Depressive Disorders in Psychology Chapter 5
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Questions and Answers

What is the minimum duration for a major depressive episode to be classified as such?

  • 2 weeks (correct)
  • 6 weeks
  • 1 week
  • 1 month

    • Which of the following disorders was specifically added to address concerns about overdiagnosis of bipolar disorder in children?

  • Disruptive mood dysregulation disorder (correct)
  • Persistent depressive disorder
  • Premenstrual dysphoric disorder
  • Major depressive disorder

    • Which depressive disorder is characterized by mood disturbances lasting for at least 2 years in adults?

  • Persistent depressive disorder (correct)
  • Substance/medication-induced depressive disorder
  • Major depressive disorder
  • Disruptive mood dysregulation disorder

    • What is the required frequency of temper outbursts for a diagnosis of disruptive mood dysregulation disorder?

    <p>Three or more times per week</p> Signup and view all the answers

    Which condition's symptoms tend to be more severe when occurring alongside major depressive disorder?

    <p>Bereavement</p> Signup and view all the answers

    How long must depressive symptoms last to consider a diagnosis of persistent depressive disorder in children?

    <p>1 year</p> Signup and view all the answers

    Which type of depressive disorder includes the symptoms of cyclical mood changes associated with the menstrual cycle?

    <p>Premenstrual dysphoric disorder</p> Signup and view all the answers

    What distinguishes disruptive mood dysregulation disorder from typical mood disorders?

    <p>Developmentally inappropriate temper outbursts</p> Signup and view all the answers

    What characterizes the chronic mood of children diagnosed with disruptive mood dysregulation disorder (DMD)?

    <p>Chronic, persistently irritable or angry mood</p> Signup and view all the answers

    At what age must the onset of disruptive mood dysregulation disorder occur for a proper diagnosis?

    <p>Before 10 years</p> Signup and view all the answers

    Which of the following is a key distinguishing factor between disruptive mood dysregulation disorder and bipolar disorder in children?

    <p>Duration and persistence of symptoms</p> Signup and view all the answers

    What type of mood disturbance is NOT characteristic of disruptive mood dysregulation disorder?

    <p>Elevated mood</p> Signup and view all the answers

    Which condition is often present concurrently with disruptive mood dysregulation disorder?

    <p>Attention-deficit/hyperactivity disorder</p> Signup and view all the answers

    What factor is NOT typically associated with the development of disruptive mood dysregulation disorder?

    <p>Presence of healthy sibling relationships</p> Signup and view all the answers

    Which statement is true about the diagnosis of disruptive mood dysregulation disorder?

    <p>It requires the presence of severe mood symptoms.</p> Signup and view all the answers

    How is the prevalence of disruptive mood dysregulation disorder characterized across genders in clinic samples?

    <p>Higher in males</p> Signup and view all the answers

    In regard to educational performance, how do children with disruptive mood dysregulation disorder typically fare?

    <p>They often struggle academically.</p> Signup and view all the answers

    Which of the following would NOT lead to the diagnosis of disruptive mood dysregulation disorder?

    <p>Persistent low mood without irritability</p> Signup and view all the answers

    Which is a critical component regarding the longitudinal course of symptoms in children with disruptive mood dysregulation disorder?

    <p>Symptoms are stable and persistent.</p> Signup and view all the answers

    Which of the following is true about the relationship between disruptive mood dysregulation disorder and oppositional defiant disorder?

    <p>Mood symptoms in DMD are more prominent than in oppositional defiant disorder.</p> Signup and view all the answers

    Which common factors in family life are linked to disruptive mood dysregulation disorder?

    <p>Psychological abuse or neglect</p> Signup and view all the answers

    Which of the following conditions is primarily characterized by severe temper outbursts and persistent irritability in children with autism spectrum disorders?

    <p>Disruptive Mood Dysregulation Disorder</p> Signup and view all the answers

    Which of the following symptoms is NOT a criterion for diagnosing a major depressive episode?

    <p>Frequent interruptions in routines</p> Signup and view all the answers

    What is required for a symptom to count toward a diagnosis of a major depressive episode?

    <p>It must be newly present or worsened compared to pre-episode status.</p> Signup and view all the answers

    Which disorder typically overlaps most with Disruptive Mood Dysregulation Disorder?

    <p>Oppositional Defiant Disorder</p> Signup and view all the answers

    How long must symptoms persist before diagnosing Disruptive Mood Dysregulation Disorder?

    <p>Three months</p> Signup and view all the answers

    Which statement is correct about the relationship between major depressive disorder and disruptive mood dysregulation disorder?

