Psych Midterm 2 Ch 8: Mood Disorders

Key features of Major Depressive Disorder (MDD)

- Irritability - Sadness - Loss of interest or pleasure in nearly all activities (anhedonia) - Other symptoms i.e. hopelessness, sleep disturbances (symptoms must represent change from previous functioning) - Symptoms are present for at least 2 weeks

Diagnosing MDD in children

- Same criteria for school-age children and adolescents as adults - Depression is easily overlooked because other behaviors attract more attention - Some features (e.g., irritable mood) are more common in children and adolescents than in adults

Depression in preschoolers

- Somber and tearful - Lack of enthusiasm - Excessive whiny and clingy behaviour towards mothers; fear of separation/abandonment - Irritability - Negative, self-destructive verbalizations; physical complaints (i.e. stomachache)

90% of young people show significant impairment in daily functions. Depression in young people is a serious concern because of what

- long-lasting emotional suffering - bipolar disorder - heightened risk for suicide - higher health care costs - poor health outcomes - substance abuse - problems in everyday living

Experience and expression of depression change with age. In children under age 7 (as young as 3-5) what happens?

- tends to be diffuse and less easily identified Anaclitic depression (Spitz) - Infants raised in a clean but emotionally cold institutional environment displayed reactions resembling depression, sometimes resulting in death - Similar symptoms can occur in infants raised in severely disturbed families

*Lifetime prevalence estimates of MDD range from __-__%, but rates may be underestimated

10-14%

Most common age of onset of DD?

11-12 - may be a precursor for MDD for some children

What ages are the peak periods for first suicide attempts?

13 and 14

Childhood-onset dysthymia has a prolonged duration, with average episode length of how long?

2-5 years

Most children eventually recover from initial MDD episode, but the disorder does not go away. What are the chances of recurrence? About one-third develop what disorder within five years after onset of depression?

25% within one year, 40% within two years, and 70% within five years Bipolar disorder (bipolar switch)

Children with both MDD and DD have what?

"double depression" - Both chronic depressive disorders - MDD on top of existing DD

According to Beck's cognitive model, people with depression have cognitive problems in what three areas?

Information-processing biases (negative automatic thoughts) Negative outlook regarding oneself, the world, and the future ("negative cognitive triad") Negative cognitive schemata

_________ is one of the most common symptoms of depression, occurring in 80% of clinic-referred, children with depression

Irritability

Family problems in children with depression

Less supportive and more conflicted relationships with parents and siblings Feel socially isolated from families and prefer to be alone

What factor predicts depression in adolescent girls but not boys?

Low birth weight

What is the most common comorbid disorder of dysthymic disorder (DD)?

MDD - Nearly 70% of children with DD may have an episode of major depression - About one-half of children with dysthymic disorder also have one or more co-occurring nonaffective disorders that preceded dysthymia, such as anxiety disorders, conduct disorder, or ADHD

Mood disorders run the spectrum from severe depression to extreme mania. Where do most people fall?

Middle of the spectrum

Profound feelings of hopelessness, helplessness, and despair may lead to suicide attempt. ____ youngsters with depression think about suicide, and as many as _/_ who think about it, attempt it

Most 1/3

What are the gender differences in MDD?

No gender differences until puberty; then, females are two to three times more likely to suffer from depression; also, more susceptible to milder mood disorders, and more likely to experience recurrent episodes

What is the overall outcome of MDD?

Not optimistic - Children often continue to experience adjustment and health problems and chronic stress (at risk for future episodes)

Relationship between depression and race and ethnicity during childhood?

Not well studied; inconsistent findings

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 what three things?

Oversensitivity to negative stimuli High negative emotionality Disposition to feeling negative affect * These early dispositions are shaped by negative experiences in the family, which may create an inconsistent emotional and social environment, making it difficult for the child to regulate emotions and interpersonal behavior, and to cope with stress

Attachment theory of depression

Parental separation and disruption of an attachment bond are predisposing factors for depression

The sharp increase in MDD in adolescence may result from what?

Puberty (biological changes) interacting with developmental changes

What does diagnosis of major depressive disorder include?

Requires the presence of a major depressive episode and ruling out physical factors, normal bereavement, and underlying thought disorders

Dysthymic Disorder

Symptoms of depressed mood that occur on most days, and persist for at least one year - Also display at least two cognitive (i.e. low self-esteem) or somatic symptoms (i.e. eating problems) - Less severe symptoms but more chronic than MDD

T/F Adolescents with DD receive less social support than those with MDD

True

MDD is rare among preschool and school-age children (1-2%) but increases how much by adolescence? Rates vary with time frame in which symptoms are assessed

Two or threefold

Disruptive Mood Dysregulation Disorder

Used to address kids who get random bouts of rage without diagnosing them with bipolar disorder (a chronic condition) which was not appropriate

The overall rate of depression and the proportion of females with depression increase dramatically during ________

adolescence

___________ is a strong risk factor for the onset of depression in adolescent females

co-rumination

Depression in school-aged children

combativeness, tantrums, increasing irritability, disruptive behaviour (suicide threats may start)

Socioenvironmental model of depression

emphasize the relationship between stressful life events and depression

Neurobiological models

emphasize the role of genetic vulnerabilities and neurobiological abnormalities

In the past, what was mistakenly believed about childhood depression?

it was mistakenly believed that depression did not exist in children in a form comparable to that in adults We now know that children do experience recurrent depression, and that depression in children is not masked, but rather may be overlooked because it frequently co-occurs with other more visible disorders

Rates of DD are _____ than MDD, with approximately 1% of children and 5% of adolescents displaying disorder

lower

Most recover from DD but are at high risk for developing what?

other disorders, especially MDD, anxiety disorders, and conduct disorder - Increased risk for subsequent development of bipolar disorder and substance use disorders

60% of adolescents with MDD have comorbid _______ disorders

personality disorders - especially borderline personality disorders

Depression in preteens

self-blame, low self-esteem, persistent sadness, and social inhibition

Diathesis-stress model of depression

the impact of stress may be moderated by individual risk factors (e.g., genetic risk). The occurrence of depression is based on the interaction between youngster's personal vulnerability (diathesis) and life stress.

