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Psychiatry3 > Childhood depression and anxiety > Flashcards

Childhood depression and anxiety Flashcards

1
Q

How were emotional disorders traditionally categorized in children?

A

They were traditionally “lumped” together into relatively broad categories such as ‘EMOTIONAL DISORDERS OF CHILDHOOD’ and ‘INTERNALIZING DISORDERS’.

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2
Q

What is a major downsides of the traditional categorization of emotional disorders in children?

A

The major downside to the traditional categorization is the lack of diagnostic precision.

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3
Q

What significant change has occurred over the past two decades in the classification of emotional disorders?

A

There has been a ‘splitting’ approach, delineating or categorising the large number of different anxiety and depressive disorders included in ICD-10 and DSM-IV & V.

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4
Q

What was the aim of the ‘splitting’ approach in diagnosing emotional disorders?

A

The aim was to increase diagnostic precision

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5
Q

What are some downsides/disadvantages of the new diagnostic criteria ?

A
  • Some individuals have difficulties that do not quite match any set of operationalized diagnostic criteria,and
  • others with broad symptomatology qualify for several labels simultaneously.
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6
Q

What is the prevalence of depression in pre-pubertal children aged 5 to 10 years?

A

The prevalence is 0.2% in 5 to 10 year olds (pre-pubertal children).

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7
Q

What is the prevalence of depression in adolescents aged 11 to 15 years?

A

The prevalence is 2% in 11 to 15 year olds (adolescents).

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8
Q

What factor seems to be more closely linked to the rise of depression in adolescence?

A

The rise in adolescence seems to be more closely linked to pubertal status than to chronological age.

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9
Q

What trend is observed regarding the sex ratio in depression from middle or late adolescence?

A

The female preponderance seen in adult depression is evident from middle or late adolescence.

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10
Q

What is the sex ratio for depression before puberty?

A

Before puberty, the sex ratio is equal, or there may even be a male preponderance.

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11
Q

Is there a link between social disadvantage and depression ?

A

A link with social disadvantage has been suggested, but the evidence is contradictory

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12
Q

What is a key observation regarding the familial aspect of depression?

A

Depression runs in families.

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13
Q

How do depressed children compare to children with other psychiatric disorders in terms of family history?

A

Depressed children are more likely than children with other psychiatric disorders to have parents or siblings who are themselves depressed.

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14
Q

What is the relationship between parents with depression and their children?

A

Parents with depression are more likely to have depressed children.

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15
Q

What do twin studies suggest about the heritability of depression?

A

Twin studies suggest moderate heritability, but this has not been replicated in adoption studies.

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16
Q

what is meant by a gene–environment interaction?

A

Refers to the complex interplay between an individual’s genetic predispositions and the environmental factors they encounter, which together influence the development of certain traits or disorders, such as depression.

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17
Q

What are the core symptoms of depression?

A
  • Persistent and pervasive sadness or unhappiness
  • Loss of enjoyment of everyday activities (anhedonia)
  • Irritability
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18
Q

What are some associated symptoms of depression?

A

“NIGHT SAD”

N – Negative thinking and low self-esteem
H – Hopelessness
I – Ideas of guilt, remorse, or worthlessness (Unwarranted)
G – Grim thoughts of death or suicide
H – Hypoactivity and lack of energy (increased fatigability)
T – Trouble concentrating, forgetfulness
S – Sleep disturbances (insomnia or hypersomnia)
A – Appetite disturbance (decrease or increase)
D – Diminished activity and fatigue

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19
Q
A
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20
Q

What are the core requirements for diagnosing a major depressive episode?

A
  1. Presence of core symptoms
  2. Presence of some associated symptoms (usually four should be present)
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21
Q

What does “pervasiveness” mean in the context of a major depressive episode diagnosis?

A

Symptoms must be present every day, most of the day.

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22
Q

What is the minimum duration for symptoms to be considered for a major depressive episode diagnosis?

