Lecture 8

Question 1

Overview of Mood Disorders

Answer 1

The DSM-5 divides mood disorders into 2 general categories:
Depressive Disorders: excessive unhappiness (dysphoria) and loss of interest in activities (anhedonia)
Bipolar Disorder: mood swings from dysphoria to high elation (euphoria) and expansive mood (mania)- both extremes

Depression vs.mania
Fall under mood disorder
Disturbance in mood- primary symptom
Extreme persisten and poorly regulated emotional states
Dimension
Depression vs mania(manic episodes)

Depressive- left side of spectrum

Question 2

Mood disorders

Answer 2

Depression- avoidance, sinking into activity t avoid feelings
Negative cognition- fixated on negatives, hopeless, negative bias to interpreting others behavior
Misreading social cues as most negative
Difficulty remembering joy
Underlying expectation that life will continue this way
Difficulty concentrating

Question 3

Depressive disorder

Answer 3

Historically, it was believed that children did not experience depression (rooted in psychoanalytic theories)

We now know:
Children do experience depression
Children’s depression is not masked, but may be overlooked

Psychoanalytic suggested- depression was inwards anger and children didn’t have concious developed to engage in self reflection- thought couldn’t be depressed like adults
Similar to adults
Show irrability more than adults

Question 4

Depression in children

Answer 4

Saw them as cognitively immature
Feeling sad is normal and important for development
When sadness persists= poor cool performance, poor relationships, more depression
Sad, fun has gon out of life
Parents and teachers- first to identify
Irritable and unhappy- 2 to 4 weeks and worsen- may be depressed
Worried, moody, tearful,bored, overeating, under eating,
Additional symptoms- aches and pains- non specific, social withdrawal, lack enjoyment in activities, isolated or clingy, loose interest in appearance
Must display range of symptoms for diagnosis that abuse impaired functioning
PDD- need regular sleep routine, healthy diet
Often just do to circumstances if persist and worsen- need to be refereed
Difficult to diagnose as may not be aable to describe feelings

Question 5

Depression and development

Answer 5

Expression of depression looks different throughout development and developemental stage of depression
Infancy
Little known, hard to identify
Early research found infants. Raised in hostile, cold environments show depression- sleep disturbance, not eating, crying more
Anacletic depression
Arises in neglect and abuse
Over sensitivity to stimuli, negative affect
Preschool
Withdrawn, inhibited
Some r, lack excitement
Show clingiest. And whining behaviour- issues separating from parent- complaining of physical symptoms
Elementary School
Similar to preschool
Argumentative behaviour
Irritability
Tantrums
Academic difficulties and peer problem
Physical complaints- sleep disturbance, headaches, weight issues
We=uicidal thoughts and behavior

Adolescence
Consistent with previous stages
Inc isolation
Cognitive issues- self blame, hopelessness
Excessive fatigue, eating disturbances
Suicidal attempts

Question 6

Depression symptoms syndrome disorder

Answer 6

Symptoms
Feeling sad or miserable- everyone feels depressed at one point in time, not a disorder- can occur without a problem
Common at all ages
Temporary and related to environment- breakup, bad grade

Syndrome
More then a sad mood- constellation of symptoms that co occur- anxiety, reduced pleasure and interest
Cluster of symptoms

Disorders
Also reflects a syndrome but underlying pattern and features distinguishing it from syndrome

Question 7

DSM-5 CRITERIA FOR MAJOR DEPRESSIVE DISORDER (MDD)

Answer 7

(A) 5 or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least 1 of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of day nearly dandy day
Loss of interest of pleasure
Significant weight gain
Insomnia or hypersonic
Fatigue
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to another
medical condition.
The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
There has never been a manic episode or hypomanic episode.- bipolar is more likely to be diagnosed
Same criteria used for school-age children, adolescents, and adults
Irritable mood is more common in children and adolescents than in adults
Irritable mood can be subsistuted for depressed mod in children
It is commonly portrayed with depressed mood

Question 8

Prevelanxe of MDD

Answer 8

Between 1–3% of preschool and school-age children experience MDD

Between 2–8% of children ages 4–18 years experience MDD

Lifetime prevalence estimates range from 11–20%- across all of childhood ranging across adulthood

Question 9

MDD and comorbidity

Answer 9

As many as 90% of young people with depression have one or more other disorders and 50% have 2 or more
Common comorbid disorders include:

Anxiety disorder persistence depressive disorder conduct problems adhd and substance abuse Anxiety- most often portrayed with depression

