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Lecture

PSYC 3342 Lecture Notes - Specific Phobia, Separation Anxiety Disorder, Common Cold


Department
psychology
Course Code
PSYC 3342
Professor
valeriedare

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Mood Disorders Ch. 8
February 26, 2013
8:34 PM
Overview of mood disorders
Mood disorders run the spectrum from severe depression to extreme mania and involve extreme, persistent or
poorly regulated emotional states
DSM-IV-TR divides mood disorders into two general categories:
o Depressive disorders: excessive unhappiness (dysphoria) and loss of interest in activities (anhedonia)
Irritability is one of the most common symptoms, occurs in 80% of clinic-referred, depressed children
o Bipolar disorder: mood swings from deep sadness to high elation (euphoria) and expansive mood (mania)
Depression
A pervasive unhappy mood disorder more severe than the occasional blues or mood swings everyone gets from
time to time
o The symptoms are so universal that it is sometimes called "the common cold of psychopathology"
o Children who are depressed can't shake their sadness and it interferes with their daily routines, social
relationships, school performance and overall functioning
Often accompanied by anxiety or conduct disorder
Often goes unrecognized and untreated
History
o In the past, it was mistakenly believed that depression didn’t exist in children in a form comparable to that
in adults
o We now know that kids do experience depression, and that depression in kids is not masked, but rather may
be overlooked because frequently co-occurs with other more visible disorders
Depression in Young ppl
o 5% of kids and 10-20% of teens experience significant depression at some time
They display lasting depressed mood in face of real or perceived distress with disturbances in thinking,
physical functioning and social behavior
Suicide among teens is a serious concern
90% show significant impairment In daily functions
o Depression in young ppl is a serious concern because of long lasting emotional suffering, problems in
everyday living, heightened risk for suicide, substance abuse, bipolar disorder, poor health outcomes, and
higher health care costs
Depression and Development
o Experience and expression of depression change with age
o In kids under age 7 (as young as 3-5) it tends to be diffuse and less easily identified
o Anaclitic depression (spitz): infants raised in a clean but emotionally cold institutional environment
displayed reactions resembling depression, sometimes resulting in death
Similar symptoms can occur in infants raised in severely disturbed families
o Depressed preschoolers may appear extremely somber and tearful, lacking exuberance, bounce, and
enthusiasm; may display excessive clinging and whiny behavior around moms, and fear of separation or
abandonment; irritability
o Depressed school-aged kids show similar symptoms, plus increasing irritability, disruptive behavior,
tantrums and combativeness
o Preteens show similar symptoms, plus self-blame and low self-esteem
Anatomy of depression
o As a symptom: feeling sad or miserable
Occurs in 40% or more of kids and teens; for most, symptoms are temporary
o As a syndrome: a group of symptoms that occur together more often than by chance; mixed symptoms of
anxiety and depression that tend to cluster on a single dimension of negative affect
o As a disorder:
Major depressive disorder(MDD): minimum duration of 2 weeks; associated with depressed mood,
loss of interest, other symptoms and significant impairment in functioning

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Dysthymic disorder: depressed mood, generally less severe but longer lasting symptoms (a year or
more) and significant impairment in functioning
Major Depressive Disorder (MDD)
Key features: sadness, loss of interest or pleasure in nearly all activities (anhedonia), irritability, and other specific
symptoms that are present for at least 2 weeks
Symptoms must represent change from previous functioning
Diagnosis requires the presence of a major depressive episode, exclusion of other conditions (e.x. prior occurrence
of a manic episode) and ruling out physical factors, normal bereavement or underlying thought disorder
Diagnosis in kids:
o Same criteria for school age kids and teens
o Depression is easily overlooked because other behaviors attract more attention
o Some features (i.e. irritable mood) are more common in kids and teens than in adults
o Prevelence:
2-8% of kids ages 4-18
Rare among preschool (<1%) and school age kids (2%) increases two to threefold by teens and adults
Rates vary with length of time in which symptoms are assessed; prevalence is about 3% if assessed at
a single point in time and 8% if assessed over a 1 year period; lifetime prevalence in teens may be as
high as 20% for 14-18 years old, although this may be underestimated
The modest increase from preschool to elementary school may reflect growing self-awareness and
cognitive capacity, verbal ability to report symptoms, and increased performance and social pressures
The sharp increase in teens may result from biological maturation at puberty interacting with
developmental changes
Comorbidity: as many as 90% of youngsters with depression have one or more other disorders; 50% have two or
more
o Most common comorbid disorders in clinic-referred youngsters are anxiety disorders (especially GAD),
specific phobias, separation anxiety disorder
o Depression and anxiety are more visible as separate, co-occurring disorders as severity of disorder increases
and kid gets older
o Other common comorbid disorder are dysthymia, conduct problems, ADHD substance use disorders
o 60% have comorbid personality disorders, especially borderline personality disorder
Onset, course, and outcome
o May be gradual or sudden; usually a history of milder episodes that do not meet diagnostic criteria
o Age of onset usually between 13-15 years
o Average episode lasts 8 months (longer if a parent has a history of depression)
o Most kids eventually recover, but the disorder doesn’t go away
Change of recurrence: 25% within 1 year, 50% within 2 years, 70% within 5 years
About 1/3 develop bipolar disorder within 5 years after onset of depression
o Overall outcome is not optimistic: even after recovery, kids often continue to experience adjustment and
health problems and chronic stress
Gender, ethnicity and culture
o No gender differences until puberty; then females are 2-3 times more likely to suffer from depression; also
more susceptible to milder mood disorders, and more likely to experience recurrent episodes
o Symptom presentation is similar for both sexes, although correlates of depression differ for the sexes
o Physical, psychological, and social changes are related to the emergence of sex differences in teens
o Low birth weight predicts depression in teens girls but not boys
o Sex differences partly rooted in biological differences in brain processes that regulate emotions
o Relationship between depression and race and ethnicity during childhood is not well studied
Dysthymic disorder (DD)
Dysthymic disorder (DD) or dysthymia is characterized by depressed mood for most of the day, on most days, for
at least 1 year
o It is less severe but more chronic than MDD
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