A

Symptoms must be present for at least two weeks.

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23
Q

What impact must the symptoms have for a diagnosis of major depressive episode?

A

Symptoms must cause impairment in functioning or significant subjective distress.

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24
Q

What conditions must be ruled out when diagnosing a major depressive episode?

A
  1. Symptoms must not be the manifestation of the effects of a substance or another medical condition.
  2. Symptoms should not be due to another mental disorder.
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25
Q

How do pre-pubertal children typically present symptoms of depression?

A
  • Irritability (temper tantrums, non-compliance)
  • Afffect is reactive
  • Somatic complaints (e.g., headaches, stomachaches)
  • Frequently comorbid with anxiety, behavior problems,
    and ADHD.
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26
Q

How do adolescents typically present symptoms of depression?

A
  • Irritability (grumpy, hostile, easily frustrated, angry
    outbursts)
  • Affect is reactive*
  • Hypersomnia
  • Increased appetite and weight gain
  • Somatic complaints
  • Extreme sensitivity to rejection (falsely perceived putdown or criticism)
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27
Q

What makes in difficult for adolescents presenting with depression to maintain relationships ?

A

They have extreme sensitivity to rejection (e.g., falsely perceived
putdown or criticism) resulting, for example, in difficulties
maintaining relationships.

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28
Q

What are the key symptoms of depression in adults?

A
  • Anhedonia
  • Lack of affective reactivity
  • Psychomotor agitation or retardation
  • Diurnal variation of mood (worse in the morning)
  • Early morning waking
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29
Q

What symptom is common across all age groups when it comes to depression?

A

Irritability

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30
Q

What complaints should alert clinicians to the possibility of depression in young people?

A
  • Irritability or cranky mood
  • Chronic boredom or loss of interest in previously enjoyed leisure
    activities (for example, dropping out of sporting activities, or dance and
    music lessons)
  • Social withdrawal or no longer wanting to “hang out” with friends
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31
Q

What additional complaints associated with school should alert clinicians to the possibility of depression ?

A
  • Avoiding school
  • Decline in academic performance.
  • Change in sleep-wake pattern (for example, sleeping in and
    refusing to go to school).
  • Current problems represent a change from the teenager’s previous level of functioning or character.
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32
Q

What additional complaints associated with behaviour should alert clinicians to the possibility of depression?

A
  • Development of behavioral problems (such as becoming more de
    ant, running away from home, bullying others).
  • Abusing alcohol or other substances
  • Current problems represent a change from the teenager’s previous level of functioning or character.
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33
Q

What additional complaints realed too somatic symptoms should alert clinicians to the possibility of depression?

A

Frequent unexplained complaints of feeling sick, headaches,
stomach-aches

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34
Q

What defines a moderate depressive episode?

A
  • Five depressive symptoms (at least one core symptom)
  • Mild impairment in functioning (distressed by the symptoms, some difficulty in continuing with ordinary work and social activities, which can be done with extra effort)
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35
Q

What defines a moderate depressive episode?

A
  • Six or seven symptoms (at least one core symptom)
  • Considerable difficulty in continuing with school work, social, and family activities.
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36
Q

What are the characteristics of a severe depressive episode?

A
  • More than seven depressive symptoms
  • Hallucinations or delusions can be present
    (psychotic depression)
  • Severe impairment in most aspects of functioning
    (home, school, social)
  • Significant risk of suicide is often present
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37
Q

How are persistent symptoms of depression classified?

A
  • If they meet the criteria for a depressive episode can be assigned one of several diagnoses, depending on:
  1. How many episodes they have had
  2. Whether they have also had any manic, hypomanic, or mixed episodes.
38
Q

What is classified as major depressive disorder, single?

A

One major depressive episode with no manic, hypomanic, or mixed episodes .

39
Q

What is classified as major depressive disorder, recurrent?

A

Two or more major depressive episodes but no manic, hypomanic, or mixed episodes .