Question 10

Onset, Course, and Outcomes of MDD

Answer 10

Age of onset: usually between 13–15 years
Typical length:
Average initial episode 4 mos. in childhood, 2 mos. in adolescence
Clinical samples: average episode lasts 8 mos.
Recurrence/outcomes:
25% have a recurrence within 1 year
40% have a recurrence within 2 years
70% have a recurrence within 5 years
Bipolar switch: about 1 in 3
Milder symptoms- before MDD
Can be sudden or duration
High chance of recurrence
Bipolar switch – 1in 3 get diagnosed with bipolar

Question 11

Persistent Depressive Disorder (P-DD)

Answer 11

At least 2 somatic or cognitive symptoms
Double depression
Characterized by less severe, but more chronic symptoms of depressed mood that:
Also called dysthymic disorder or chronic major depression
Characterized by less severe, but more chronic symptoms of depressed mood that:
Occur for most of the day
Occur on most days
Persist for at least 1 years
Somatic- poor appetite, low energy
Cognitive- can’t concentrate, hopelessness
To get diagnosis- cant be without symptoms for more than 2 months
Persistent depression
Common to also be diagnosed with MDD- double depression can be diagnosed with both at same time

Question 12

Prevalence and Comorbidity of P-DD

Answer 12

1% of children and 5% of adolescents
70% of children with P-DD also have MDD
50% of children with P-DD have 1 or more nonaffective disorders that preceded:
Anxiety disorder conduct problems and adhd

Question 13

Onset, Course, and Outcomes of P-DD

Answer 13

Age of onset: 11–12 years

Typical length: 2–5 years

Outcomes: Most recover, but risk for other disorders is high
Earlier than MDD
3 years earlier than MDD
Prolonged course

Question 14

Disruptive Mood Dysregulation Disorder (DMDD)

Answer 14

Chronic, severe, persistent irritability with an onset prior to age 10 present for 12+ months
Irritability characterized by:
Frequent verbal or physical temper outbursts (3–4 times/week) in 2/3 settings (home, school, peers)
Chronic, persistently irritable or angry mood present most of the day, nearly every day
New disorder in DSM-5
Alternative to diagnosing BD in young children too frequently

Cant go longer than 3 months without displaying symptoms
Similar to adhd, ODD
Cant be diagnosed with both ODD or DMDD receive dmdd over it if portray both
Came about it reduce diagnoses of BD
Reflect individuals who are more depressed but portray irritability-s this useful- is it distinct form bd

Question 15

Bipolar disorder

Answer 15

Periods of elevated or irritable mood accompanied by increased goal- directed activity or energy, alternating with 1 or more major depressive episodes

Manic phases characterized by 2 mood states: elation and euphoria

Euphoria followed by depressive episode
Euphoria.= joy, intense happiness, exaggerated sense of well-being and confidence
Mania= excitement ad lots of energy- pressured speech- speaking quick, racing mind, hard to follow
Dec need for sleep, distracxtibility, impulsive, don’t feel need to eat, purchase big price item
In children- co occur with depression, blurred lines of symptoms of mania and depression

Question 16

Bipolar Disorder Symptoms and Types

Answer 16

Symptoms: restlessness, agitation, sleeplessness, pressured speech, flight of ideas, racing thoughts, sexual disinhibition, surges of energy, expansive grandiose beliefs

Three subtypes:
Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder

3 subtypes of bipolar disorder
Bipolar 1- lavender- depressed= for 2 weeks- MDE followed by mania- present for 1 week
Hypomania= less severe manic episode- 4 days to a week
Most severe
MDE followed by mania and alternates in. This pattern
Bipolar 2- still see MDE- 2 weeks followed by hypomania- less severe and shorter duration of mania
Cyclothymic- numerous and persistent hypomanic and depressed symptoms cause impaired functioning and depressed mood- don’t reach diagnosis for depression or mania
Black line
Red= normal- never reach severity

Question 17

Prevalence and Comorbidity of Bipolar Disorder

Answer 17

Between 0.5–2.5% of children ages 7–21 experience BD
Milder bipolar II and cyclothymic disorder more common than bipolar I
Commonly co-occurring disorders and medical problems:

Rare in children inc after puberty
Mildre subtypes- more common
To differentiate- symptoms only appear during mood episode- BD
If occur all the time- conduct disorder

Question 18

Onset, Course, and Outcomes of Bipolar Disorder

Answer 18

Age of onset: peak age of onset 15–19 (about 60% have 1st episode prior to age 19 and onset before age 10 is rare)

