ch #10 mood disorders lecture notes Flashcards
describe depression in infants
anaclitic depression (spitz)—infants raised in a clean but emotionally cold institutional environment or in severely dysfunctional families show depression like reactions
describe depression in preschoolers
may appear extremely somber and tearful, lacking exuberances; may display excessive clinging and whiny behaviour around mothers.
describe depression in school-age children
similar as preschool children, plus increasing irritability, disruptive behaviour and tantrums
describe depression in preteens
irritable, self blame, low self-esteem, persistent sadness, and social inhibition
discuss the prevalence of mood disorders and depression
-between 2% and 8% of children 4-18 experience MDD
-depression is rare among preschool children (1-2%)
-the increase during school age years due to social pressures, increase in cognitive abilities and self-awareness
-the sharp increase in adolescence may result from biological maturations at puberty interacting with developmental changes
describe onset, course and outcome of MDD/depression
-onset my be gradual or sudden
-age of onset: 13-15 yrs
-average duration of an episode: 8 months
-reoccurrence of other episodes is common: up to 70% chances of reoccurrence within 5 years
-30% will later develop bipolar disorder
describe the comorbidity associated with MDD
-90% of young people with depression have one or more other disorders
-50% have two or more other disorders
-depression+anxiety=73.8%–85% of cases anxiety comes first
-depression+behaviour problems=47.2%
-60% of adolescents with MDD have comorbid personality disorders, especially borderline personality disorder.
-dysthymia and substance use disorder
what are the differences between MDD and PDD?
- milder symptoms (at least 2 instead of 5)
-longer duration (instead of 2 weeks)
-associated with poorer response to treatment
-if PDD is presented with MDD it is called Double Depression
-PDD develops earlier (11yrs) - average episode 2-5 years
what are some associated characteristics with mood disorders in regards to intellectual and academic functioning
-difficulty concentrating, loss of interest and slowness of thought and movement may affect academic functioning–lower scores on tests, poor teacher rating, 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
what are some associated characteristics in regards to cognitive biases and distortions
-selective attentional biases to negative information (negative emotional expressions)
- 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
what are some associated characteristics in regards to 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:
-have more conflicted relationships with parents and siblings
-feel socially isolated from families and prefers to be alone (often to avoid conflict)
-be negative towards family members who may in turn be negative/harsh or dismissive towards them
-most youngsters with 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 13-14 are peak periods for a first suicide attempt by those with depression
what are some associated characteristics in regards to suicide
In Canada in 2016:
-5 children/youth out of 100000 die of suicide
-200 children/youth out of 100000 were hospitalized because of self injury
Depression is one of the strongest risk factor and warning signs for suicidality
what are some causes of depression?
-Biological factors (genes, brain)
-Environmental factors (family, stess)
-Psychological factors (cognitive errors)
describe the biological causes of mood disorders
-twin and other genetic studies suggest moderate genetic influence, with heritability estimates ranging from 30-45%
-children of parents with depression have about 3x risk of having depression
-what is inherited is likely a vulnerability to depression and anxiety, not one specific gene for depressive symptoms (with certain environmental stressors needed for this disorders to be expressed –> gene environment interaction
-abnormalities in the structure and function of several brain regions that regulate emotional functions
describe the environmental causes of mood disorders
the families of children with depression tend to be:
-more critical and punitive toward the depressed child than toward other children
-more likely to experience high levels of stress
-more likely to experience marital conflict
-more likely to experience lack of social support
-more likely to be depressed (especially postpardum depression) which negatively affects their parenting skills
-more likely to be characterized by insecure attachment styles
triggers for depression may involve:
-interpersonal stress and actual or perceived personal losses
-life changes
-violent family environment
-everyday life events/challenges
what are the psychological causes of mood disorder
-theory that explains how youth and adults with depression tend to have altered cognitions about themselves, the world around them and future (learned helplessness?)
-biases in self-referential processing have been interpreted as reflecting the presence of negative self-schemas in individuals with depression and these negative biases predict the onset of a new depressive episode
-attentional bias towards negative stimuli (dot probe task)
-INTERPRETATION: bias in interpretation of ambiguous stimuli (ambiguous words-dye/die or ambiguous faces)
-MEMORY: negative bias in encoding and retrieval, but also deficit in remembering details about positive events
-COGNITIVE CONTROL: all the processes that control the information in our working memory
-individuals with depression tend to struggle ignoring negative informations
-have issues removing negative memories from their working memory (ruminating)
-cognitive emotion regulation strategies , 1. rumination 2. reappraisal 3. distraction
what is reappraisal
reinterpreting the meaning or interpretation of an emotion eliciting situation in order to modify the emotional experiences
what are the most common interventions for depression
-psychosocial interventions (CBT, interpersonal therapy)
-medications
-family oriented interventions
what is cognitive behavioural therapy
-aimed at addressing the behavioural and cognitive component of the disorders
ACTION PROGRAM:
A=always find something to do to feel better (target=behavioural)
C= catch the positive (build positive self-schema)
T= think about it as a problem to be solved (reframing)
I= inspect the situation
O= open yourself to the positive
N= never get stuck (identification of negative thoughts and use of cognitive restructuring)
what is interpersonal psychotherapy for adolescent depression
-improving interpersonal communication
-addressing romantic relationship, separation from parents and peer relationships
-identification of social triggers and social supports
what are some medications for depression?
-tricyclic antidepressants consistently fail to demonstrate any advantage over placebo in treating depression in youth (have serious cardiovascular side effects)
-SSRI’s (Prozac, zoloft) are the most commonly prescribed medications for treating childhood depression (side effects include suicidal thoughts and self harm and lack of information about long-term effects on developing brain)
-up to 60% of depressed youth respond to placebo
what are some symptoms of bipolar disorder
restlessness, agitation, sleeplessness, pressured speech, flight of ideas, racing thoughts, sexual disinhibition, surges of energy, expansive grandiose beliefs
what are the three subtypes of bipolar disorder
- bipolar I disorder
-bipolar II disorder
-cyclothymic disorder
describe how bipolar disorder presents in adolescence
with mania may present with atypical symptoms–volatile and erractic changes in mood, psychomotor agitation, and mental excitiation
-irritability, belligerence, mixed manic-depressive features occur more often than euphoria
-classic symptoms for children with mania include pressured speech, racing thoughts and flight of ideas
what is the prevalence of BD
-lifetime estimates of BD range from 0.5 to 2.5% of youth 7-21 yrs old
-in youngsters milder bipolar II and cyclothymic disorder are more likely than bipolar I
-extremely rare in young children–rate increased after puberty
what is the onset, course and outcome of BD
-60% of patients with BD 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 behaviour
-early onset and course is chronic and resistant to treatment (long term prognosis is poor)
what are the biological causes of BD
-genes
-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
what is the treatment for BD
-no cure
multimodal plan includes:
-monitoring symptoms closely
-educating the patient and the family
-matching treatments to individuals
-administering medication(lithium)
- addressing symptoms and related psychosocial impairments with psychotherapeutic interventions
