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
Predictors of relapse of depresion
1) Natural course of MDD
2) Duration
3) Negative life events
4) Decrease or discontinuation of treatment
5) Age of onset
Predictors of duration of depression
1) Severity
2) Comorbidity
3) Parental psychiatric disorders
4) Negative life events
5) Poor psychosocial functioning
What is the difference between relapse and recurrence?
Relapse = an isolated incident that happens once
Recurrence = emergence of symptoms for more than two months
Likelihood of a relapse
Likelihood for a 2nd episode after having a 1st is about 70% over 5 years
Depression and Bipolar Disorder
- 20% of depressed children develop Bipolar Disorder within 5 years
- most common you see before mania and BD
Predictors of developing Bipolar Disorder from Depression
1) Early onset of MDD
2) Psychomotor retardation
3) Psychosis
4) Family history of MDD, Bipolar, or other Mood Disorders
5) Pharmalogically induced
6) Age of onset
