Mood Disorders - Depression Flashcards
perspective of psychoanalysis in the history of child and adolescent depression
Psychoanalytic theory
- depression results from an intrapsychic conflict between the ego (“who I am”) and a persecutory superego (“who I think I should be”)
- held that the superego was formalized only after resolution of the Oedipus Conflict, which occurred by late adolescence
STATINGGGG
children could not experience intrapsychic conflict and, ergo, could not develop mood disorders
incidence (definition)
Number of new cases in a given time period
- Eg., a 5% incidence means that in a given year (or whatever period of time) 5% of the population is affected
prevalence (definition)
Total number of cases in a population at any given time
- Eg., a 5% prevalence means that at any given time 5% of the population is affected
acute vs chronic
An illness with a high incidence and low prevalence is ACUTE
- Eg., lots of people get sick, but they don’t tend to stay sick very long
- Example: common cold
An illness with a low incidence and a high prevalence is CHRONIC
- Eg., not that many people get sick, but once they get sick, they tend to stay sick for a long time
- Example: anorexia nervosa
epidemiology and prevalence
Lifetime prevalence of MDD among adolescents is 15-20% (similar to adults)
–> Most people are gonna have a depressive episode by the time they hit 17 or 18, but not everybody
Prevalence increases during adolescence, possibly due to:
- Biological factors (Sexual maturation)
- Environmental factors (increased social/academic expectations, more chance of exposure to negative events)
- Psychological and cognitive factors (increased autonomy and abstract thinking)
gender ratios
1:1 in childhood
2:1 (female to male) by adolescence (1.5-3x higher rates in females)
comorbidities
Most children with MDD have a comorbid psychiatric diagnosis:
- 40-90% have a second psychiatric disorder
- 20-50% have two or more comorbid disorders
DSM 5 criteria
- The DSM-5 requires 5 to 9 symptoms for the diagnosis
- At least one symptom is either depressed mood or anhedonia (diminished interest or pleasure in life)
- At least two straight weeks in duration with symptoms present pretty much every day or most of every day
SYMPTOMS
- depressed mood
- insomnia or hypersomnia
- fatigue
- feelings of worthlessness
- weight changes
neurovegetative signs of depression
- Decrease in appetite
- Insomnia or hypersomnia
- Fatigue or loss of energy
- Diminished ability to think or concentrate or indecisiveness
why does depression increase with age?
Increase stress, increased responsibility and expectations, biological changes - puberty, hormonal changes (pubertal)
theories of depression
Psychodynamic
- Anger turned inward; sever superego
Attachment
- Increase early attachment
Behavioral
- Inability to obtain reinforcement
Cognitive
- Depressive mindset (negative cognitions)
Self-control
- Deficits in self-monitoring, self-evaluation, and self-reinforcement
Interpersonal
- Characteric to individual, roles and events
Socio Environmental
- Stressful life circumstances exacerbate vulnerabilities
Neurobiological
- Neurochemical, endocrine, amd receptor abnormalities
genetics in depression!!!!
Children with a parent who suffered from depression as a child are up to 14x more likely than controls to become depression prior to age 13
Children of parents with depression have about2-4x the risk of having depression
mothers vs fathers
risks for anxiety disorders, major depression, and substance dependence were ~3x higher in the offspring of depressed parents vs non depressed parents
- Treat in mothers and kids get better or don’t get depression at all
- Mothers more influential than fathers
- Studies in fathers are not as good as the mothers
–>Greatest factor of influence: mother has depression as a child
serotonin transporter gene
SHORT AND LONG ALLELE
SHORT:
- leads to transcription of that gene
LONG:
- having protection for depression and its severity
MEANING:
Adults with one or two copies of the short allele of the 5-HT Transporter gene have been shown to exhibit more depressive symptoms, diagnosable depression, and suicidality in relation to stressful life events
- you need one short allele
- two long alleles = pulmonary hypertension
child vs adolescent (depression looks like)
–> developmental variants
CHILD:
- More symptoms of anxiety (phobias, separation anxiety), somatic complaints, and auditory hallucinations
- temper tantrums and behavior problems
ADOLESCENT:
- More cognitive components to their depression than children
- Guilt and hopelessness become apparent
- More sleep and appetite disturbances, delusions, suicidal ideation, and attempts
clinical course of child/adolescent depression
Most of it goes away (treated or not) within 6-9 months
HIGH RATE OF RECURRENCE
- 70% or so of depression episodes will return in children (higher than the rate in adults)
50% RELAPSE
Chronic course of depression is lower → 10% of kids will develop a chronic ongoing depression that isn’t treated well
–> 20% in adults
suicide risk factors
–> Prior history of suicide attempts of threats
- But most completed suicides are not preceded by prior attempts (most how die, die on the first attempt)
–> Being single or living alone
–> Having prominent feelings of hopelessness
–> LGBTQ
–> Not doing well in treatment
–> Having repeated episodes
–> Having repeated hospitalizations
male vs female (suicide)
Being a male increased suicide completion
- often uses more ending ways of suicide (gun)
Being a female increased suicide attempt
- often seeing cuts or attempted overdose
suicide crisis syndrome
75% of people don’t express SI in the month prior to an SA; so we must look at other factors
- Frantic hopelessness and entrapment !!! (all roads to escape are blocked)
- Affective dyscontrol
- Loss of cognitive control; they feel as their head is going to explode, may have headaches
- Overarousal
Predictors of recurrence
Earlier age at onset
Increased number of prior episodes
Severity of initial episode
Psychosis
Psychosocial stressors
Dysthymia and other comorbidities
Treatment noncompliance
Predictors of relapse
Natural course of MDD, lack of compliance, negative life events, rapid decrease/discontinuation of therapeutic treatment
factors that increase the risk of Bipolar Disorder among children/adolescents with depression
20-40% of depressed children and adolescents develop bipolar disorder within 5 years of index episode of MDD
- People with bipolar disorder have had depression before (first episode of depression)
–> Being activated by anti depression
–> Family member with bipolar disorder
–> Earlier onset depression
