Mood Disorders (Depression) Flashcards
The perspective of psychoanalysis in the history of child and adolescent depression
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.
Epidemiology
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%.
DSM Diagnostic Criteria
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
Neurovegetative Signs of Depression
Impairments in sleep, appetite, energy, and concentration
Why does depression increase with age?
Biological factors (sexual maturation) Environmental factors (increased social and academic expectations) Psychological/Cognitive factors (abstract)
Describe at least 3 theories of depression
Cognitive (depressive mindset)
Psychodynamic (severe superego)
Behavioral (inability to obtain reinforcement)
Attachment (insecure early attachment)
Genetics in Depression
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%
Serotonin Gene
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.
Developmental Variants
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.
Clinical course of child/adolescent depression
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
Factors that increase the risk of Bipolar Disorder among children/adolescents with depression
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