    <p>Children with both should only receive a diagnosis of major depressive disorder.</p> Signup and view all the answers

    Which of the following is a defining characteristic of a major depressive episode?

    <p>Duration of symptoms for at least two weeks</p> Signup and view all the answers

    What additional symptom must be present for a major depressive episode besides depressed mood?

    <p>At least four other specified symptoms</p> Signup and view all the answers

    In which context should the diagnosis of disruptive mood dysregulation disorder NOT be made?

    <p>During specific routines of autism</p> Signup and view all the answers

    Which of the following can be a consequence of major depressive disorder symptoms lasting sufficiently long?

    <p>Impaired functioning in key life areas</p> Signup and view all the answers

    What is an example of a psychomotor disturbance associated with major depressive disorder?

    <p>Trouble sitting still or pacing</p> Signup and view all the answers

    Which of the following statements about sleep disturbances in major depressive disorder is accurate?

    <p>Some may experience hypersomnia, but not all.</p> Signup and view all the answers

    Which of the following is a common misconception regarding the criteria for major depressive disorder?

    <p>Symptoms must occur sporadically over time.</p> Signup and view all the answers

    What is a common cognitive symptom associated with major depressive disorder?

    <p>Impaired ability to think and concentrate</p> Signup and view all the answers

    Which factor may be considered a significant motivation for suicidal thoughts in individuals with major depressive disorder?

    <p>An inability to foresee enjoyment in life</p> Signup and view all the answers

    Which type of depressive symptom may persist during periods of remission and indicate a risk of recurrence?

    <p>Presence of mild depressive symptoms</p> Signup and view all the answers

    What is a misconception about the symptoms of major depressive disorder in children?

    <p>Their primary symptom is separation anxiety.</p> Signup and view all the answers

    Which statement regarding the epidemiology of major depressive disorder is true?

    <p>Non-Hispanic Whites showed a significant increase in prevalence after demographic adjustments.</p> Signup and view all the answers

    Which factor does NOT typically contribute to the cognitive impairment observed during a major depressive episode?

    <p>Increased cognitive clarity</p> Signup and view all the answers

    What proportion of females is noted to experience major depressive disorder compared to males?

    <p>Twofold higher rates</p> Signup and view all the answers

    What characteristic is associated with excessive worry and complaints of physical health in major depressive disorder?

    <p>Obsessive rumination and anxiety</p> Signup and view all the answers

    Which of the following signifies the potential transition from major depressive disorder to schizophrenia?

    <p>Presence of manic features</p> Signup and view all the answers

    Which statement best reflects the neurobiological findings related to major depressive disorder?

    <p>The hypothalamic-pituitary-adrenal axis is frequently investigated.</p> Signup and view all the answers

    Which is an example of a nonvegetative symptom of major depressive disorder?

    <p>Persistent feelings of worthlessness</p> Signup and view all the answers

    What may individuals with major depressive disorder incorrectly blame for their symptoms?

    <p>Their own worthlessness or guilt</p> Signup and view all the answers

    What percentage represents the approximate twelve-month prevalence of major depressive disorder in the United States?

    <p>7%</p> Signup and view all the answers

    What complication may occur if a major depressive episode presents in the elderly?

    <p>It can be mistaken for early signs of dementia.</p> Signup and view all the answers

    What factor is primarily associated with the increased risk of major depressive disorder in women?

    <p>Adverse childhood experiences</p> Signup and view all the answers

    Which of the following life stages is NOT identified as a risk period for women developing depressive disorders?

    <p>Menopause</p> Signup and view all the answers

    What is a significant risk factor for suicide associated with major depressive disorder?

    <p>Past history of suicide attempts</p> Signup and view all the answers

    Which of the following symptoms may be more commonly experienced by women with depression compared to men?

    <p>Gastrointestinal symptoms</p> Signup and view all the answers

    What type of depressive disorder diagnosis requires the presence of an underlying medical condition?

    <p>Major depressive disorder</p> Signup and view all the answers

    In individuals with major depressive episodes that develop against the background of another disorder, what is likely to occur?

    <p>Increased resistance to treatment</p> Signup and view all the answers

    Which of the following accurately reflects a cultural diagnostic issue related to depression?

    <p>Significant cultural differences in course and prevalence</p> Signup and view all the answers

    Which demographic group is particularly noted for being at risk for multiple adverse childhood experiences?

    <p>Women</p> Signup and view all the answers

    What differentiates bereavement-related grief from a major depressive episode?

    <p>Type of emotional response</p> Signup and view all the answers

    Which condition is NOT considered a medical condition that can lead to major depressive episodes?

    <p>Bipolar disorder</p> Signup and view all the answers

    Which of the following describes differences in treatment response related to sex and gender?

