Internalising disorders

Question 1

developmental psychopathology

Answer 1

The study of the onset and maintenance of psychological disorder across the lifespan

It takes into account:
o Changes in symptomatology
o Deviations from normal development
o Early precursors of mental health problems
o The influence of multiple pathways 

Children may outgrow the disorder

Classification system important to test effectiveness of treatments and when collecting information about the prevalence of the disorder

Classification systems important for differential diagnosis

Question 2

internalising disorders

Answer 2

“Inward-looking and withdrawn behaviours, which in children may represent the experience of depression, anxiety and active attempts to socially withdraw” (Davey, 2008)

Common factor in anxiety and depression – e.g. negative affect (feel sad, worried etc.)

There are also differences between disorders

The focus is inward

Question 3

depression and anxiety over the life course

Answer 3

see notes

Problems can be quite stable

Question 4

changes in anxiety disorder presentation across the lifespan

Answer 4

Some only prevalent at certain ages (e.g. fear of falling)

How can we differentiate fear v anxiety?

Walk away – adaptive response – fear

Anxiety – maladaptive – causes significant impairment in the indv

see notes

Question 5

perceived family impact of preschool anxiety disorders

Answer 5

see notes

Some disorders can cause a lot of problems

Separation anxiety

Obsessive Compulsive Disorder (OCD)

Specific phobias

(Problems with specific situation or object)

Question 6

DSM-IV diagnostic criteria for Generalised Anxiety Disorder (GAD)

Answer 6

1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events/activities (such as work or school perf)
2. Indv finds it difficult to control worry
3. Anx and worry associated with 3 (/+) of following symptoms (with at least some symptoms having been present for more days than not for past 6 months) – only 1 item required in children:
   • Restlessness/feeling keyed up/on edge
   • Easily fatigued
   • Difficulty concentrating/mind going blank
   • Irritability
   • Muscle tension
   • Sleep disturbance (difficulty falling/staying asleep/restless, unsatisfying sleep)
4. Anx, worry/physical symptoms cause clinically sig distress/impairment in social, occupational/other imp areas of functioning
5. Disturbance not attributable to phys effects

Question 7

vulnerability risk factors for anxiety

Answer 7

(personal attributes that can lead to maladjustment under stress/adversity)

Genetics

Behav inhibition

Info processing

Question 8

env risk factors for anx

Answer 8

Life events

Info transfer

Modelling

Parenting

Question 9

genetic factors

Answer 9

“Genetic factors play an imp role in most, if not all, psychiatric disorders

Few common single gene psychiatric disorders exist, and genetic influence is more commonly the result of a no. of genes, each having small effects

Genetic contribution to psychiatric disorder variable, being higher in bipolar disorder and autism, and lower in anx disorders”

Genetic factors only explain 1/3 of variance in anx problems

Higher in MZ twins as they share more DNA

Question 10

behavioural inhibition

Answer 10

Refers to temperamental pattern of responding characterised by fearfulness, reticence or restrain when faced with unfam people/situs

Strong association between BI and anx disorder in children – not all BI children develop anx disorders suggesting other factors also at play – only 50%

Question 11

interactions between child’s and parent characteristics in predicting child’s behaviour

Answer 11

(Aktar, Majdandžić, de Vente and Bögnels, 2013)

N = 122 12-month-old infants

Took part in social referencing paradigm in lab – met stranger and saw mechanical dinosaur

Looked at mothers body posture and behav

Sig interaction between infants with moderate to high levels BI and parents’ anx in predicting infants’ avoidance – effects didn’t differ by parent’s gender

see notes

Question 12

BI in adolescence

Answer 12

N = 968 adolescents aged 12-18

Completed a questionnaire about BI,

Question 13

interpretation of ambiguity

Answer 13

27 children with anx disorder and mothers and 33 children from community and mothers – 7-15

Mothers and children completed measure of anx and indicated most likely interp of ambiguous scenarios

Sig pos links between child’s and mother’s anx

After treatment, decrease in threat interp in both mothers and children

Anx interp can be changed with treatment

Question 14

cognitive biases can maintain/cause anxiety

Answer 14

(Steinman & Teachman, 2010)

N = 75 Ps who scored high on anx allocated to pos training condition (resolved ambiguous scenario pos)/one of 2 control conditions (neutral/no training)

Pos training resulted in more pos and less neg interps and was associated with lower levels of anx

Neg biases changed with treatment

Better when trained to give pos interp in ambiguous scenario

see notes

Question 15

environment risk factors for anxiety disorder (summary)

Answer 15

Neg life events

Info transfer

Modelling

Question 16

negative life events

Answer 16

Can lead to development and maintenance of anx in children

May be bi-directional influences – anx can predict subsequent neg life events

Why?
o Anx indvs focus more on negative aspects
o Might have more physical health problems leading to more neg experiences
o Attract neg experiences
o Anx adolescents avoid fears and so experience depression and loneliness – criticised by others

Question 17

information transfer (Field)

Answer 17

Examined if transfer/threat info influence children’s fears/avoidance

Results indicated that children who received neg info reported greater fear beliefs about fictitious monster

Info received from adult had greater influence

Question 18

parental modelling of anxiety

Answer 18

Study examined effect of parenting modelling on fear acquisition and avoidance of novel stim

Sample = 30 toddlers and mothers

Toddler presented with rubber snake and spider, paired with maternal pos and neg facial expressions

Results showed toddler more fearful and avoidant when mothers expressed neg facial expressions

Effects greater in girls – mothers may have greater effect on girls

Question 19

examining the association between parenting and childhood anxiety: a meta-analysis

Answer 19

(McLeod, Wood and Weisz, 2007)