Course: bipolar episodes last 4–6 months if untreated
70% of adolescents recover from initial episode within 6 months
50% have at least 1 recurrent episode

Outcomes: Adolescents with mania typically have psychotic symptoms, unstable moods, and severe deterioration in behavior

No cure
Often continue to show difficulties- symptoms may worsen

Question 19

Gender and Depressive and Bipolar Disorders

Answer 19

Depressive Disorders
Starting around age 15, females are 2–3 times more likely to have clinical depression
Symptom presentation is similar

Bipolar Disorder
No gender differences in prevalence
Symptom presentation may differ (boys – manic moods; girls – depressed moods)

Until 15- no gender differences
Bipolar-
Boys- more manic moods
Girls- more emphasis on depressed mood

Question 20

Depression and Suicide

Answer 20

About 60% of youths with depression report having thought about suicide

1 in 3 who think about suicide, attempt it

Peak period for first attempts: ages 13–14
Depression and suicide co-occur
Among adolescents- suicide attempts double
Around 17- less attempts
Gender inference- girls more likely to attempt
Boys more likely to die during attempt- use more violent means, less likely to seek treatment

Question 21

Other Associated Characteristics

Answer 21

Intellectual and Academic Functioning
Difficulty concentrating, loss of interest, and slowness of thought and movement may have a harmful effect on intellectual and academic functioning
Not necessarily related to intellectual deficits
Low energy levels- impacts academic and intellectual functioning
Not difficulties in intellect
Cyclical pattern
Learning difficulties- feeling worthless and inadequate causing depression which worsens learning difficulties

Question 22

Cognitive Biases and Distortions

Answer 22

Selective attentional biases

Feelings of worthlessness

Depressive ruminative style

1-focus on neg cues, infer negative e events are caused by them- internalize it and see it as stable and unchanging
Reason why something bad happened applies tto all other situation.
2- low self esteem, attribution of failure
3- focus on negative events for long period of time

Question 23

Negative self esteem

Answer 23

Low and unstable self-esteem
Developmental model of feedback from others based on (in)competence in different domains:

Academic social relations sports
Includes in stable self esteem - highly reactive to enviromenment- causing fluctuations in self esteem
as individuals take info from others to learn about ourselves- competencies and incompetencies- related to negative self esteem and depression.

Question 24

Social, Peer, and Family Problems

Answer 24

2 mechanisms leading to relationship problems
Social withdraw- social helpless- withdrawn, little social interactions leading
Aggressive- arr aggressive and irritable
Co-rumination- two people focus on negative together- cycles into negative conversation- focus on negative
Can create social trauma bond
Is associated with higher. Ratings of social quality but causes worsening symptoms

Question 25

Psychodynamic Theories

Answer 25

Depression is the conversion of aggressive instinct into depressive affect in which an individual’s rage toward a lost “love object” is turned inward against the self.
Love object caregiver
Can be literal or symbolic(maltreatment, inadequate parenting)= creates anger, cant place it on love object so gets redirected to self
Not currently used or promoted
See depression without loss

Question 26

Attachment Theories

Answer 26

Focuses on parental separation and disruption of an attachment bond as predisposing factors for depression

Emotion regulation processes
Parent child relationship
Parent- consistently failing to meet needs of child= insecure attachement= in stable internal working models of self= worthless cant be loved and of other= not trusting, cant rely on others
Early relationships affect emotional regulation processes- co regulation from parent os crucial for emotional regulation- reducing stress and depression
Emotional regulation difficulties= factor of depression
In stable attachment= unstable emotional regulation= depression more likely

Question 27

Behavioral Theories

Answer 27

Depression is related to a lack of response-contingent positive reinforcement.
Emphasis on learning, environmental consequences, and skills and deficits
In activity- lead to depression
Change context change depression

Question 28

Cognitive Theories

Answer 28

Depressogenic cognitions

Hopelessness theory

Focus on relationship between negative thinking and mood.
Vulnerability in cognitive distortion interact with environment to in depressive symptoms
View of self, life and world influences behaviour
Depressogenic cognitions- overlap negative attribution style- focus on negative info

Hopelessness theory- depression caused by perceived absence of control over situation
Depression prone= make internal and stable attribution to explain negative events- caused by the, always be there and applies to everything
Good thing happens- externalizers it- not cause of them, wont happen again, unique- specific event

Question 29

Aaron Beck’s Cognitive Model

Answer 29

Depressed individuals make negative interpretations about life events. Three areas of cognitive problems
Information-processing biases
Negative cognitive triad
Negative cognitive schemata