    <p>Women may experience more disturbances in appetite</p> Signup and view all the answers

    Which of the following conditions would preclude a diagnosis of major depressive disorder?

    <p>Presence of hypomanic episodes</p> Signup and view all the answers

    Which of the following symptoms is considered commonplace across diverse cultural contexts for depression?

    <p>Diffuse pain</p> Signup and view all the answers

    What aspect of major depressive disorder is described as having a range of functional consequences?

    <p>Social isolation</p> Signup and view all the answers

    What common coping strategy might be more prevalent in men with depression than in women?

    <p>Alcohol or drug misuse</p> Signup and view all the answers

    What is a key differentiating factor for Persistent Depressive Disorder (PDD) compared to major depressive episodes?

    <p>There has never been a manic or hypomanic episode.</p> Signup and view all the answers

    Which comorbid disorder is more prevalent among women in relation to major depressive disorder?

    <p>Anxiety disorders</p> Signup and view all the answers

    What is the minimum duration for which depressed mood must persist to diagnose Persistent Depressive Disorder (PDD)?

    <p>2 years for adults and 1 year for children and adolescents.</p> Signup and view all the answers

    Which symptoms are NOT associated with Persistent Depressive Disorder (PDD)?

    <p>Euphoria or manic episodes.</p> Signup and view all the answers

    What is the relationship between the prevalence rates of Persistent Depressive Disorder (PDD) in men and women?

    <p>Women are more likely to receive a diagnosis than men.</p> Signup and view all the answers

    Which factor increases the likelihood of developing Persistent Depressive Disorder (PDD)?

    <p>Parental loss or separation during childhood.</p> Signup and view all the answers

    In which scenario would an additional diagnosis of major depressive disorder be appropriate alongside Persistent Depressive Disorder?

    <p>When criteria for major depressive episode are met during the PDD period.</p> Signup and view all the answers

    What is a common misconception about Persistent Depressive Disorder regarding symptom resolution?

    <p>Symptoms typically resolve fully in PDD.</p> Signup and view all the answers

    Which of the following is NOT a symptom of Persistent Depressive Disorder?

    <p>Intense euphoria.</p> Signup and view all the answers

    What factor is relevant for differential diagnosis between Persistent Depressive Disorder and chronic major depressive disorder?

    <p>Duration of symptom absence during the disturbance.</p> Signup and view all the answers

    What is NOT a risk factor for poorer long-term outcomes in Persistent Depressive Disorder?

    <p>Parental support during childhood.</p> Signup and view all the answers

    Which of the following best describes the symptom patterns in Persistent Depressive Disorder?

    <p>Symptoms may be continuously present, but not for more than 2 months absent.</p> Signup and view all the answers

    Which statement regarding cultural perceptions of Persistent Depressive Disorder is accurate?

    <p>Some cultures may normalize long-standing depressive symptoms.</p> Signup and view all the answers

    What is the estimated 12-month prevalence of chronic major depressive disorder in the United States?

    <p>1.5%</p> Signup and view all the answers

    What is a key distinguishing factor for diagnosing persistent depressive disorder compared to depressive disorder due to another medical condition?

    <p>Symptoms must not arise from another psychiatric disorder.</p> Signup and view all the answers

    Which of the following is a criterion for cyclothymic disorder?

    <p>Numerous periods of hypomanic symptoms not meeting the criteria for a hypomanic episode.</p> Signup and view all the answers

    What is required for a diagnosis of premenstrual dysphoric disorder?

    <p>Symptoms must cause clinically significant distress or interference.</p> Signup and view all the answers

    Which of the following is true about the occurrence of symptoms in premenstrual dysphoric disorder?

    <p>Symptoms occur primarily during the luteal phase and remit around the onset of menses.</p> Signup and view all the answers

    Which personality disorder clusters are early-onset persistent depressive disorder associated with?

    <p>Clusters B and C.</p> Signup and view all the answers

    Diagnosis of which disorder precludes a diagnosis of persistent depressive disorder?

    <p>Cyclothymic disorder</p> Signup and view all the answers

    Which of the following correctly defines the incidence of premenstrual dysphoric disorder over a specified follow-up period?

    <p>New cases in Germany over 40 months is estimated at 2.5%.</p> Signup and view all the answers

    Which is NOT a critical feature for diagnosing premenstrual dysphoric disorder?

    <p>Symptoms must be confirmed through retrospective evaluations.</p> Signup and view all the answers

    What influence do environmental factors have on premenstrual dysphoric disorder?

    <p>They may exacerbate symptoms depending on individual experiences.</p> Signup and view all the answers

    Which of the following is a common symptom of premenstrual dysphoric disorder?

