Depression

Question 1

Mood Disorders in Children

Answer 1

• Most research tends to make evident that the majority of younger children develop depression in response to situational events.
• This differs with increasing age, as adolescents are seen to have a genetic basis for developing mood disorders
• As a psychologist in schools it is my professional and ethical responsibility to be an advocate for the child; this advocacy begins with the assumption that the defect does not rest within the child, but within the environment.

Question 2

Risk factors for Mood Disorders

Answer 2

Difficult temperament
Low positive mood
Family conflict 
Maternal depression
Parenting style
Rejection by peers
Poverty
Stressful life events
Trauma

Question 3

Protective factors

Answer 3

Increased attentional control (being able to shift focus from negative events) & locus of control
High academic achievement
School connectedness
Family cohesion
Supportive peer group

Question 4

Disruptive Mood Dysregulation Disorder

Answer 4

• persistent irritability and frequent episodes of extreme behavioral dyscontrol
• Severe recurrent temper outbursts manifested verbally &/or behaviorally that are grossly out of proportion in intensity/duration to the situation/provocation.
• Temper outbursts inconsistent with developmental level
• Temper outbursts occur, on average, 3x+/week
• The mood between temper outbursts is persistently irritable/angry most of the day, nearly every day, & is observable by others
• Criteria above has been present for 12+ months
• No period lasting 3+ months without all of the sx above
• Criteria 1 & 4 are present in at least 2 out of 3 settings (home, school, peers) & are severe in at least 1 setting
• This dx should not be made for 1st time before age 6 or after age 18
• By hx/observation, the age of onset is before 10 years
• Never been a distinct period lasting more than 1 day during which the full sx criteria except duration for manic/hypomanic episode have been met
• Developmentally appropriate bx not applicable
• Bx does not occur exclusively during an episode of MDD & not better explained by another dx or general medical/neurological condition
• DMDD >ODD
• Manic/Hypomanic Episode>DMDD

Question 5

Major Depressive Disorder

Answer 5

• 5+ sx of the following below have been present during the same 2 week period & represent a change from previous fx
• Depressed mood most of the day, nearly every day, as indicated by report/observation (in children/adolescents, can be irritable mood)
• Markedly diminished interest/pleasure in all, or almost all, activities most of the day, nearly all day (by account/observation)
• Significant weight loss when not dieting/weight gain or decrease/increase in appetite nearly every day (in children: consider failure to make expected weight gain)
• Insomnia/hypersomnia nearly every day
• Psychomotor agitation/retardation nearly every day
• Fatigue/loss of energy nearly every day
• Feelings of worthlessness/excessive/inappropriate guilt (which may be delusional) nearly every day
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, suicide attempt, or specific plan for committing suicide
• Diminished ability to think/concentrate, indecisiveness nearly every day
• At least one of the sx is either 1) depressed mood/2) loss of interest/pleasure
• Do not include sx attributable to another medical condition
• Sx cause clinically significant distress/impairment in social, occupational, or other important areas of fx
• Episode not attributable to the physiological effects of a substance/another medical condition

Question 6

Major Depressive Disorder (Specify)

Answer 6

Specify:
Mild
Moderate
Severe
W/ psychotic features
In partial remission
Specify if: Single Episode/Recurrent episode
Specify if: In full remission/Unspecified
Specify:
W/ anxious distress
W/ mixed features
W/ melancholic features
W/ atypical features
W/ mood-congruent psychotic features
W/ mood-incongruent psychotic features
W/ catatonia
W/ periparturm onset
W/ seasonal pattern

Question 7

Persistent Depressive Disorder (Dysthymia

Answer 7

Depressed mood for most of the day, for more days than not, as indicated by either subjective account/observation by others, for at least 2 yrs
In children & adolescents, mood can be irritable & duration must be at least 1 yr
Presence, while depressed, of 2+ of the following:
Poor appetite/overeating
Insomnia/hypersomnia
Low energy/fatigue
Low self-esteem
Poor concentration/difficulty making decisions
Feelings of hopelessness
During the 2 year period (1 yr for children/adolescents) of the disturbance, the individual has never been w/out the sx above for more than 2 months at a time
Criteria for MDD may be consistently present for 2 yrs
There has never been a manic episode/hypomanic episode & criteria never met for hypomanic episode
Not better explained by another mental disorder
Sx not attributable to effects of a substance
Sx cause clinically significant distress/impairment in social, occupational, or other important areas of fx

Question 8

Persistent Depressive Disorder (Dysthymia) (Specify)

Answer 8

W/ anxious distress
W/ mixed features
W/ melancholic features
W/ atypical features
W/ mood-congruent psychotic features
W/ mood-incongruent psychotic features
W/ catatonia
W/ periparturm onset
W/ partial remission
W/ full remission
Early onset
Late onset