Depression Flashcards
Psychoanalytic Perspective in child and adolescent depression
- psychoanalytic theory posits that depression results from an intrapsychic conflict between the ego and persecutory superego ( no yet fully developed)
- psychoanalysis held that the superego was formalized only after resolution of the Oedipal Conflict, which occurred by late adolescence
- by this theory then, childsren could not experience intrapsychic conflict, and ergo, could not develop mood disorders
- children were unable to feel profound guilt, shame, and a sense of absolute right and wrong and were, therefore, unable to develop clinical depression
Epidemiology of depression and prevalence
- 12 month prevalence in the US is about 7%
- general accepted 1 year incidence is:
- preschool age- 1%
- school age- 2%
- adolescent age- 4-8%
- lifetime prevalence of MDD among adolescents is 15-20% (similar to adults)
Gender Ratio for Depression:
Childhood:
1:1
Adolescence:
2: 1 (female to male)
* 1.5-3x higher rates in females
DSM-5 diagnostic criteria of Depression
- requires 5 of 9 symptoms for the diagnosis
- at least one symptom is either depressed mood or anhedonia (diminished interest or pleasure in life)
- at least 2 weeks straight in duration with symptoms pretty much every day or most of the day
MDD:
- depressed mood
- anhedonia
- significant decrease in weight (5%)
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- diminished ability to think or concentrate or indecisiveness
- recurrent thoughts of death or suicidal ideation.
Neurovegetative signs of depression
- impairments in sleep, appetite, energy and concentration
- adolescents tend to suffer fewer vegetative problems than do depressed adults
Why does depression increase with age?
prevalence increases during adolescence, possibly due to:
- biological factors ( sexual maturation)
- environmental factors
- increased in social and academic explanations
- psychological and cognitive factors
Describe at least 3 theories of depression
Psychodynamic: anger turned inward, severe superego
- suffer from a severe and unrelenting superego and are extremely critical and prohibitive of their own fantasies, feelings, and actions
Attachment: insecure early attachment
- never adequately bonded to their primary caregivers- feel adrift and alone
Behavioral: inability to obtain reinforcement
- cannot gain pleasure from life
Cognitive: depressive mindset
- see the world in a distorted fashion
Genetics in Depression
- findings from twin studies suggest a moderate genetic influence on depression in community samples with heritability ranging from 35-75% across studies
- twin/adoption studies have not been conducted, so the extent to which clinical depression in children and adolescents is genetically driven is not known
- still. children with a parent who suffered from depression as a child are up to 14x more likely than controls to become depressed prior to age 13.
- Children of parents with depression have about 2-4x the risk of having depression
- Children of depressed parents have an earlier age of onset for their depression by 3 years
- their lifetime history of MDD in mothers of children with MDD is also high, about 50-75%
- A family history of depression is more common in 1 degree relatives of children with MDD than in children without MDD
The Serotonin Gene
- among those with pervasive suicidal thoughts and intent, levels of the major serotonin metabolite (5-HIAA) are lower in the cerebrospinal fluid
- adults with one or two copies of the short allele of the 5-HT transporter gene have been shown to exhibit ore depressive symptoms, diagnosable depression and suicidality in relation to stressful life events.
- short allele leads to reduced transcription of the 5-HT receptor and less serotonin uptake
Developmental variants (differences between children and adolescents) of depression;
- children have more symptoms of anxiety (phobias, separation), somatic complains and auditory hallucinations, while adolescents have more cognitive components to their depression than children
- Children depression is expressed as temper tantrums and behavior problems, whereas adolescent depression is expressed when guilt and hopelessness becomes apparent
- Children have fewer delusions or serious suicide attempts, and adolescents have more sleep and appetite disturbances, delusions, and suicidal ideation and attempts
- by middle childhood, reoccupations with death, lowered self-esteem , social withdrawal/rejection, and poor school performance
- adolescents, compared to adults, still have more behavior problems and fewer neurovegetative difficulties
how child/adolescent variation depression varies from adult depression
unlike adults, their negative mood may not entirely consume them, and they may still be able to enjoy numerous activities, engage with peers effectively, and compete their work relatively well at times, while demonstrating severe discomfort and behavior problems at other times. they have an inconsistent mood
Clinical course of child/adolescent depression
median duration:
- clinically referred: 7-9 months
- community: 1-2 months
90% off MDD episodes remit within 1-2 years after onset (remission is 2 weeks to 2 months with only 1 clinically significant symptom)
around 50% relapse
6-10% of MDD are protracted/ chronic
Predictors of increased duration and relapse of depression
predictors of increased duration: depression severity comorbidity negative life events parental psychiatric disorders poor psychosocial functions
Factors that increase the risk of Bipolar Disorder among children/adolescents with depression
- 20-40% of depressed children and adolescents develop bipolar disorder within 5 years of index episode of MDD
Predictors of Bipolar I Disorder onset:
- early onset MDD
- psychomotor retardation
- psychotic features
- family history of bipolar disorder
- family history of psychotic depression
- heavy familial loading for mood disorders
- pharmacologically induced (hypo)mania
