days 14-17 Flashcards
3 core symptoms of depression in youth
dysphoria, irritability, anhedonia
dysphoria
prolonged sadness
irritability
Extra sensitive. Perceived peer rejection. Hositility. Moodiness.
anhedonia
loss of pleasure or interest in previously enjoyable activities
what is a major depressive disorder defined by ? the presence of __ ?
MDD is defined by the presence of a major depressive episode.
do the depressive episodes need to be recurring to have a diagnosis of MDD?
No, a diagnosis of Major Depressive Disorder (MDD) in children (and adults too) only requires one major depressive episode, it doesn’t need to be recurring.
if a child has multiple episodes of depression, could he still receive the diagnosis of MDD?
Yes!
If a child has one episode, it’s diagnosed as MDD, single episode.
If they later have another distinct episode (meaning a period of at least 2 months in between where symptoms mostly go away), it becomes MDD, recurrent.
How atypical is the atypical features specifier for depressive disorders?
It’s actually pretty common in youth.
there are a lot of specifiers for depressive disorders, try to remember the general idea for each: anxious distress, mixed featured, melancholic features, atypical features, psychotic features, catatonia, peripartum onset, seasonal pattern
Anxious: The child shows a lot of anxiety symptoms along with depression
Mixed features: There are some symptoms of mania or hypomania mixed into the depressive episode (like elevated mood, high energy, talking fast) — but not enough to meet criteria for bipolar disorder.
Melancholic: The depression is more “classic” — very severe
Atypical: mood can improve a bit with good news, increase appetite, sleeping a lot
With psychotic features: The depression is so severe that it includes psychosis: hallucinations or delusions.
With catatonia: abnormal movement or lack of movement, very severe
Peripartum onset: not common in youth, but relevant for older teens, depression that starts during pregnancy or within 4 weeks after delivery
Seasonal pattern: The depressive episodes show up around the same time every year
What are the diagnostic criteria for major depressive disorder in youth?
5 symptoms total during the same 2 week period. one of the symptom has to be either depressed mood or anhedonia.
other symptoms: weight loss or weight gain, insomnia/hypersomnia, psychomotor retardation, fatigue or loss of energy, feelings of worthlessness/inappropriate guilt, diminished ability to think or concentrate, indecisiveness, recurrent thoughts of death or suicidal ideation
What are the diagnosis criteria for PDD?
- depressed or irritable mood for most of the day, most days than not
- for children and adolescents, must last ONE year
- two or more other symptoms (poor appetite, insomnia, low energy…)
- during one year period, the person has never been without the symptoms for more than 2 months at a time
What is pure PDD?
You haven’t met criteria for a major depressive episode in the past year.
Can you be diagnosed with MDD and PDD at the same time?
Yes, it’s called “PDD with intermittent major depressive episodes
What are the diagnosis criteria for disruptive mood dyregulation disorder (DMDD)
○ Key feature: frequent temper oubursts (3+ times a week) that are way out of proportion
○ Child is always irritable or angry
○ Symptoms last for at least 12 months
○ Not diagnosed before 6 and after 18
Age of onset must be before 10
How would you differentiate DMDD and bipolar disorder in terms of irritability ?
DMDD has chronic irritability. With bipolar disorder you’re looking more at a specific episode
How would you differenciate DMDD and ODD
In DMDD, the core is irritability. In ODD core issue is behavior – defiant, argumentative, vindictive.
Is the validity of the DMDD diagnosis firmly established?
No, not well differenciated from CD or ODD
prevalence of MDD across time?
pre-school children: 1%
elementary school children: 2%
adolescents: 11%
gender differences of MDD?
in childhood: no differences
becomes pronounced in adolescence
possible explanations for gender gap in MDD
- Help-seeking behavior
Girls may seek help more → might inflate rates
But findings are mixed — not consistently supported
- Biological factors
Early puberty = higher risk in girls
Hormonal changes may increase sensitivity to stress
3a. Actual stress (esp. during puberty)
Physical/appearance changes
Gender role expectations
Increased sexualization, unwanted attention
3b. Interpersonal stress
Girls often experience more peer conflict, rejection
Relationships are more emotionally intense/socialized differently
- Cognitive style
Catastrophic thinking patterns found in both genders
May not fully explain gender gap
- Coping strategies
Girls more likely to ruminate (repetitive, passive focus on distress)
Rumination linked to longer, more intense depressive symptom
They say children of depressed parents are more likely to be depressed. They also say children with a parent who was depressed as a child are 14x more likely to become depressed before age 13. Why is that?
- heritability: between 35% and 75%
- stress reactivity: early exposure to stress which may sensitize a person to later stress
ex. number of months a women is depressed during pregnancy predicts elevated levels of cortisol when children are 6-7 years old
ex2. suggested that higher cortisol levels leads to more cortisol in breast milk
how does depression impact social-cognitive processing (response search and response decision steps)
response search: identify fewer assertive stratgies (not asking for what they want as much)
response decision: choosing the assertive strategies less because belief that not able to carry them out
Stress exposure models of depression vs stress generation models
- Stress exposure: depression results from experiencing stressful events
- Stress generation: depression may lead individuals to generate or play a part in future stressful events.
Study that tested the Stress Generation Model of Depression. What type of stressor is most associated with depression?
Kids with depression had more dependent, interpersonal stress. aka they were more likely to be involved in creating relationship stress (like fights with friends or rejection). These interpersonal circumstances, in turn, may exacerbate depression
This supports the stress generation model:
Depressed kids may unintentionally contribute to creating stressful situations, especially in their relationships.
