Chapter 13 - Psychosocial Problems Flashcards
What is the most common psychological disturbance among adolescents?
depression
What is the difference between depressed mood and major depressive disorder?
depressed mood
- feeling down, sad, empty, frustrated, stressed, unmotivated
- but passes
depressive disorders
- much more serious, can be disabling
- involve serious disturbances in mood
- extreme sadness/irritability
What are the 3 main areas of disturbance in depression?
affect/emotion
cognition
behaviour/functioning
How is emotion/affect disturbed in depression?
feelings of sadness, lowered mood, worthlessness, guilt
anhedonia - without pleasure
- decreased interest in previously enjoyed activities
- nothing feels good anymore
How is cognition disturbed in depression?
negative thoughts involving self-criticism, self-blame, expectations of negative outcomes
decreased concentration, slowed thinking
thoughts of death or suicide
How is behaviour/functioning disturbed in depression?
fatigue aches and pains change in sleep, appetite, weight behavioural slowing agitation loss of sexual desire/performance reduced participation in activities
How is adolescent depression typically displayed?
irritable mood
misinterpreted as annoying and argumentative
undetected and undiagnosed
What are some notable depressive symptoms in adolescence?
withdrawal from family
co-occurring substance misuse
NSSI
What is smiling depression?
non-clinical term describing people who mask their symptoms of depression
work hard to disguise symptoms
adolescents frequently hide depression
Why do youth keep their depression a secret?
fear of burdening others
- don’t want to stress family/friends
embarrassment over appearing weak or imperfect
denial
fear of peer disapproval
guilt and shame
- “shouldn’t be depressed”
- feel they must be doing something wrong
unrealistic views of happiness
- influenced by social media
- believe they are the only ones struggling
What are some signs to look for in youth to determine depression?
neuro-vegetative symptoms
change in habits, fatigue, loss of interest
What are the 3 main DSM-5 depressive disorders?
major depressive disorder (MDD)
persistent depressive disorder (dysthymia)
- chronic
premenstrual dysphoric disorder (PMDD)
What is premenstrual dysphoric disorder?
intense emotional and physical symptoms in the weeks prior to menstruation
markedly depressed mood, intense mood swings, increased sensitivity to rejection, anxiety, panic attacks, anhedonia
similar to PMS but so severe it impairs functioning in social activities, work, and relationships
typically starts in adolescence
What is major depressive disorder?
recurrent, discrete episodes of at least 2 weeks with clear changes in affect, cognition, and physical functions
inter-episode remissions
What are the DSM-5 criteria for MDD?
a) many symptoms, at least one of which is depressed mood or loss of interest/pleasure
- weight loss/gain
- appetite change
- insomnia or hypersomnia
- feeling worthless or guilty nearly everyday
- recurrent thoughts of death
b) symptoms cause significant distress or impairment in multiple areas of functioning
c) episode not attributable to physiological effects of a substance or other medical condition
d) episode can’t be explained by another psychological disorder
e) never been a manic episode
What is dysthymia?
ongoing, low-level depression
at least 2 years
same symptoms as MDD but less intense and continuous
“a veil of sadness”, chronic depressed mood
symptoms hard to spot, mild enough to hide easily and function daily
What happens when dysthymia starts in adolescence or earlier?
youth come to believe that depression is part of their personality
don’t remember what it feels like not to be depressed
What is double depression?
MDD and PDD at the same time
often PDD experience worsening symptoms resulting in onset of MDD
- often triggered by trauma
What is the difference between sadness and depression?
sadness
- caused by specific trigger
- temporary, distractible
- can sleep, eat, remain motivated
- a normal emotion!
depression
- no trigger needed
- all consuming
- serious disruption of eating, sleeping, motivation
- pervasive sense of worthlessness and guilt
How prevalent are depressive disorders in adolescence?
