Day 14-16 - Depression Flashcards
What is dysphoria?
prolonged sadness
Distinguish between Symptom, Syndrome, and Disorder in terms of depression
- symptom: feeling/emotion of sadness (very common)
- syndrome: cluster of common symptoms, extreme on dimension of negative mood/affect
- disorder: syndrome that has been occurring for certain amount of time and w certain level of impairment
What is are the requirements for MDD in the DSM?
- presence of major depressive episode
- 5 symptoms during same 2w period
- at least one of: depressed mood/irritability most of day OR anhedonia most of day
- plus 3-4 other symptoms (sleep issues, weight issues, decreased concentration, etc)
What are the 8 specifiers for depressive disorders?
- Anxious distress
- Mixed features
- Melancholic features
- Atypical features
- With psychotic features
- With catatonia
- Peripartum onset
- Seasonal pattern
Which 2 specifiers of depression are the only ones relevant to persistent depressive disorder?
- anxious distress
- atypical features
What is required for a diagnosis of pervasive depressive disorder?
- depressed mood for 2y in adults (1y for kids/teens)
- 2+ symptoms
- never been without symptoms for more than 2mo during period of 1/2y
What is required for a diagnosis of DMDD?
- severe recurrent temper outbursts
- outbursts inconsistent w developmental level
- outbursts avg 3+ times per week
- irritable or angry mood between outbursts
- symptoms for 12mo+
- not diagnosed before 6 or after 18
- age at onset of outbursts/mood is before 10y
- has never met criteria for manic/hypomanic episode
DMDD is not diagnosed concurrently with ___ or ___
ODD (DMDD is more severe) or bipolar disorder
(T/F) DMDD is well-differentiated from ODD/CD
FALSE (no diff btw youth w/wo DMDD diagnosis in symptom severity or functional impairment)
In Copeland’s study, DMDD occurred w another disorder ___% of the time
62-92% of time
The ____ of the DMDD diagnosis is not firmly established
validity
What is the lifetime prevalence of MDD for:
- preschool kids
- elementary kids
- teens
- preschool kids: 1%
- elementary kids: 2%
- teens: 11% (increases across teens)
What is the gender ratio for MDD?
- similar levels in childhood but gap widens in late teens
- far more women diagnosed
What are the 5 possible explanations for the gender gap in MDD? What does research say about each one?
- girls more likely to seek help (FALSE)
- biological factors (puberty linked to dep in girls only)
- stress/interpersonal stress
- cognition (cognitive bias; appears comparable across genders)
- coping (girls more likely to ruminate)
Early onset depression is usually linked with (higher/lower) risk for more severe depression later on
HIGHER
What are some particular considerations for MDD in preschoolers?
- 2w MDE duration criterion not as relevant
- MDD in preschool ass w MDD 2y later even if 2w MDE criterion not met
- 2.7x more likely to be depressed at school age
- higher rates of anxiety and ADHD
Children w parent who was depressed as child are __x more likely to become depressed before age 13. What are 2 reasons for this?
- 14x
- heritability (35-75%)
- stress reactivity (early exp to stress can sensitize to later stress)
T/F only post-partum depression can have lasting impact on the baby
FALSE (prenatal dep has effect on child’s cortisol at 6-7y)
What are 2 ways postpartum depression can impact the baby?
- through breastmilk (not much research)
- behavioral (less responsive parenting)
What stage of information processing most often goes wrong for those w mood disorders?
- interpretation (automatic negative interpretation!)
What did the study looking at interpretation of ambiguous words in girls at risk for depression find?
- 10-14yrs (mom w history of dep OR control)
- NONE had current diagnosis
- presented w 2 words at same time (eg cry and dry)
- assessed interpretation
- at risk girls showed pref for negative words if depression-related!!
- controls showed pref for positive words in neutral-pos pairing
How are response search and response decision impacted in depression?
- identify fewer assertive strategies
- report self less able to carry out assertive strategies
- think avoidant strategies are more likely to result in positive outcomes
Define stress exposure vs stress generation models of depression
- stress exposure: depression results from exposure to stressful events
- stress generation: depression may lead individuals to generate stressful life events
Describe the 2000 study by Rudolph investigating the stress generation model of depression
- assessed life stress in 88 kids
- subjective and objective (researcher ratings)
- depression ass w dependent (caused by child) and interpersonal stress
- depression not ass w independent stressors
- kids w both depression and externalizing disorder experienced highest lvl of both interpersonal and non-interpersonal dependent stress
- generally supports stress generation models
How do depressed children impact their friends’ affect?
- friends’ affect becomes more negative over interaction
- co-rumination increases FQ but also increases internalizing sx
- reassurance seeking gets irritating to friends
Depression may begin or deepen as part of a ____
downward emotional spiral
The goal of CBT is to bring the ___ in line with the ___
reaction in line w the event
CBT is a great example of therapy as ____ and ____
observation and experiment
CBT involves helping youth learn how to ___ their thoughts/feelings/behavior, ____ alternative explanation, and ____
observe, consider, solve problems
A 2019 meta-analysis of CBT effectiveness for kids and teens by Oud et al found that:
- subclinical @ baseline had __% lower risk dep at follow-up
- clinical dep @ baseline had __% lower risk
- _____ and ____ predicted positive outcomes
- subclinical: 63% lower risk
- clinical: 45% lower risk
- combo behavioral activation + thought challenging AND involving parents in intervention
What 3 types of depression interventions for teens in LMIC worked best?
- CBT
- integrated (CBT and others)
- economic interventions
- (interpersonal therapy helped but not reliable finding)
What are 4 types of antidepressants used for youth? What evidence do we have of efficacy?
- Tricyclic antidepressants (no evidence of efficacy in youth)
- MAOIs (mixed evidence for teens, potentially lethal side effects)
- SSRIs (good evidence for Prozac in teens, not fatal in OD)
- SNRIs (like SSRI but also block norepi and slower acting)
What is a black box warning?
- warning by FDA on SSRIs
- suggestion of increased risk of suicide in kids/teens
What do recent studies suggest about suicidality and antidepressants?
- might not actually be a link
- generally, as antidepressant use goes up in an area, suicidality goes down
- FDA warnings decreased med use but increased attempts (no change in actual suicides)
- basically, evidence is MIXED
How is depression treated in preschoolers?
- evidence for adapted parent management training
- not much research otherwise
- therapy recommended as first approach
- if needed can try Prozac w lots of monitoring
What did the Treatment for Adolescents with Depression (TADS) study find? What about the follow-up?
- groups w active meds did better in terms of dep sx
- CBT did not outperform placebo pill!!!! (maybe bc sample was very severe)
- CBT is potential protective factor against suicidal events
- SSRI + CBT best for moderate-severe MDD
- after 36w CBT group caught up in terms of gains
- suicidal ideation more common in meds only tx
- gains maintained 1y later for all groups!
