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Chapter 7

Chapter 7 - ONLINE

15 Pages

Course Code
Psychology 2042A/B
Richard Brown

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Psych 2042A Chapter 7: Mood Disorders when moods are unusually elevated or persistent or when they interfere with the individuals functioning, they may be labeled as mania or depression. mood disorders in children have not received a great deal of attention until recently improvements in diagnostic practices have facilitated the study of mood disorders in children and adolescents. however, we cannot permanently conclude that phenomena are the same in children and adults mood disorders often go hand in hand with anxiety disorders big literature concerning depression when it comes to mood disorders A Historical Perspective dominant view in child clinical work for many years was the orthodox psychoanalytic perspective depression viewed as a phenomenon of superego and mature ego functioning - superego acts as the punisher of the ego since a childs superego is not fully developed, it was hard to think that children would have depressive disorders second major perspective added to the controversy regarding the depressive disorders occurring in children; concept of masked depression masked depression is the concept whereby the sad mood and other typical features of depression were not present but were represented by other depressive equivalents such as hyperactivity or delinquency the fact that depression was masked in children made it underestimated distinction between depression as a symptom and depression as a syndrome is important to consider here. developmental perspective: suggested that behaviours that led to the diagnosis of depression might be only transitory developmental phenomenon that were common among children in certain age groups. (ie. insufcient appetite, excessive reserve) The DSM Approach to the Classication of Mood Disorders diagnostic criteria is the same for children, adolescents, and adults. mood disorders are considered as unipolar or bipolar DSM describes mood episodes as the building blocks for mood disorders 4 types of mood disorders are described: Major Depressive Episode: depressed mood or loss in interest Manic Episode: period of abnormally and persistently elevated, irritable mood Mixed Episode: mix of both manic and depressive episodes Hypomanic Episode: same symptoms as a manic episode, but are not as severe and does not cause impairment in functioning Denition and Classication of Depression Dening Depression phenomenon of depression is composed of an interplay of inuences and a complex clinical presentation Kazdin did a study on 231 consecutive child admissions to an inpatient psychiatric facility - direct interviews with parents and children this method of diagnosing depression was compared to the results of the Childrens Depression Inventory (CDI) - both children and parents completed the CDI according to the CDI, depressed children were more hopeless, had lower self- esteem, made more internal attributions regarding negative events, and were more likely to believe that control was due to external factors. when depression was high in the parent CDI score, children with high depression scores exhibited more problems across a wide range of symptoms it is not possible at this point to make denition statements about the correct denition of depression - dominant view is that child/adolescent depression is a syndrome, or a disorder, and that the most often employed denitions are those offered by the DSM. Depressive Disorders: The DSM Approach Major Depressive Disorder (MDD): primary DSM category for dening depression presence of one or more major depressive episodes symptoms are the same for children, adolescents, and adults with one exception: children/adolescents may express irritable mood rather than depressed mood - over 80% of youths experience irritable mood 5 or more symptoms must be present - 1 of these must be depressed/irritable mood symptoms must be present for at least 2 weeks and impairs functioning Dysthymic Disorder: symptoms of a major depressive episode are present in less severe form but are more chronic symptoms are present for at least 1 year with the 2 or more symptoms symptoms must indicate impairment in functioning double depression: instances in which both dysthymia and a major depressive episode are present. dysthymia usually develops prior to MDD Adjustment Disorder with Depressed Mood: disorder that is viewed as a response to a stressor in which depressive symptoms do not meet the criteria for other depressive disorders Depression: Empirical Approaches Achenbach instruments are used: the syndromes that include depressive symptoms that regularly occur together also include symptoms of anxiety and withdrawn behaviour youths may experience depression in many different ways depending on their development stage depression in youth may be best described as dimensional rather than categorical many youths who do not meet the diagnostic criteria may still exhibit impairment in everyday functioning and be at risk for future difculties Description of Depression subjective experience of sadness, or dysphoria is also a central feature of the clinical denition of depression youths can express depression through an irritable mood- temper tantrums, tears, yelling, throwing things, loss of pleasure, social withdrawal, lower self-esteem, inability to concentrate, and poor academic functioning biological disturbances can also be present - sleep disturbances, eating problems young person may also express thoughts of wishing to die youth experiencing depression may also experience anxiety disorders, conduct disorders, and oppositional deant disorder Epidemiology of Depression MDD is the most common form of affective disorder among children and adolescents youths with unipolar disorders - 80% have MDD, 10% dysthymia, and 10% double depression in overall community surveys - 12% have MDD life time prevalence rates indicate that episodes of clinical depression may be quite common (high as 20 to 30%) Oregon Adolescent Depression Project (OADP) - studied a sample of adolescents aged 14-18; found that by age 19, 28% of adolescents have experienced a major depressive disorder (35% of the females and 19% of the males) about 1 out of 4 young people in the general population experiences a depressive disorder sometime during their childhood or adolescence youth who exhibit depressive symptoms but do not t the criteria are not included in the prevalence estimates Age and Gender depression is less prevalent in children than in adolescents no gender differences reported for children aged 6 to 12 in adolescents, depression is more prevalent in girls (2:1 ratio) - 12-14 yrs old study done in New Zealand - rates of clinical depression and dysthymia disorder were measured between ages of 11 to 21 at 11, males sowed a tendency to have higher rates of depression than females, at 13 there were no gender differences, and at ages 15, 18, and 21, females had higher rates of depression gender differences were greatest around age 15 to 18 - begin to level off at 18 Socioeconomic, Ethnic, and Cultural Considerations lower SES is reported to be associated with higher rates of depression not a great deal of information regarding racial and ethnic differences suggestion where there are higher rates of depression in Mexican American children and adolescents high prevalence among African American (AA) boys compared to AA girls and European American (EA) boys and girls Co-occurring Difculties 40-70% of youths with MDD also meet the criteria for another disorder 20-50% have two or more additional disorders
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