    <p>Marked affective lability.</p> Signup and view all the answers

    Which statement is correct about personality disorders in relation to persistent depressive disorder?

    <p>They may coexist alongside persistent depressive disorder.</p> Signup and view all the answers

    What percentage of menstruating women with premenstrual dysphoric disorder was identified in the United States using prospective ratings?

    <p>1.3%</p> Signup and view all the answers

    Which characteristic is common to individuals with persistent depressive disorder compared to those with major depressive disorder?

    <p>They are at a higher risk for psychiatric comorbidity.</p> Signup and view all the answers

    What is a key characteristic that differentiates premenstrual syndrome from premenstrual dysphoric disorder?

    <p>Mood-related symptomatology requirement</p> Signup and view all the answers

    What should be documented alongside substance/medication-induced depressive disorder if there is a comorbid substance use disorder?

    <p>Mild, moderate, or severe classification</p> Signup and view all the answers

    In which scenario should premenstrual dysphoric disorder not be assigned?

    <p>Individual only has premenstrual exacerbation of another disorder</p> Signup and view all the answers

    What is required for the diagnosis of substance/medication-induced depressive disorder (SIDD)?

    <p>Symptoms must dominate the clinical picture</p> Signup and view all the answers

    What is the estimated prevalence of premenstrual syndrome in the population?

    <p>20%</p> Signup and view all the answers

    Which symptom is specifically associated with substance/medication-induced depressive disorder?

    <p>Diminished interest or pleasure in activities</p> Signup and view all the answers

    Which category of drugs is most likely to induce depressive disorders?

    <p>Depressants</p> Signup and view all the answers

    Under what condition can both a mental disorder and premenstrual dysphoric disorder be diagnosed concurrently?

    <p>When symptoms are markedly different from the ongoing disorder</p> Signup and view all the answers

    Which requirement is necessary for establishing a diagnosis of SIDD?

    <p>Symptoms must appear during intoxication or withdrawal</p> Signup and view all the answers

    What is a significant risk factor associated with the premenstrual phase?

    <p>Perceived risk for suicidal behavior</p> Signup and view all the answers

    What may indicate that an individual has an independent depressive disorder despite substance use?

    <p>Symptoms persist after intoxication or withdrawal</p> Signup and view all the answers

    Which of the following factors is NOT a recognized risk factor for substance-induced depressive disorder?

    <p>History of anxiety disorders</p> Signup and view all the answers

    What type of symptoms overlap significantly with premenstrual dysphoric disorder and other mood disorders?

    <p>General mood symptoms</p> Signup and view all the answers

    What is the lifetime prevalence of substance/medication-induced depressive disorder in a U.S. adult population without a history of non-substance-induced depressive disorders?

    <p>0.26%</p> Signup and view all the answers

    Substance/medication-induced depressive disorder is distinguished from an independent depressive disorder based on which of the following?

    <p>Duration of depressive symptoms</p> Signup and view all the answers

    Which is a common functional consequence of premenstrual dysphoric disorder?

    <p>Impairment in social functioning</p> Signup and view all the answers

    What diagnostic code should be used for substances that do not fit established classes?

    <p>Other substance code</p> Signup and view all the answers

    In diagnosing substance-induced depressive disorder, what role does the clinical history play?

    <p>It is crucial for establishing time course and characteristics.</p> Signup and view all the answers

    Which symptom pattern is typically associated with substance intoxication or withdrawal?

    <p>Mood symptoms resolving quickly post-abstinence</p> Signup and view all the answers

    What percentage of individuals with relevant substance use disorders may experience alcohol- and stimulant-induced depressive episodes?

    <p>40% or higher</p> Signup and view all the answers

    Which category of drugs is NOT mentioned as being potentially involved in medication-induced depressive disorder?

    <p>Painkillers</p> Signup and view all the answers

    How is the course of substance-induced depressive disorder typically characterized?

    <p>Possible fading after substance abstinence</p> Signup and view all the answers

    In the diagnosis of depressive disorder due to another medical condition, which aspect is essential?

    <p>Direct pathophysiological consequence of another medical condition</p> Signup and view all the answers

    What differentiates substance/medication-induced depressive disorder from an independent depressive disorder in terms of mood symptom onset?

    <p>Symptoms occur at times completely unrelated to substance use.</p> Signup and view all the answers

    Which group is more likely to have a comorbidity with substance/medication-induced depressive disorder?

    <p>Individuals with antisocial personality disorder</p> Signup and view all the answers

    Which of the following substances is associated with depressive symptoms specifically during withdrawal?

