Chap 9: Depression/ Bipolar Flashcards
– Depressive disorders excessive unhappiness
dysphoria
loss of interest in activities
anhedonia
Bipolar disorder mood swings from deep sadness to
high elation
euphoria
expansive mood
mania
• A pervasive unhappy mood disorder
– More severe than the occasional blues or mood
swings everyone experiences
-Children who are ________ 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
Depression
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
– May appear extremely somber and tearful, lacking
exuberance; may display excessive clinging and whiny
behavior around mothers
Preschoolers
– The above, plus increasing irritability, disruptive
behavior, and tantrums
School-aged children
– The above, plus self-blame, low self-esteem,
persistent sadness, and social inhibition
Preteens
: feeling sad or miserable
– Occurs without existence of serious problem, and
is common at all ages
Depression (symptom):
: 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 (syndrome):
• Has a minimum duration of two weeks
• Is associated with depressed mood, loss of interest, and
other symptoms; and significant impairment in functioning
Major depressive disorder (MDD):
is generally less
severe but with longer lasting symptoms (a year or
more) and significant impairment in functioning
– Dysthymic disorder depressed mood
Prevalence
• Between 2% and 8% of children ages 4-18 experience
MDD
• Depression is rare among preschool and school-age
children (1-2%)
– Increases two- to threefold by adolescence
• The sharp increase in adolescence may result from
biological maturation at puberty interacting with
developmental changes
….
Most common comorbid disorders of Depression include:
–
Anxiety disorders (especially GAD), specific phobias,
and separation anxiety disorders
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
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, self-deprecation, 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
Persistent Depressive Disorder [P-DD] (Dysthymia)
Depression and Suicide
• 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 and 14 are peak periods for a first suicide
attempt by those with depressio
• 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
Psychodynamic 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 responsecontingent positive reinforcement
Behavioral 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)
Cognitive Theories
– Negative perceptual and attributional styles and
beliefs associated with depressive symptoms
depressogenic
– Depression-prone individuals have a negative
attributional style (blame themselves for negative
events in their lives)
Hopelessness theory
depressed individuals make
negative interpretations about life events
– Biased and negative beliefs are used as
interpretive filters for understanding events
– Three areas of cognitive problems
• Information-processing biases
• Negative outlook regarding oneself, the world, and the
future (negative cognitive triad)
• Negative cognitive schemata
Beck’s cognitive model
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
• 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
• 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
Bipolar Disorder
Three subtypes of BP
– Bipolar I disorder
– Bipolar II disorder
– Cyclothymic disorder
• Symptoms include restlessness, agitation,
sleeplessness, pressured speech, flight of ideas,
racing thoughts, sexual disinhibition, surges of
energy, expansive grandiose beliefs
Bipolar Disorder
multimodal plan for BP
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