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ch 8 Mood Disorders.docx

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PSYC 3342

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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  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 o Symptoms include poor emotion regulation: constant feelings of sadness and of being unloved and forlorn, self-deprecation, low self-esteem, anxiety, irritability, anger, and temper tantrums o Kids with both MDD and DD have "double depression"  Prevalence and comorbidity o Rates of DD are lower than MDD with approx. 1% of kids and 5% of teen affect o Most common comorbid disorder is MDD; about one half of dysthymic kids also have one or more co- occurring nonaffective disorders that preceded dysthymia, such as anxiety disorders, conduct disorder, or ADHD  Onset, course and outcome o Most common age of onset 11-12years o May be a precursor to MDD for some kids o Average episode length 2-5 years o Most recover but are at high risk for developing other disorders, especially MDD, anxiety disorders and conduct disorder o Teens with DD receive less social support than those with MDD Associated characteristics of depressive disorders  Intellectual and academic functioning: difficulty concentrating, loss of interest and slowness of thought and movement are likely to have a harmful effect on intellectual and academic functioning, resulting in lower scores on tests, teacher ratings, and levels of grade attainment o Interference with academic performance, but not necessarily related to intellectual deficits; may have problems on tasks requiring attention, coordination and speed  Cognitive disturbances: deficits and distortions in thinking; feeling of worthlessness, attributions of failure, self- critical automatic thoughts, depressive ruminative style, pessimistic outlook, negative thinking and faulty conclusions generalize across situations, hopelessness, and suicidal ideation  Negative self-esteem: low or unstable self-esteem; may be related to body image  Social and peer problems: few close friendships, feelings of loneliness and isolation, social withdrawal, ineffective coping in social situations  Family problems: less supportive/more conflictual relationships with parents and siblings; feel socially isolated from families and prefer to be alone  Depression and suicide o Profound feelings of hopelessness, helplessness, and despair may lead to suicide attempt  Most youngsters with depression think about suicide; as many as one third attempt it o Most common methods: drug overdose and wrist cutting o Most common methods for those who complete suicide are firearms, hanging, suffocation, poisoning, overdoes  Strongest risk factors worldwide are having a mood disorder and being a young female Theories of depression  Psychodynamic o Depression is the conversion of aggressive instinct into depressive affect and results from the actual or symbolic loss of a love object that is loved ambivalently  Attachment o Parental separation and disruption of an attachment bond are predisposing factors for depression  Behavioral o Emphasizes the importance of learning, environmental consequences and skills and deficits in the onset and maintenance of depression  Depression is related to a lack of response-contingent positive reinforcement  Cognitive o Focuses on the relationship between negative thinking and mood and emphasize "depressogenic" cognitions -- the negative perceptual and attributional styles and beliefs associated with depressive symptoms  Hopelessness theory: depression-prone individuals tend to make internal, stable, and global attributio
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