40
Q

What happensn to those with mider smptoms that do not meet the diagnosis of MDD?

A

Those with milder symptoms may meet the diagnostic criteria for dysthymia or adjustment disorder with depressed mood.

41
Q

What is dysthymia?

A

Dysthymia involves chronic mild symptoms of depression for at least one year (as opposed to the two years stipulated for adults).

42
Q

What is an adjustment disorder with depressed mood?

A

An adjustment disorder can be diagnosed if the symptoms occur shortly after an identifiable stressor (within three months according to DSM-V) and do not outlast the stressor by more than six months.

43
Q

What percentage of depressed children in epidemiological samples have at least one other psychiatric disorder?

A

Over 50% of depressed children

44
Q

What are some common psychiatric disorders that may co-occur with depression in children?

A
  • Anxiety disorder
  • Disruptive behavioral disorder
  • Learning disorder
45
Q

What is considered normal sadness in the context of differential diagnosis for depression?

A

Normal sadness includes normal bereavement reactions and does not meet the criteria for a depressive disorder

46
Q

How can misery present in relation to other psychiatric disorders?

A

Misery can occur as just one feature of another psychiatric disorder, without the additional affective, cognitive, and behavioral features needed to diagnose a true depressive disorder.

47
Q

What are some medical conditions that can lead to depressive symptoms?

A

hypothyroidism

48
Q

In spite of some “angst,” what is true about the moodiness of a normal adolescent?

A
  • They show no significant and enduring change in behavior.
  • meaning , it’s are temporary and do not result in lasting changes in behavior or functioning.
49
Q

What is the behavior change in an adolescent with clinical depression?

A

There is a change from previous behavior (e.g., became sad, irritable, lost interest in everyday activities, dramatic response to perceived slights or rejections, frequent complaints of boredom).

50
Q

How do normal adolescents respond to sadness?

A

Although they can be sad and tearful at times, this usually occurs in response to life events and is short-lived.

51
Q

How do adolescents with clinical depression experience sadness?

A

Core depressive symptoms (sadness or anhedonia) are present every day, most of the day for at least two weeks.

52
Q

What is the impact on functioning for a normal adolescent?

A

No significant change in functioning.

53
Q

What is the impact on functioning for an adolescent with clinical depression?

A

There is deterioration from previous functioning (e.g., not coping at school, drop in marks, stopping previously enjoyed activities).

54
Q

How do adolescents with clinical depression manage homework and class work?

A

They take longer to complete homework and class work than before and it takes more effort; school performance may decline.

55
Q

How frequent are suicidal thoughts in normal adolescents?

A

Thoughts of death and suicide are infrequent.

56
Q

How frequent are suicidal thoughts and attemps in adolescents with clinical depression?

A

Suicidal thoughts and attempts common

57
Q

Give examples of the suicidal thoughts in depressed adolescents

A
  • life is not worth living
  • I may be better off dead
58
Q

What kind of risk behaviors are common in normal adolescents?

A

Risk behaviors, such as reckless driving, drinking, and experimentation with sex are common but usually contained within reasonable limits for that adolescent’s character

59
Q

What kind of risk behaviors might an adolescent with clinical depression engage in?

A

May start engaging in uncharacteristic, dangerous or high-risk behaviors, such as reckless driving, out-of-control drinking, and thoughtless, unsafe sex.

60
Q

What are the stress reduction intervention ?

A
  • school liaison
  • supportive individual therapy and
    family interventions
61
Q

How can addressing bullying impact a child’s depression?

A

Tackling the bullying may be enough to cure the depression if the bullying is the primary stressor.

62
Q

In what situations is it necessary to treat depression directly?

A
  • When it is not possible to identify and eliminate key stressors.
  • When the original stressor has triggered a vicious cycle that needs to be interrupted.
63
Q

What are the best researched psychological treatments?