1- only process negative info
2- negative views about onselsf, futures and world
3- negative self related schema hold model together- ensure depression continues

Question 30

Socio-Environmental Theories of Depression

Answer 30

Emphasize the relationship between stressful life events and depression
Diathesis-stress model
Emphasize the relationship between stressful life events and depression
Diathesis-stress model
Emphasize the relationship between stressful life events and depression
Diathesis-stress model
Stressful life event- can cause depressive episodes
Not all go on to exhibit disorder
Predisposition and stressful environment t work together to cause disorder

Answer 31

Genetic and Family Risk
Heritability estimates range from 30–45%

Children of parents with depression have about 3x risk of having depression

Transmission in families may be genetic, psychosocial, or both

Some genetic component
Linley to be combo of both genetic and psychosocial

Question 32

Neurobiological Influences

Answer 32

Abnormalities in structure and function of several brain regions involved in regulating emotional functions
Abnormalities in amygdala, cingulate, prefrontal cortex, hippocampus
Cortical thinning in the right hemisphere
HPA axis dysregulation – higher baseline levels of cortisol, overactive responses to stress
Overactivity of the amygdala
Read associated with regulating emotion
Over active amygdala- recognizing social stimuli
Ordinary interpersonal events seen as negative
Cortical thinning- reduce arousal cause attention and memory difficulties
More cortisol and more cortisol released in response to stressor

Question 33

Family Influences

Answer 33

Families of children with depression
Families display more critical and punitive behavior towards the depressed child than other children in the family- which causes which

Families where parents are depressed
Depression interferes with the parent’s ability to meet the needs of the child

Question 34

Stressful Life Events

Answer 34

Triggers for depression:
Interpersonal stress and actual or perceived personal losses
Life changes
Violent family environment
Daily hassles and other less severe stressful life events

Question 35

Emotion Regulation

Answer 35

Challenges with:
Emotional awareness
Recognizing changes in emotion
Accurately interpreting the conditions that led to mood change
Setting goals to change one’s mood
Have problems with emotional regulation
1- can’t recognize other’s emotions or their own, don’t know why they feel how they feel
Using avoidance to deal with stress

Question 36

Treatment

Answer 36

Fewer than 50% of children with depression receive help for their problem

Psychosocial interventions (behavior therapy, cognitive therapy, cognitive- behavioral therapy)
Interpersonal Psychotherapy for Adolescent Depression (IPT-A)
Psychopharmacological treatments

Question 37

Psychosocial Interventions

Answer 37

Behavioral Therapy
Aim is to teach children and their families how to strengthen positive child behaviors and eliminate or reduce unwanted or problem behaviors.

Cognitive Therapy
Aim is to teach depressed children to identify, challenge, and modify their negative thought processes to more positive, optimistic thought processes.

Cognitive-Behavioral Therapy
Most common and effective
Combines behavioral and cognitive therapies. Aim is to support more adaptive cognitions which can lead to more adaptive behavior and vice versa.
Behavioural- feeling depressed- go do something, be active instead of inactive
CBT= primary and secondary control enhancement training- teach control skills- action skills- change events and activities the ménage in, teach to relax
Think skills- change subjective impact of stressful events, changing thoughts and feelings

Question 38

Interpersonal Psychotherapy for Adolescent Depression (IPT-A)

Answer 38

Aims to increase adolescents’ independence and capacity to address relationship- based issues
Focus on social aspect
Relationships and moods work together
Adolescent- takes activ e role, identifies problem, engage in social strategies and support relationships, easing depression
Cans also include family- I’ve them ways to support child
Leading treatment- lowers risk and prevents reoccurrence

Question 39

Psychopharmacological Treatments

Answer 39

Treat mood disturbances and other symptoms of depression using antidepressants, especially selective serotonin reuptake inhibitors (SSRIs; e.g., Prozac, Zoloft, Celexa)
With the exception of SSRIs, which can have problematic side effects, medications have been less effective than CBT and IPT-A

Question 40

Treatment bipolar

Answer 40

Multimodal plan:
Monitor symptoms closely
Educate the individual and the family
Medication (e.g., lithium)
Psychotherapeutic interventions to address symptoms and related impairments
Stabilize mood and control symptoms
Emphasis on medication

Question 41

Prevention-Based Efforts

Answer 41

School-based initiatives aim to enhance protective factors in the environment and develop young people’s individual resiliency skills
Currently limited evidence of effectiveness
Stop depression before onset
Little research on effectiveness