There is research indicating that we who are not depressed are engaged in what?

unrealistic optimism

Self-control theory of depression

view depression as associated with difficulties in organizing behavior in relation to long-term goals - Deficits in self-monitoring, self-evaluation, and self-reinforcement

Interpersonal model of depression

view disruptions in relationships as the basis for the onset and maintenance of depression

What is inherited is likely a _________ to depression and anxiety, with certain environmental stressors needed for these disorders to be expressed

vulnerability

Children of parents with depression have about __ times the risk of having depression; higher when both parents have mood disorders

3x

Twin and other genetic studies suggest moderate genetic influence, with heritability estimates ranging from 30-__%

45%

As many as _% of children and 10-20% of adolescents experience significant depression at some time

5%

How long does the average MDD episode last?

8 months (longer if a parent has a history of depression)

Between 2% and _% of children ages 4-18 experience MDD

8%

Over _00,00 teens in U.S. suffer from depression yearly, and more than _00,00 make a suicide attempt that requires medical attention

800,000 500,000

As many as __% of young people with depression have one or more other disorders; 50% have two or more

90

Depression as a 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

Depression often goes unrecognized and untreated and is often accompanied by what two disorders?

Anxiety and conduct disorders

What are the most common comorbid disorders of MDD in clinic referred youngsters?

Anxiety disorders (especially GAD), separation anxiety disorders, and specific phobias - Depression and anxiety are more visible as separate, co-occurring disorders as severity of disorder increases and child gets older - Other common comorbid disorders are dysthymia, conduct problems, ADHD, and substance-use disorder

What is the question he has to ask patients after they've been hospitalized for suicide?

Are you still having thoughts of self-harm?

What are the two most common suicide attempt methods? Successful attempts?

Attempt: drug overdose, wrist cutting Successful: overdose, suffocation, hanging, firearm, poisoning

What criteria for MDD did the textbook rule out?

Bereavement - Very difficult to set rules about bereavement (cultural differences etc.) - Controversy is that bereavement is normal. If you don't demonstrate grief after a loss, then he would be worried. - It's usually 3 months (to recover from many types of disasters i.e. house burns down, death)

Cognitive biases and disturbances of children with depression

Biases, deficits, and distortions in their thinking Selective attentional biases Feelings of worthlessness, negative beliefs, attributions of failure, self-critical and automatic thoughts, Depressive ruminative style; pessimistic outlook Negative thinking and faulty conclusions generalize across situations, hopelessness, and suicidal ideation Cognitive distortion -> you expect bad things to happen so you remember all the negative things that happened to you during the day and ignore the positive things Negative self-esteem (may be related to body image)

What is the onset of MDD like?

Can be gradual or sudden; usually a history of milder episodes that do not meet diagnostic criteria Age: usually between 13 and 15 years old (early adolescence)

What is dysthymic disorder characterized by?

Constant feelings of sadness, of being unloved and forlorn, self-deprecation, low self-esteem, anxiety, irritability, anger, and temper tantrums, poor emotional regulation

Beck's cognitive model

Depressed individuals make negative interpretations about life events because they use biased and negative beliefs as interpretive filters for understanding these events

The symptoms of what disorder are so universal that it is sometimes called "the common cold of psychopathology"

Depression

_________ will be the number one problem in the next 15 years

Depression

Behavioural theory of depression

Depression is related to a lack of response-contingent positive reinforcement

Psychodynamic theory of depression

Depression is the conversion of aggressive instinct into depressive affect and results from the actual or symbolic loss of a love object that is loved ambivalently

Hopelessness theory

Depression-prone individuals tend to make internal, stable, and global attributions to explain causes of negative events (negative attributional style)

DSM-IV-TR divides mood disorders into what two general categories?

Depressive disorder - excessive unhappiness (dysphoria) - loss of interest in activities (anhedonia) Bipolar disorder - mood swings from deep sadness to high elation (euphoria) and expansive mood (mania)

Intellectual and academic functioning of children with DD

Difficulty concentrating, loss of interest, and slowness of thought and movement are likely to have a harmful effect on intellectual and academic functioning - Results in 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

Mood disorders

Extreme, persistent, or poorly regulated emotional states

Depression as a symptom

Feeling sad or miserable - Occurs without the existence of a serious problem and is common at all ages

Social and peer problems in children with depression

Few close friendships, feelings of loneliness, and isolation Social withdrawal and ineffective styles of coping in social situations

Cognitive theory of depression

Focus on relationship between negative thinking and mood Emphasize "depressogenic" cognitions - Negative perceptual and attributional styles and beliefs associated with depressive symptoms

The modest increase of MDD prevalence from preschool to elementary school may reflect what?

Growing social and performance pressures, verbal ability to report symptoms, and growing self-awareness and cognitive capacity

What are the two strongest risk factors for suicidal behaviour worldwide?

Having a mood disorder and being a young female