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CHAPTER 8.docx

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University of Toronto St. George
Anna Grivas Matejka

CHAPTER 8: MOOD DISORDERS 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:  Depressive disorders: irritability and angry in depressed children, behavioral disorders. Easiest emotion to feel is anger-effortless, eventually become sad.  Bipolar disorder: mood swings, cycling through being depressed to a low to a high mood. Unipolar depression- low side-one side of curve. Bipolar: both sides high and low experience. Depression  Apervasive unhappy mood disorder-longevity, more severe than mood swings. Generally people regularly feel mood swings in the population, is normal.  Children who are depressed can’t shake their sadness; it interferes with their daily routines, social relationships, school performance, and overall functioning ie/trouble going to school, in social relation groups, eating a meal with family. Biggest problem is that it goes unrecognized, bad picking up young children but not for teens.  Over 800,000 teens in U.S. suffer from depression yearly. Often have anxiety. Over half of them are suicidal- half a million attempting suicide. Every two minutes.  History of depression in children: didn’t exist, not in DSM, no research in children until recently. Depression has no age barrier to have a true depression even infants. When children do have depression often coexists with other disorders. High risk for bipolar disorder.  As many as 5% of children and 10-20% of adolescents experience significant depression at some time. Recurrent episodes. People having relapses is common.  Concerns: suicide among teens, depression in young people. Higher risk for bipolar, risk of suicide, substance abuse, poorer medical health issues.  90% show significant impairment in daily functions Depression and Development  Experience and expression of depression change with age: effects all ages  Infants: mutually deprived environment, often times primary caregiver is depressed, orphanages. 3 months of a baby being sad, expressionless. No interest to eye contact, stare onto distance, disconnected, sleeping and feeding problems. Very irritable. Difficult to soothe. Disinterested in social interactions. Separate baby from mother would do better.  Preschoolers- lack enthusiasm, lack energy, low self-esteem,  School-aged children: lots of self-blame. Have lots of social inhibition-isolated. Anatomy of Depression  Depression as a symptom: feeling sad or miserable  Depression as a disorder:  Major depressive disorder (MDD): occur for two weeks, loss of interest of social interaction, significant daily functioning.  Dysthymic disorder: more long lasting, more severe, low level of depression for at least a year. Can be described as a personality. Major Depressive Disorder (MDD)  Key features: short length 4-5 days, criteria the same with one difference. Often misdiagnose as a behavior. Need 9 symptoms. Feeling sad and loss of interest. Other: eating habits, insomnia, psychomotor agitation, guilt.  Symptoms must represent change from previous functioning  Diagnosis requires the presence of a major depressive episode, the exclusion of other conditions, and ruling out physical factors, normal bereavement, or underlying thought disorders  Diagnosis in children  Prevalence- ages 4 to 18. Under 4 have no data. Rare. Lifetime prevalence is 10-14% will continue to have it through adulthood. Individuals start to self reflect and don’t have interest to be with friends.  Comorbidity- 90% of adolescence will also have another condition at some point. 50% will have two or more conditions.Alot of funding from government given attention to mental health.  Onset- come suddenly or gradually. Most common age is around 13 for depression. Average depressive episode lasts 8 months. No gender differences until puberty so more girls diagnosed b.c of hormones, social circles. Things become more complex more of environmental issue not genetic. Dysthymic Disorder (DD)  Dysthymic disorder (DD), or dysthymia, is characterized by symptoms of depressed mood that occur on most days, and persist for at least one year  Less severe symptoms  Characterized by poor emotion regulation:  Chronic depressive disorder has been proposed to describe both MDD and DD in DSM- V: double depression  Prevalence- not as common. Comorbidity is still high: 50% have some other diagnosis. Mood, anxiety or ADHD  Onset:12. Children with DD have higher chances of going into double depression. Onset in childhood is more persistent and chronic as adult, worse prognosis b.c pathways have longer to practice and longer it stays, didn’t have a chance to experience health emotion regulation, cope with current state, stronger genetic component if at 5 is rare but evidence that a lot of genes associated so presenting easier. Associated Characteristics of Depressive Disorders: as a way of investigating the individual. Different from diagnostic characteristics b.c these features below have other diagnoses as well, so assoc.  Intellectual and academic functioning: have a hard time concentrating. Speaking to teachers. Children losing interest when have a mood disorder. Thinking is slow, low grades. Poor ratings. Processing speed is low in various of tasks, but production and quality can still be there.  Cognitive biases and disturbances: thinking style. Distortions are analyzed here. They have a selective attention bias. Selective what they pay attention to. Mostly on the negative event. Lots of negative beliefs and negative attitudes. Evaluating negative thoughts and their self critical statements they make.And is this generalized in their thinking when they make a faulty belief.  Negative self-esteem: low s-e with unstable self esteem. Different on days. Both equally as damaging. Body image-mood and eating disorder closely linked. Is body image distorted.  Social and peer problems: fewer close relationships with people who have mood disorder. Are they seeking social and peer interactions these people will not but have high level of loneliness. So are misunderstood that these mood children do not want social relationships but they cant follow through with it with their disorder at the time. Ineffective coping style with their social isolation. High risk factor for mood disorders b.c two are closely correlated especially with kids who are bullied.  Family problems: family becomes less supportive and more conflict arises in both parent- child relationship and sibling parent relationship. Withdrawl and lonely feeling in families b.c the stress dealing with a child who has a mood disorder causes this and will not do anything. So young adolescence are not in clinics. Education is the answer ie/campaigns.  Depression and suicide: common technique is drug overdose, cutting is second one. Cutting multiplies quickly to cope with their problems without the intension of suicide. Form of coping mechanism is the idea that when emotions build up so is a panic attack so blood flow is releasing emotions. No long lasting effect so cut again. Over time cuts become deeper and visible. People are doing it in groups as a support group to cut together. More powerful with group mentality. Dangerous is learning from others, very hard to treat. Suicide: boys 13 Causes of Depression: genes huge factor. Twin studies-if one twin has depression, 30% for other twin to have depression. Whereas bipolar has a stronger correlation. Children who have depressed parents, are three times as likely to have a mood disorder. Evidence from genetics but mostly environment the child is growing up is created by parents. Genetics for depression-really inheriting a vulnerability for depression and to turn it on requires an environmental stressor which can be a depressed parent. All stressors are not equal to everyone, depends on individual and how they procc
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