    <p>Alcohol</p> Signup and view all the answers

    Which of the following statements about diagnostic markers for substance-induced depressive disorder is true?

    <p>A positive test does not confirm a diagnosis.</p> Signup and view all the answers

    The relationship between neurochemical changes and depressive symptoms is particularly noted during which period?

    <p>During withdrawal from substances</p> Signup and view all the answers

    What is a key factor to consider when diagnosing depressive disorder due to another medical condition?

    <p>The presence of prior depressive episodes before the medical condition</p> Signup and view all the answers

    Which condition is most closely associated with higher risks of depression due to physiological changes?

    <p>Cushing’s syndrome</p> Signup and view all the answers

    What characterizes demoralization in contrast to depressive disorder due to another medical condition?

    <p>It allows for moments of pleasure in meaningful activities</p> Signup and view all the answers

    Which factor is significantly correlated with the risk of acute onset of major depressive disorder following a cerebrovascular accident?

    <p>Location of the lesion</p> Signup and view all the answers

    In which scenario is a diagnosis of depressive disorder due to another medical condition typically not given?

    <p>If symptoms occur during a delirium</p> Signup and view all the answers

    What common reaction to chronic medical illness is characterized by feelings of hopelessness and helplessness?

    <p>Demoralization</p> Signup and view all the answers

    What is an essential component in establishing that depressive disorder is due to another medical condition?

    <p>Clear etiology linking depression and the medical condition</p> Signup and view all the answers

    Following which medical event does depression onset typically seem acute, often within days?

    <p>Cerebrovascular accident</p> Signup and view all the answers

    Which demographic shows a differentially higher risk of depression in the context of cardiovascular disease?

    <p>Women, particularly post-stroke</p> Signup and view all the answers

    What is a key symptom of anxious distress during a major depressive episode?

    <p>Difficulty concentrating because of worry</p> Signup and view all the answers

    What is the relationship between major depressive episodes associated with medical conditions and the risk of suicide?

    <p>It is comparable and potentially greater</p> Signup and view all the answers

    What must be present for a diagnosis of major depressive episode with melancholic features?

    <p>Loss of pleasure in activities</p> Signup and view all the answers

    Which component is least likely to be involved in depressive disorders associated with medical conditions?

    <p>Prior substance use disorders</p> Signup and view all the answers

    Which specific vitamin deficiency is associated with an increased risk of depressive disorder?

    <p>Vitamin B12</p> Signup and view all the answers

    Which feature characterizes atypical depression?

    <p>Mood reactivity to positive events</p> Signup and view all the answers

    What defines mixed features in the context of depressive disorders?

    <p>A combination of depressive symptoms and hyperactive behavior</p> Signup and view all the answers

    What differentiates depressive disorder from adjustment disorders in a clinical context?

    <p>The duration of depressive symptoms</p> Signup and view all the answers

    In which category of depressive episodes would you find significant changes in mood during pregnancy or postpartum?

    <p>Peripartum onset</p> Signup and view all the answers

    Which of the following is typically not considered a medical condition that could induce major depression?

    <p>Chronic migraines</p> Signup and view all the answers

    What is a significant risk factor for postpartum episodes with psychotic features?

    <p>Prior history of postpartum psychosis</p> Signup and view all the answers

    Which characteristic is indicative of atypical features in a major depressive episode?

    <p>Hypersomnia</p> Signup and view all the answers

    What defines a depressive disorder due to another medical condition?

    <p>Symptoms clearly linked to a known medical issue</p> Signup and view all the answers

    What does the 'distinct quality' of mood in melancholic features indicate?

    <p>Profound despair that does not respond to positive life events</p> Signup and view all the answers

    During which stage of a major depressive episode is the 'with psychotic features' specifier applied?

    <p>At any time during the episode if delusions or hallucinations are present</p> Signup and view all the answers

    Which of the following is NOT a characteristic of maternity blues?

    <p>Significant impairment in daily functioning</p> Signup and view all the answers

    What is the estimated prevalence of major depressive episodes in the postpartum period?

    <p>Around 7%</p> Signup and view all the answers

    What symptom is associated with leaden paralysis in atypical depression?

    <p>A sense of heaviness in limbs</p> Signup and view all the answers

    What does catatonia in the context of depressive episodes refer to?

    <p>Catatonic features during most of the depressive episode</p> Signup and view all the answers

    What is a significant characteristic of seasonal major depressive episodes?

    <p>They must have occurred in a 2-year period without any nonseasonal episodes.</p> Signup and view all the answers

    In which demographic is winter-type seasonal pattern prevalence found to be highest?

    <p>Younger individuals living in higher latitudes.</p> Signup and view all the answers

    How does grief differ from a major depressive episode in terms of self-esteem?

