Depressive Disorders Flashcards
core characteristics of depression
- a low mood OR loss of interest/pleasure (anhedonia) in combination with other symptoms
- more intense and persistent than the blues, interferes w/ daily routines, school performance, relationships
symptoms of depression
affective/emotional: sadness, irritability
physical: fatigue, poor sleep
cognitive: poor concentration, negative self view or of future
behavioral: withdrawn, agitation
depression as a symptom, syndrome, and disorder
symptom - feeling sad/miserable
syndrome - more than sadness, anhedonia, combo of symptoms
disorder - diagnosis when interfere w/ life, we look at 3
major depressive disorder (MDD)
5+/9 symptoms most of day nearly every day for 2 weeks; 1 must be depressed mood OR anhedonia
- avg episode in children lasts 8mos
- children/youth may show irritable mood instead of depressed, may fail to gain expected weight
- must specify if symptoms new or recurring
- acute condition, can come on sudden and leave
persistent depressive disorder (PDD)
2 years+ of depressed mood most of the day more days than not and 2+/6 symptoms; can’t be w/o symptoms for more than 2mos
- chronic condition, stays awhile
- youth can show irritable mood; duration for diagnosis must be 1 year
- must specify early or late onset (age 21) and severity
variation of depression with age
infants - passive, unresponsive
preschoolers - tearful, clingy, somatic probs
school age - argumentative, somber, withdrawn
adolescence - hopelessness, guilt, disturbed sleep, eating probs, more likely to have symptoms of suicide or psychosis
comorbidity of MDD and PDD
- up to 90% of youth have 1+ comorbid disorders
- MDD and PDD co-occur, PDD usually first
- MDD & PDD both co-occur w/ anxiety, ADHD, CD, substance use disorders, eating disorders, personality disorders (usually BPD)
- MDD and PDD usually develop after other disorders except for substance use disorders
3 theories of depression
attachment - insecure early attachments; distorted internal working models of self and others
psychodynamic - actual or symbolic loss of love object (parent); anger toward love object turned inward, severity of superego, loss of self-esteem
cognitive - distorted/maladaptive cognitive structure/processes; negative view of self, world, future, poor prob solving, hopelessness
etiology
interactions b/t biological, environmental, individual factors
bio - genetics show mod. heritability (.40), neurobio show smaller amygdala, altered neural circuits, etc
individual/emotional - inaccurate identification of own/others’ emotions, poor emotional regulation
environmental - interpersonal (less warm/supportive parents, critical/conflicts, impaired social skills) and other environmental (more severe and nonsevere stressful life events in previous 6-12mos)
CBT
most successful and most common
- attribution training used to challenge youths’ pessimistic beliefs
2 best therapy approaches (just list)
- CBT
- Interpersonal Psychotherapy for Adolescent Depression (ITP-A)
ITP-A
explores family and interpersonal interactions that maintain depression
- family sessions and individual sessions may be used
- encourage youth to understand their cognitive styles
medication
- SSRIs are first line of treatment, treat mood disturbances and other symptoms of depression, can be very helpful
- some have concerns about serious side effects in youth (suicidal thoughts, self harm), and the lack of info on long-term effect on developing brains
outcomes of depression
- some youth recover spontaneously; recovery rate w/ intervention is high, especially for MDD; but relapse rate is also higher (earlier age of onset, higher risk of relapse)
- 30% of youth w/ MDD develop Bipolar | within 5 years; MDD has higher mortality rate than many diagnoses
- as adult, higher risk for leaving school, marital probs, substance use, hospitalizations
- fewer stressful life events + social support = positive prognosis
core characteristics of DMDD
- disturbance in mood + other symptoms that disrupt functioning
- new DSM diagnosis to ID children w/ persistent irritability and frequent extreme behavioral dyscontrol
- used to address the extreme increase of diagnoses of bipolar in children
- included in DSM before evaluated empirically
- more common in boys and before adolescence
