Mood Disorders (Depression) Flashcards

1
Q

The perspective of psychoanalysis in the history of child and adolescent depression

A

Psychoanalytic theory posits that depression results from intrapsych conflict between the ego and superego. Super ego is not formalized until after the Oepidal conflict is resolved. Children could not experience the conflict and develop depression.

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2
Q

Epidemiology

A
12 month prevalence is in the US is 7%
Preschool age- 1%
School age- 2%
Adolescent- 4-8%
Sex ratio: 1:1; then 2:1 (female:male) 
Lifetime prevalence of MDD among adolescents is 15-20%.
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3
Q

DSM Diagnostic Criteria

A
5 of 9 symptoms; at least one symptom is either depressed mood or anhedonia (diminished interest or pleasure in life) 
2 weeks straight in duration:
Depressed mood
Anhedonia
Significant decrease in body weight (5%)
Insomnia or hypersomnia
Psychomotor retardation or agitation
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Diminished ability to concentrate
Recurrent thoughts of suicide
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4
Q

Neurovegetative Signs of Depression

A

Impairments in sleep, appetite, energy, and concentration

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5
Q

Why does depression increase with age?

A
Biological factors (sexual maturation)
Environmental factors (increased social and academic expectations)
Psychological/Cognitive factors (abstract)
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6
Q

Describe at least 3 theories of depression

A

Cognitive (depressive mindset)
Psychodynamic (severe superego)
Behavioral (inability to obtain reinforcement)
Attachment (insecure early attachment)

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7
Q

Genetics in Depression

A

Twin studies (35-75%)
Children whose parents suffered from depressions as a child are 14 times more likely to become depressed prior to age 13.
Children of parents who are depressed have a 2 -4 times the risk of having depression.
Children of depressed parents have an earlier age of onset by 3 years
The lifetime history of MDD in mothers who have depressed children is 50-75%

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8
Q

Serotonin Gene

A

Major serotonin gene (5-HIAA) are lower in the CSF
Adults have one or two copies of the short allele of the 5-HT transporter gene–exhibit more depressive symptoms, diagnosable depression, and suicidality–> less serotonin uptake.

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9
Q

Developmental Variants

A

Child: more symptoms of anxiety, somatic complaints, and auditory hallucinations.Depression is expressed by temper tantrums and behavior problems. Fewer delusions and serious suicide attempts. By middle childhood, perception of death, lowered self-esteem, social withdrawal, and poor social performance.

Adoslescents: more cognitive components. Guilt and hopelessness become apparent. More sleep and appetite disturbances, delusions, suicidal ideation and attempts. Compared to adults, still more behavior problems and fewer neurovegetative signs.

Unlike adults, adolescents negative mood may not entirely consume them, and they may still be able to enjoy numerous activities, engage with peers effectively, and complete their work relatively well at times, while feeling severe discomfort and behavior problems at other times. They have an inconsistent mood.

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10
Q

Clinical course of child/adolescent depression

A

Median Duration: clinically referred (7-9 months) and community(1-2 months)

Predictors of increased duration: depression severity, comorbidity, negative life events, parental psychiatric disorders, poor psychosocial functions.

90% of MDD episodes remit within 1 to 2 years after onset. Around 50% relapse. 6-10% of MDD are chronic. d. 70% will have another episode over 5 years

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11
Q

Factors that increase the risk of Bipolar Disorder among children/adolescents with depression

A

20-40% of depressed c/a develop BP disorder within 5 years of index episode of MDD

Earlier Onset of MDD
Psychomotor retardation
Psychotic features
Family history of BP/psychotic depression
Heavy familial loading for mood d/o
Pharmacologically induced (hypo)mania
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