    <p>Self-esteem is generally preserved in grief.</p> Signup and view all the answers

    Which symptom differentiates major depressive episodes from grief?

    <p>Persistent depressed mood and inability to anticipate happiness.</p> Signup and view all the answers

    What is a common presentation of depression among children and adolescents?

    <p>Physical symptoms and irritability.</p> Signup and view all the answers

    Which aspect of depressive disorders can significantly affect children's language and speech development?

    <p>Pediatric and developmental irritability.</p> Signup and view all the answers

    What is the connection between youth depression and public health concerns?

    <p>Childhood depressive disorders are substantial global public health concerns.</p> Signup and view all the answers

    Which factor is NOT typically associated with the development of depressive disorders?

    <p>High levels of social competence.</p> Signup and view all the answers

    Which demographic shows a significant increase in rates of depressive disorders?

    <p>Children and adolescents across all countries.</p> Signup and view all the answers

    What type of mood disturbances is common in depressive disorders in children?

    <p>Sadness and irritability.</p> Signup and view all the answers

    Which of the following behaviors might depressive disorders in children manifest as?

    <p>Physical aggression and disruption.</p> Signup and view all the answers

    What is a critical factor in the persistence of depressive disorders over time?

    <p>Provision of preventive health services.</p> Signup and view all the answers

    How are children and adolescents affected by depressive disorders in terms of academic engagement?

    <p>They often show diminished enthusiasm and performance.</p> Signup and view all the answers

    Which condition has high comorbidity with depressive disorders among children and adolescents?

    <p>Anxiety disorders.</p> Signup and view all the answers

    What is the primary goal of early identification and treatment of non-depressed symptoms in patients with depressive disorders?

    <p>To improve overall prognosis.</p> Signup and view all the answers

    Which statement accurately describes the relationship between depressive disorders and anxiety in children?

    <p>Anxiety symptoms can coexist in over 50% of children with major depressive disorder.</p> Signup and view all the answers

    What factor complicates the pharmacotherapy treatment of depressive disorders in children and adolescents?

    <p>High levels of comorbidity with other psychiatric conditions.</p> Signup and view all the answers

    What is a major potential risk of using medication for emotional symptoms without psychotherapy?

    <p>Higher dropout rates from medication protocols</p> Signup and view all the answers

    What role does the prefrontal cortex-amygdala circuit have in understanding depressive disorders?

    <p>It may contribute to the higher fear associated with anxiety in depression.</p> Signup and view all the answers

    Which of the following is a defining characteristic of disruptive mood dysregulation disorder (DMDD) in children?

    <p>Severe temper outbursts that are disproportionate to provocation.</p> Signup and view all the answers

    Which of the following approaches is NOT a primary mechanism used by therapies targeting depressive symptoms?

    <p>Medical intervention through increased serotonin</p> Signup and view all the answers

    What type of therapy is specifically highlighted as a model that incorporates family and individual approaches?

    <p>Pediatric Mood Disorders program</p> Signup and view all the answers

    What additional symptom is typically observed in dysphoric children with depressive disorders?

    <p>Reactive behavior under specific circumstances.</p> Signup and view all the answers

    How does the diathesis-stress model of depression primarily characterize depression?

    <p>As a strict monoamine deficiency model</p> Signup and view all the answers

    What impact does life change have on the symptoms and recovery rates in children with depressive disorders?

    <p>Life changes can decrease hippocampal volume and remission rates.</p> Signup and view all the answers

    Which treatment strategy shows promise for those who have not responded well to traditional therapies?

    <p>Transcranial magnetic stimulation</p> Signup and view all the answers

    Which public screening tool is frequently used to assess depressive disorders in children?

    <p>The Children's Depression Rating Scale Revised.</p> Signup and view all the answers

    Why is accurate assessment of temper outbursts essential in children suspected of having DMDD?

    <p>To identify potential co-existing mood or anxiety disorders.</p> Signup and view all the answers

    Which factor is NOT typically considered in treatment-resistant cases of depression?

    <p>Speculative diagnosis of personality disorders</p> Signup and view all the answers

    What is a common misconception regarding the relationship between major depressive disorder and children's attention-deficit/hyperactivity disorder (ADHD)?

    <p>Symptoms of ADHD can mimic those of depression.</p> Signup and view all the answers

    What is one limitation of pharmacotherapy for children and adolescents dealing with depressive disorders?

    <p>Offers only short-term relief</p> Signup and view all the answers

    Which characteristic distinguishes depression with atypical features concerning treatment response?