17% of 12-19 year olds have experienced a major depressive episode
15-24 year olds have highest rates of mood and anxiety disorders
- and increasing, though treatment rates are not changing
What are the biological factors contributing to depression?
genetics
NT imbalance
brain structure and processing difference
cortisol release
What is the diathesis stress model?
some people have a diathesis (vulnerability/predisposition) to depression
some people experience a stressor (negative circumstance/event)
combination of diathesis and stress = depression
What are some potential stressors for youth depression?
normative events
- puberty, grade transition
non-normative events
- divorce, moving
living in neighbourhoods with low collective efficacy
poor peer relationships
romantic relationship issues
cognitive factors
response style
How can peer relationships cause depression?
bullying/exclusion
strained relationships compounded by alienating behaviours that lead to avoidance by peers
- cycle of rejection and depression
What are the cognitive factors that can lead to depression?
3 attribution styles
- internal (something about me)
- global (not just this situation, all situations always)
- stable (will go on forever)
learned helplessness
How can response style lead to depression?
rumination
- dwelling on negative thoughts/feelings/events
- amplifies negative mood and depressive symptoms
- more common in females
distraction
- more common in males
- sports, video games, drinking
What are some treatments for depression?
anti-depressants
- effect delay, trail and error, side effects, withdrawal, increased risk of suicidal behaviours
psychotherapy
mindfulness
relaxation therapy
lifestyle changes (diet/exercise)
most effect is medication and psychotherapy in combinatino
How had COVID-19 affected Canadians mentally?
fewer Canadians report excellent or very good mental health
youth (15-24) report greatest declines
those with poor mental health prior to the pandemic impacted even more
- increased difficulty accessing resources
- loneliness and social isolation
- fear of illness for self and others
- job loss/financial stress
What is the “second wave of brain growth”?
beginning in adolescence
in prefrontal cortex (thinking) and limbic system (emotion and motivation)
critical to intelligence and performance in all areas
brain blossoms with new brain cells and neural connections
- connections not used are pruned, connections that are used are hardwired for life
brain you have when you enter your teen years is not the one you have when you grow out of them
Why are teens that use drugs particularly susceptible to lifetime addiction?
brain is still developing
- pathways used are hardwired
adolescence period of increased risk-taking
- increased sensation seeking, decreased decision-making
higher risk of developing addiction
- teen limbic system very sensitive to dopamine, released in high quantities during drug use
immature nucleus accumbens
- leads to motivation deficit: prone to engaging in behaviours with high excitement or low effort (or both: eating, drinking, smoking)
Why are teens hardwired to take risks?
evolved out of the need for offspring to leave the safety of the nest and take risks to find a life of their own
Why do teens experiment with drugs/alcohol?
peer pressure
attraction to novelty
desire to loosen sexual inhibitions
primarily due to changes in dopamine-rich areas
What are the 4 key changes in the brain that lead to heightened susceptibility to addiction?
active wiring while under construction
changes associated with risk taking
dopamine abundance/sensitivity
motivational deficit
What is the primary cause of schizophrenia?
levels of dopamine surge and overstimulate receptors, affect ability of the brain to stimulate accurate signals
many malfunctioning parts throughout the brain, orchestrated by prefrontal cortex
misfiring of the brain produces symptoms (ex. sounds that aren’t there)
How is addiction developed using NT?
addictive drugs alter levels of NT
mimic NT (usually dopamine) and clog dopamine vacuums so it can’t be reabsorbed, causes dopamine high
tricks your brain into feeling happy, makes you feel like you can’t be happy without it
What are the general principles of psychosocial problems?
most problems reflect transitory experimentation
not all problems begin in adolescence
most problems do not persist into adulthood
problems during adolescence are not caused BY adolescence
What is substance abuse?
misuse of alcohol or other drugs to a degree that causes problems in the individual’s life
co-morbid with internalizing and externalizing disorders
What are externalizing disorders?
those in which young person’s problems are turned outwards and manifested in behavioural problems
“acting out”
delinquency, antisocial aggression, truancy
What are internalizing disorders?
those in which young person’s problems are turned inwards and manifested in emotional and cognitive distress
depression, anxiety, disordered eating
In what order are internalizing and externalizing problems developed?
in girls, internalizing problems precede conduct problems
reverse for boys
What is problem behaviour syndrome?
