMDD is ________.

Severe irritability.

Maggie, 14, explains to Dean that seeing him is pointless. "You can't help me like people, like myself!" Why would Dean see this as a cue that cannot be ignored by him, her parents, teachers, and friends?

Such cues are serious because they express the child's hopelessness.

The alternative term for a mood disorder is "affective disorder." What is operant in the word "affective"?

The way an emotional state regulates behavior.

Why might children with ADHD be perceived by therapists as having some form of childhood depression in the past?

Their symptoms are similar to some of those associated with masked depression.

What is the attributable difference between just "feeling sad" and depression?

There is no attributable difference.

What is MDD's "double standard"?

Twice as many females than males suffer from depression.

The average episode of MDD in clinically referred children is ___________.

about 8 weeks.

Carla no longer enjoys going to gymnastics class as her body changed with puberty. She no longer enjoys eating, even though she overeats to compensate for what is missing her life. The term that best describes this state is _________.

anhedonia.

Given the changes in how DMDD has been defined, it has only recently been classified ___________ in the DSM-5.

as one of the depressive disorders.

The gradual increase in depression from preschool through grade school can be attributed to ___________.

increased performance and social pressures & the child's growing self-awareness.

The most common co-occuring symptom of depressive in clinic-referred children is _________.

irritability.

Given the many associations that depressive symptoms have with a child's academic and intellectual functioning, this association _________.

is still weak in the broad sense.