    <p>Response to norepinephrine antidepressants</p> Signup and view all the answers

    What factor does not correlate with the clinical presentation of major depressive disorder (MDD)?

    <p>Increased initiative and motivation.</p> Signup and view all the answers

    What distinguishes the emotional symptoms of disruptive mood dysregulation disorder (DMDD) from major depressive disorder?

    <p>DMDD includes high levels of emotional liability out of proportion to triggers.</p> Signup and view all the answers

    What is a critical aspect of effective treatment for disruptive mood dysregulation disorder (DMDD)?

    <p>Incorporation of psychosocial interventions</p> Signup and view all the answers

    What is a significant outcome for children with comorbid ADHD and DMDD compared to children with just ADHD?

    <p>They often experience more severe mood dysregulation.</p> Signup and view all the answers

    What factor can significantly influence the selection of a CBT program for youths with disruptive mood disorders?

    <p>Individual goals and motivation for change</p> Signup and view all the answers

    Which of the following is true about the coordination of treatment for children with severe depressive disorders?

    <p>Collaboration with multiple providers may enhance outcomes</p> Signup and view all the answers

    Which of the following best highlights the challenges faced in treatment for chronic mood disorders?

    <p>Need for a multimodal treatment approach</p> Signup and view all the answers

    Regarding the neurobiology of mood disorders, what trend has been observed in recent research?

    <p>Significant growth in understanding major mood disorders</p> Signup and view all the answers

    What is considered a primary strategy in addressing refractory depressive disorders?

    <p>Reassessment of selected approaches and possibly more intensive strategies</p> Signup and view all the answers

    Which factors are important for effective collaboration in treating childhood depressive disorders?

    <p>Family involvement and mental healthcare professional collaboration</p> Signup and view all the answers

    What aspect of treatment can help minimize the side effects of psychotherapy and pharmacological interventions?

    <p>Specific strategies to avoid anticipated side effects</p> Signup and view all the answers

    What is the suggested response or remission rate for various treatments in youth with severe depressive disorders?

    <p>60% or more</p> Signup and view all the answers

    What is a critical component in preventing adolescent depressive disorders from continuing into adulthood?

    <p>Intervening during adolescence or earlier</p> Signup and view all the answers

    Which approach is being developed to address family involvement in mental health treatment?

    <p>Group rather than individual interventions</p> Signup and view all the answers

    How can cultural considerations positively influence the treatment of depressive disorders?

    <p>By assessing socio-ecological factors impacting depression</p> Signup and view all the answers

    What is the role of primary care providers in addressing mental health issues in children?

    <p>To promote culturally sensitive mental health care</p> Signup and view all the answers

    Which preventive approach is directed towards families, even before mental health difficulties manifest?

    <p>High-impact preventive therapies</p> Signup and view all the answers

    What is a significant incentive for parents to support public health approaches to mental health?

    <p>Inclusion of all families in preventive strategies</p> Signup and view all the answers

    What is essential for recognizing emotional distress in children and adolescents?

    <p>Improving individual approaches through evidence-based screening tools</p> Signup and view all the answers

    Which approach emphasizes the need for mental health awareness among various healthcare providers?

    <p>Promotion of mental health awareness in primary and specialty care</p> Signup and view all the answers

    What challenge does the increasing prevalence of depressive disorders pose to clinicians?

    <p>It complicates the care for children with mental health issues</p> Signup and view all the answers

    What is a critical ethical consideration when treating patients with depression disorders?

    <p>Treatment must be well documented and justified.</p> Signup and view all the answers

    How should conflicts in treatment opinions among medical team members be handled?

    <p>Patient autonomy must remain central in the decision-making process.</p> Signup and view all the answers

    What role does confidentiality play in clinical work with patients?

    <p>It is a fundamental aspect supporting patients' rights and dignity.</p> Signup and view all the answers

    Which of the following is a key factor in the informed consent process?

    <p>Recognition of the need for authority and legitimacy.</p> Signup and view all the answers

    What characteristic must a treatment team prioritize during pediatric mental health interventions?

    <p>Collaboration and respect for patient autonomy and dignity.</p> Signup and view all the answers

    In the context of restraints during treatment, what is a necessary condition for their use?

    <p>Use must be based on demonstrable clinical safety decisions.</p> Signup and view all the answers

    What is a common challenge researchers face when working in pediatric psychiatric care?

    <p>Establishing effective communication and trust with families is often complex.</p> Signup and view all the answers

    What is an outcome commonly pursued in pediatric psychiatry for children experiencing severe irritability?

    <p>Identifying criteria for more accurate diagnoses beyond DMDD.</p> Signup and view all the answers

    What is one challenge clinicians face when treating adolescents with depressive disorders?

