Depressive Disorders

Question 1

core characteristics of depression

Answer 1

• 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

Question 2

symptoms of depression

Answer 2

affective/emotional: sadness, irritability

physical: fatigue, poor sleep

cognitive: poor concentration, negative self view or of future

behavioral: withdrawn, agitation

Question 3

depression as a symptom, syndrome, and disorder

Answer 3

symptom - feeling sad/miserable

syndrome - more than sadness, anhedonia, combo of symptoms

disorder - diagnosis when interfere w/ life, we look at 3

Question 4

major depressive disorder (MDD)

Answer 4

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

Question 5

persistent depressive disorder (PDD)

Answer 5

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

Question 6

variation of depression with age

Answer 6

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school age - argumentative, somber, withdrawn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

Question 7

comorbidity of MDD and PDD

Answer 7

• 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

Question 8

3 theories of depression

Answer 8

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

Question 9

etiology

Answer 9

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)

Question 9

CBT

Answer 9

most successful and most common
- attribution training used to challenge youths’ pessimistic beliefs

Question 9

2 best therapy approaches (just list)

Answer 9

• CBT
• Interpersonal Psychotherapy for Adolescent Depression (ITP-A)

Question 9

ITP-A

Answer 9

explores family and interpersonal interactions that maintain depression
- family sessions and individual sessions may be used
- encourage youth to understand their cognitive styles

Question 10

medication

Answer 10

• 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

Question 10

outcomes of depression

Answer 10

• 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

Question 11

core characteristics of DMDD

Answer 11

• 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

Question 12

comorbidity of DMDD

Answer 12

comorbidity w/ ADHD, CD, MDD; but DSM does not allow comorbid diagnosis of ODD or Bipolar Disorder
- if show symptoms of ODD and DMDD, must pick DMDD
- if showing symptoms of bipolar and DMDD, must pick bipolar