underlying trait of unconventionality results in covariation amongst various types of externalizing behaviours
unconventionality in both adolescent’s personality and social environment
- individual: tolerant of deviance, not highly connected to educational or religious institutions
- environments: large number of individuals share same attitudes
individuals in these environments are more likely to engage in wide variety of risk taking behaviour
biological or social origins
What are problem clusters?
different types of deviance have different origins
but involvement in one type may lead to involvement in another
cluster together not because of common underlying traits but because of chain reactions in involvement
What is social control theory?
theory of delinquency that links deviance with the absence of bonds to society’s main institutions
school, family, workplace
underlying weakness in the individuals attachment to society leads to development of unconventional attitude, membership in unconventional peer group, or involvement in problem behaviours
Why is there high comorbidity among internalizing problems?
common subjective state of distress
can be thought of as different manifestations of a common underlying factor of negative emotionality
those with high negative emotionality become distressed easily, at greater risk of anxiety
those with low positive emotionality prone to depression
underlying trait may also be cognitive in nature (self-criticism, rumination, etc.)
How are the signals towards substance use and abuse mixed towards adolescents?
told how bad it is but advertising is directed towards them
What are the most common drugs of choice?
alcohol
marijuana
tobacco
What is binge drinking?
consuming 5+ drinks on one occasion, indicator of alcohol abuse
When does drug use peak?
increases during adolescence, peak during early 20’s, and then decline
Has drug use changed over time?
not dramatically
only new concern is number of teenagers who report vaping
What are the 6 distinct types of alcohol users?
non-users experimenters low escalators early starters late starters high escalators
What are the risk factors for substance abuse?
psychological
- anger, impulsivity, inattentiveness, sensation seeking
family
- distant, hostile, conflict
- overly permissive, uninvolved, neglectful
- other members use drugs
friends
- use and tolerate drugs
social
- context makes drug use easier
- community norms, drug law enforcement, drug presentation in the media
What are some protective factors for substance abuse?
positive mental health high academic achievement engagement in school close family relationships involvement in religious activities
What is conduct disorder?
repetitive pattern of antisocial behaviour that results in problems at school or work or in relationships with others
What is oppositional defiant disorder?
disorder of childhood and adolescence characterized by excessive anger, spite, and stubbornness
What is antisocial personality disorder?
disorder of adulthood characterized by antisocial behaviour and consistent disregard for the rules of society and rights of others
What are callous unemotional traits?
cluster of traits characteristic of psychopathic individuals which includes a lack of empathy and indifference towards the feelings of others
What are status offences?
violations of the law that pertain to minors but not adults
What is the age crime curve?
relationship between age and offending, showing prevalence of offending peaks in late adolescence
What is overt vs. covert antisocial behaviour?
overt = aggression towards others
covert = misdeeds that are not always detected by others (lying, stealing)
What is juvenile offending?
externalizing problem including delinquency and criminal behaviour
Compare school shootings and street shootings.
school shootings are:
- more rare
- concentrated in rural/suburbs
- mostly white middle class
- guns legally obtained
street shootings are:
- less rare
- concentrated in inner cities
- mostly low income
- non-white offenders overrepresented
- gun usually obtained illegally
Why are adolescent crime rates inaccurate?
underreported and selectively reported
almost all adolescents have engaged in delinquent behaviour at one time or another
ethnic differences smaller than reported
What are the 2 major types of offenders?
life course persistent offenders: demonstrate antisocial behaviour during childhood and continue through adolescence and into adulthood
- typically come from disorganized or neglectful homes
adolescence limited offenders: antisocial adolescents whose delinquent/violent behaviour begins and ends in adolescence
- greater than average sensation seeking
- poor parenting, unsupervised time
- affiliation with antisocial peers
What is hostile attribution bias?
tendency to interpret ambiguous interactions with others as deliberately hostile
Why do more females have depression?
adolescence more stressful for girls
- bodily changes (especially early) more stressful for girls
- experience more stressors
more likely to internalize
oxytocin hormone makes females want to invest more in close relationships, make them more vulnerable to adverse consequences of relational difficulties
What is suicide contagion?
process through which learning about others’ suicide can lead to people trying to take their own lives
What are primary and secondary control strategies?
primary = attempts to change the stressor
secondary = attempts to adapt the stressor
