Mood Disorders

Question 1

Change in Depressive Symptoms across Development

Answer 1

Infants – Anaclitic depression (weeping, withdrawal, apathy, weight loss, and sleep disturbances; decline in development)

Preschoolers – extremely sombre and tearful, lacking exuberance; excessive clinging and whiny around mothers; irritability; somatic complaints - the youngest group in which depression is reliably diagnosed

School-Age Children – The above + increasing irritability disruptive behaviour, temper tantrums, and combativeness

Preteens/Teens – The above + increasing self-blame, low self-esteem, persistent sadness, and social inhibition; sleep issues; eating disturbances; negative body image

Question 2

Depression as a symptom

Answer 2

A mood state of feeling sad (there does not need to be any other symptom or impairment and it is a common experience)

Question 3

Depression as a syndrome

Answer 3

The co-occurrence of a collection of symptoms that tend to present together more often than chance (can occur due to psychiatric or non-psychiatric factors)

Question 4

Depression as a disorder

Answer 4

Takes syndrome a step further by ruling our non-psychiatric factors (what is defined in the DSM-5)

Question 5

Arguments that the MDD criteria is too broad

Answer 5

-It is normative to experience short-term depressive symptoms in response to stressors which can include major developmental transitions that occur in adolescents

-A characteristic feature of adolescents is demonstrating high emotional intensity thus it can be challenging to distinguish MDD from normative variations in mood in adolescents

Question 6

Arguments that the DMDD criteria is too strict

Answer 6

-Subthreshold depression strongly predicts later MDD

-The criteria present depression as categorical but the research on subthreshold depression supports the idea that depression is continuous

-There is some evidence that it is useful to distinguish melancholic depression (more severe with lack of mood response to positive events) in childhood and adolescent depression

Question 7

Changes in MDD prevalence before vs during adolescents

Answer 7

Depression goes from being rare in preschool (1%) and school-aged children (3%) to being much more common in adolescents (8%)

Question 8

MDD comorbidity

Answer 8

-It’s estimated that 90% of those with depression have at least one other mental disorder diagnosis & about half have two other mental disorder diagnosis

Question 9

MDD comorbidity with Anxiety

Answer 9

-Some develop anxiety first then depression, others develop depression first than anxiety, and others develop them at the same time

-For about 85% of youth with both disorders, anxiety tends to come first (example of heterotypic continuity)

-The most common explanation for the high comorbidity is that they both reflect high negative emotionality and may share similar genetic influences

-Perhaps the experience of having anxiety contributes to the development of behavioural avoidance, cognitive biases, and higher negative affectivity

Question 10

Gender differences

Answer 10

No gender difference in prevalence rates of pre-pubertal depression but, after puberty, the prevalence rates of girls becomes more than double the prevalence rates of boys…

-May be b/c girls tend to experience more stress, particularly in their personal stress, than boys during the transition to adolescents

-Girls develop more depression than boys at similar levels of stress, demonstrating greater vulnerability to stress (may be b/c girls tend to have a greater need for affiliation and more likely to engage in rumination)

-May be due to biological changes of puberty interacting with broader social factors (ex – girls are more likely to develop higher dissatisfaction with their body than boys as their bodies undergo rapid physical changes during puberty)

Question 11

Race/ethnicity differences

Answer 11

Some studies have found greater prevalence rates of depression in adolescents of colour compared to white adolescents - these findings appear to be explained by differences in SES and ethnic/race-related stress

Question 12

MDD onset

Answer 12

-typical age of onset is 13-15 years old
-onset may be gradual or sudden

Question 13

MDD average duration

Answer 13

Average episodes lasts 8 months in a clinical refereed sample (shorter in community samples)

Question 14

Scar hypothesis

Answer 14

Each episode of depression results in a long term change that makes one vulnerable to subsequent episodes, such as becoming more sensitive to stress

Question 15

Does childhood depression predict adolescent or adult depression? Does adolescent depression predict adult depression?

Answer 15

• Adolescent depression predicts adult depression (homotypic continuity)

-Inconsistent findings that childhood depression predicts adolescent and adult depression

-This suggests that there may be different pathways of childhood depression that may reflect discontinuity, homotypic continuity, or heterotypic continuity by predicting other forms of psychopathology

Question 16

P-DD

Answer 16

A chronic but less severe version of MDD

Question 17

P-DD changes from children to adolescents

Answer 17

Approximately 1% of children and 5% of adolescents

Question 18

P-DD comorbidity

Answer 18

-Most common comorbid disorder is MDD (nearly 70% of children with P-DD may have an episode of major depression

-About 50% of children with P-DD also have one or more non-mood disorders that preceded it, e.g., anxiety disorders, conduct disorder, or ADHD

Question 19

P-DD typical age of onset

Answer 19

Most common age of onset is 11-12 years old

Question 20

P-DD approximate average duration

Answer 20

For those who develop P-DD as a child the duration is generally 2-5 years

Question 21

Is it possible for DMDD to have comorbidity with ODD and/or Bipolar Disorder?

Answer 21

NO!

-If a child meets criteria for both DMDD and ODD, DMDD diagnosis is made

-If a child meets criteria for both DMDD and Bipolar Disorder, Bipolar Disorder diagnosis is made

Question 22

Stingaris et al

Answer 22

-They wanted to examine whether childhood irritability would predict adult depressive and generalized anxiety disorders

-Found that adolescent irritability predicted MDD, generalized anxiety disorder, and dysthymia 20 years later

Question 23

Mayes et al

Answer 23

• Argue that DMDD is too overlapping with ODD and should not be considered a separate disorder

-They wanted to see whether the 2 main DMS-5 DMDD symptoms of persistent irritability and angry mood and severe temper outbursts would occur independently of ODD

-Found that 92% of children with DMDD symptoms also met the criteria for ODD while 66% who met the criteria for ODD had those 2 DMDD symptoms – this demonstrated that there is very little likelihood to have DMDD symptoms without also meeting the criteria for ODD and that there is a little bit more likelihood of meeting ODD criteria without having those DMDD symptoms (The authors interpreted this to mean that DMDD diagnosis was too overlapping with ODD, and it would make more sense as a specifier for ODD)