Mood Disorders - Depression Flashcards
What is the psychoanalytic theory of depression?
Children cannot have depression because they cannot develop a superego because they have not come to terms with their own Oedipal complex.
Definition of “acute”
high incidence (# of cases in a given time) and low prevalence (total # at any time)
Definition of “chronic”
low incidence (# of cases in a given time) and high prevalence (total # at any time)
Epidemiology of depression
1) no largely accepted rates
2) since 1940, each successive generation is at a higher risk (due to more exposure, increased social expectations, etc.)
Prevalence of depression
15% by 18 years old
Gender ratio of depression
Gender ratio starts at 1:1 ratio pre-pubertally but evolves to 2:1 female to male ratio by adolescence
Why does depression increase with age?
Depression increases with age because the opportunities for risk increase every year - hormonal/puberty changes, environmental factors (like social and academic expectations), increased abstract thought, people change over time, and “identity vs. role diffusion” issues.
Name 3 Theories of Depression
1) Psychodynamic - anger turned inward with a severe superego and critical of oneself
2) Attachment - insecure early attachment that may result in feeling adrift or alone
3) Behavioral - inability to obtain reinforcement or feel pleasure in life
4) Cognitive - depressive mindset and see the world in a distorted fashion
5) Self-control - deficits in self-monitoring, self-evaluation, and self-reinforcement
How do genetics affect depression?
- children whose parents suffered from depression as a child
- family history is high in 1st degree relatives with MDD
What is the relationship between mothers with depression and their children?
- children with mothers who suffer from depression are at a much higher risk of obtaining it
- if mother’s treat their depression are successfully recover, the child’s diagnosis decreases (mimics the mother’s experience)
What was found about the serotonin gene and its relationship to depression?
- those with pervasive suicidal thoughts and intent show lower levels of a major serotonin transporter gene (5-HIAA)
- this gene reduces transcription of the 5-HIAA receptor and decreases serotonin uptake
- this causes more depressive symptoms
- the only reason the shorter allele has stayed alive is because it may protect over other illnesses)
DSM-V Criteria for depression.
1) Not better accounted for by any other illness
2) At least two straight weeks of persistent and pervasive symptoms
3) 5 of 9 symptoms present:
- Depressed, irritable mood
- Anhedonia (diminished interest or pleasure)
- Significant decrease in weight (or failure to meet weight gain milestones)
- Insomnia or hypersomnia
- Psychomotor retardation or agitation
- Fatigue or loss of memory
- Feelings of worthlessness or excessive guilt
- Diminished ability to think, concentrate, or make decisions
- Recurrent thoughts of death or suicide
Developmental Variants between children and adolescents.
-Not that many differences in diagnostics
Children:
- fewer neurovegetative signs
- more symptoms of anxiety and phobias
- expressed as temper tantrums and behavioral problems
- irritability
- fewer delusions or suicide attempts
- by middle childhood, low self-esteem, socially withdrawn, poor school performance
Adolescents:
- more cognitive components to depression
- apparent guilt and hopelessness
- more sleep and appetite problems
- more delusions and suicide attempts
- compared to adults, more behavioral problems and still less neurovegetative difficulties
Neurovegetative signs
1) Sleep
2) Appetite
3) Energy
4) Concentration
*children have fewer than adolescents, adolescents have fewer than adults
Clinical course of depression
- median duration is 1-9 months
- 90% of those who suffer from MDD remit within 1- years of onset
- 50% relapse after an acute episode
- suggests need for continual treatment