Analyses revealed that parental control was more strongly associated with child anx than parental rejection

The modest association between parenting and child anx suggests that understanding the origins of children’s anx will require identifying factors other than parenting that account for the bulk of the variance

Don’t allow children to develop problem-solving skills – develop some habitual avoidance

Rejected how to deal with situ – prompted child until proposed avoidance strat

Question 20

treatments

Answer 20

VR (e.g. fear of flying)
o Exposure to stim will help them over time

Mindfulness
o Mindful of behaviours

Cog modification bias
o Optimistic/pessimistic etc.
o Depression – focus on threats – feel unable to deal with stressors
o Try and change maladaptive beliefs

Question 21

DMS diagnostic criteria for Major Depressive Disorder

Answer 21

Depressed mood/irritable most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad/empty) or observation made by others (e.g. appears tearful)

Decreased interest/pleasure in most activities, most of each day

Sig weight change (5%)/change in appetite

Change in sleep: insomnia/hypersomnia

Question 22

screen for cognitions that may mimic/coexist with MDD

Answer 22

Substance abuse causing depressed mood

Medical illness causing depressed mood

Other disorders:
o Mania
o Hypermania
o Bipolar
o Schizoaffective, Sz, etc.

bereavement

see notes

Delays in developmental accomplishments in infancy predict depression later in life (e.g. sleeping problems, toilet training problems, delays in intellectual growth)

Preschool children have difficulty verbalising issues – instead looked at how they play – play is very sad/neg

Separation anx is risk factor

Don’t take pride in accomplishments is risk factor for later depression

Older children
o Low self-esteem and confidence, self-criticism, destructive behavs
o Mood swings
o Neg
o Experience problems at school – academic achievement, truancy
o Sleep problems
o Changes in weight

Question 23

probability of experiencing an episode of MDD as a function of age and gender

Answer 23

see notes

Higher depression in females – why?
o More emotional
o More self-reflective
o Negative events – neg events in fam env
o Females more likely to report how they feel – methodological issue
- Changes in hormones – changes in physical characteristics – cause distress
o Differences in daily lives – sexual harassment
o More likely to be sensitive to stress – more emphasis on social r’ships

Depression increases during adolescence
o Bio changes – brain maturation, hormone changes – use of higher order thinking – think in abstract way – make generalisations and make evaluations
o Changes in emotionality – experience intense sadness and over extended periods
o Become more independent

Question 24

prevalence of depression by gender and age group

Answer 24

see notes

Question 25

risk factors for childhood depression

Answer 25

Abuse and neglect

Parental marital partner changes

Physical health

Parental mental health

Parenting and caregiving
o Unresponsive parenting

Question 26

risk factors for depression in adolescence

Answer 26

Cognition (neg cognitions and attribution style)

Dispositional factors (e.g. low self-esteem, self-consciousness)

Stress (stress and neg events)

Social skills (poor social skills, parent-child conflict)

Social support (low social support from fam and friends)

Physical health

Academic dissatisfaction (e.g. grades, school absenteeism)

Question 27

key brain regions involved in affect and mood disorders

Answer 27

see noteS

Question 28

ntms

Answer 28

Serotonin is a brain neurotransmitter involved in several processes (e.g. mood, sleep appetite) – low levels of serotonin associated with depression

Norepinephrine is a hormone that acts as a ntm – responsible for preparing the mind and body for action – ev shows its associated with depression and mania

Question 29

Beck’s cognitive triad

Answer 29

Depressed indvs tend to have neg thoughts about:
o The self (e.g. I am worthless)
o The world (e.g. the world is not fair)
o The future (e.g. there is no hope)

Cog biases in way depressed people think – think will fail or experience of loss – predispose to feel depressed

Question 30

a unified model of depression: integrating clinical, cognitive, biological and evolutionary perspectives

Answer 30

see notes

Question 31

attributions

Answer 31

Depressed indvs are more likely to attribute neg events to factors that are:
o Internal (e.g. it’s because of my personality)
o Stable (e.g. I will always fail)
o Global (e.g. my whole life is a failure)

5-year-old children of depressed mothers were more likely to express depressive cognitions about their self-worth, perf and outcome of comp game compared to children of non-depressed mothers (Murray, Woolgar, Cooper & Hipwell, 2001)

Question 32

emotion-regulation strategies across psychopathology: a meta-analytic review

Answer 32

see notes

Question 33

mood repair mechanisms in depressed and non-depressed youths

Answer 33

see notes

Question 34

the family context

Answer 34

see notes

R’ship may not be linear

Question 35

interventions

Answer 35

Drug treatments (aim to increase serotonin, e.g., selective serotonin reuptake inhibitors; SSRIs)

Behav therapy (e.g., time-out, exposure, behav management techniques)

Fam interventions (e.g., boundaries, communication) and parent training programmes

CBT (e.g. focus on problematic thoughts and feelings)

Play therapy (suitable for younger children)

Question 36

separation anxiety

Answer 36

characterised by excessive anxiety about separation from caregivers/home

often associated with somatic complaints (e.g. stomach aches, nausea)

affects 2-5% of children and adolescents

e.g. refuse to go to school, worry about the parents, need parents to stay awake while sleeping

Question 37

OCD

Answer 37

characterised by intrusive, repetitive thoughts, obsessions and compulsions (e.g. checking, washing, touching, ordering)

often comorbid with Tourette’s syndrome and tic disorders

thoughts and behaviours are difficult to resist and control

irrational

but not aware of behaviour

Question 38

specific phobias

Answer 38

e.g. social phobia is characterised by avoidance of social situations

specific phobias affect 7% of school-aged children

can lead to low self-esteem and confidence