A

cognitive behavioural therapy (CBT) and interpersonal therapy (IPT)

64
Q

What is the effectiveness of CBT and IPT in treating depression?

A

They have a moderate effect size.

65
Q

What is the purpose of the cognitive restructuring component of CBT?

A

To alter negative cognitions, improve self-esteem, and enhance coping skills.

66
Q

What does the behavioral activation component of CBT aim to achieve?

A

To increase involvement in normal and rewarding activities.

67
Q

What additional treatments may be offered alongside CBT and IPT?

A

Social skills training, problem-solving treatment, and remedial help with specific learning problems.

68
Q

What is the general consensus on the role of medication in treating depression in children and adolescents?

A

The role of medication is controversial.

69
Q

What do randomized controlled trials (RCTs) indicate about the effect of medication for depression?

A

Medication has a large effect, but there is also a large placebo effect.

70
Q

What do meta-analyses reveal about tricyclic antidepressants for children and adolescents?

A

Tricyclic antidepressants are little or no better than placebos.

71
Q

Which class of medications is shown to be more effective than placebos in treating child and adolescent depression?

A

Serotonin reuptake inhibitors (SSRIs), particularly fluoxetine.

72
Q

In which cases are SSRIs particularly effective?

A

in cases of severe depression.

73
Q

What is the only antidepressant approved by the FDA for treating depression in children?

A

Fluoxetine

74
Q

What concerns are associated with SSRIs in the treatment of depression?

A

SSRIs may increase the risk of self-harm or suicide.

75
Q

What do analyses of reported adverse effects of SSRIs suggest?

A

An increase in suicidal ideation and threats, with few attempts and no completed suicides

76
Q

How should clinicians manage mild depressed children and adolescents ?

A

Support and stress reduction

77
Q

How should clinicians manage moderate depressed children and adolescents based on severity?

A

Three-step plan:
1. Support and stress reduction.
2. If this fails, try CBT or IPT.
3. If this fails, consider a trial of fluoxetine.

78
Q

What is the recommended approach for severe depression?

A

Combination of pharmacological and psychological treatment

79
Q

When is admission to an in-patient unit indicated for depressed children?

A

When there is severe suicidality, psychotic symptoms, or refusal to eat and drink.

80
Q

How long should successful therapy continue after symptomatic remission in a single episode of depression?

A

About six months to prevent early relapse.

81
Q

What challenges are associated with the pharmacological treatment of bipolar depression?

A
  • Treatment resistance is common.
  • SSRIs can trigger mania.
82
Q

What are some pharmacological options for treating bipolar depression?

A
  • Quetiapine alone or olanzepine combined with fluoxetine.
  • Conventional mood stabilizers like lithium or sodium valproate combined with fluoxetine.
  • Lamotrigine
83
Q

Where is resistant depression best treated?

A

In specialist centers.

84
Q

What is the typical duration and recurrence likelihood of an adjustment disorder with depressed mood?

A

It usually lasts a few months and does not typically recur after the stressor is resolved.

85
Q

How long do major depressive episodes typically last, and what is their recurrence likelihood?

A

Major depressive episodes often last six to nine months and commonly recur.

86
Q

What is the prognosis for individuals with dysthymia?

A

Dysthymia typically persists for several years, and individuals with dysthymia are at a high risk of experiencing major depressive episodes.

87
Q

What is ‘double depression’?

A

‘Double depression’ refers to major depressive episodes superimposed on dysthymia.

88
Q

Someone with double depression is at risk of what?

A

likely to experience recurrent major
depressive episodes

89
Q

How does depression occurring in adolescence affect the likelihood of adult depression?

A
  • Depression occurring in adolescence is often followed by depression in adult life,
  • Also predicts a roughly six-fold increase in adult suicide rates.
90
Q

How does depression occurring before puberty affect the likelihood of adult depression?

A

Depression occurring before puberty is less likely to lead to adult depression

Psychiatry3 (7 decks)

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