    <p>Standard cognitive-behavioral therapy may not address peer interaction.</p> Signup and view all the answers

    Which therapy is suggested as a reasonable choice for treating severe depression in elderly patients?

    <p>Interpersonal therapy</p> Signup and view all the answers

    What characteristic often complicates the diagnosis of major depression in elderly patients?

    <p>Frequent neglect of psychiatric manifestations.</p> Signup and view all the answers

    What is a significant brain function change associated with aging that may affect depressive symptoms?

    <p>Decreased impulse control linked to frontal lobe changes</p> Signup and view all the answers

    Which factor is mentioned as a potential long-term risk for depression in the elderly?

    <p>Absence of precipitating stressors</p> Signup and view all the answers

    What is a noted change in neurotransmitter receptors associated with aging?

    <p>Increased sensitivity leading to a higher response to medications</p> Signup and view all the answers

    What aspect of therapy may present challenges for geriatric patients with depression?

    <p>Their cognitive capacities may be compromised.</p> Signup and view all the answers

    What is a consequence of persistent depressive symptoms in elderly patients?

    <p>Increased complexity in treatment management</p> Signup and view all the answers

    What can increase the vulnerability of women to unipolar depression following menopause?

    <p>Biological changes associated with aging</p> Signup and view all the answers

    What is a notable characteristic of depressive disorders in the elderly?

    <p>Complex presentation with slow, vigorous episodes</p> Signup and view all the answers

    Which of the following challenges may affect clinicians' recognition of depression in elderly patients?

    <p>Limited ongoing education for practitioners</p> Signup and view all the answers

    What impact does social isolation have on elderly patients with depression?

    <p>It can exacerbate feelings of hopelessness and helplessness.</p> Signup and view all the answers

    Which factor indicates the complexity of geriatric depression treatment?

    <p>Comorbidity with chronic medical conditions is prevalent.</p> Signup and view all the answers

    What is highlighted as essential for effective treatment of depressive disorders?

    <p>Empowering patients with knowledge and skills</p> Signup and view all the answers

    Which group of women is noted to experience unique risk factors related to depressive disorders?

    <p>Aboriginal and Torres Strait Islander women</p> Signup and view all the answers

    Which factor contributes significantly to the risk of depression in refugee women?

    <p>The intersectionality of gender and socio-cultural equity</p> Signup and view all the answers

    What role does family resilience play in children's mental health?

    <p>It can mitigate the effects of family adversity.</p> Signup and view all the answers

    Which technique is essential for improving clients' mental health according to clinical psychologists?

    <p>Psychoeducation and self-management techniques</p> Signup and view all the answers

    What is crucial for communicating risk in psychiatric treatment plans?

    <p>All general and specific risk estimates must be provided</p> Signup and view all the answers

    Why is it important to normalize depressive disorders in patient education?

    <p>To promote patient-centered collaborative care</p> Signup and view all the answers

    Which model focuses on shared care for anxiety and depression in primary care settings?

    <p>Coordinated Anxiety Learning and Management (BHS-CCS)</p> Signup and view all the answers

    What aspect of mental health services integration requires careful planning?

    <p>Collaboration between clinical services and pediatric physicians</p> Signup and view all the answers

    What is considered a barrier to effective restoration of social support for children with depressive disorders?

    <p>Complexities of childhood development</p> Signup and view all the answers

    What significant issue arises from treating children with chronic depressive disorders?

    <p>Children's ability to maintain social relations</p> Signup and view all the answers

    What is a main focus of educational health prevention psychology techniques?

    <p>Setting therapeutic objectives through patient engagement</p> Signup and view all the answers

    What vital element is necessary for building a support network in child treatment?

    <p>Assurance and understanding of the illness</p> Signup and view all the answers

    Which statement is true regarding the management of Major Depressive Disorder?

    <p>Understanding the reasons for treatment failures is crucial.</p> Signup and view all the answers

    Study Notes

    Depressive Disorders

    • Characterized by sad, empty, or irritable moods, affecting the ability to function.
    • Include disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, and others.

    Disruptive Mood Dysregulation Disorder (DMD)

    • A condition in children up to age 18 requiring careful distinction from bipolar disorder.
    • Added to DSM-5 due to concerns about overdiagnosis and treatment of bipolar disorder in children.
    • Characterized by frequent temper outbursts (at least 3 times a week, for at least 1 year, in 2 settings) and persistent irritability between outbursts.
    • Prevalence is unclear, but estimates suggest it may be more common in younger age groups.
    • May be associated with disrupted family life, parental psychiatric disorder, early trauma, and family history of depression.
    • Can be diagnosed comorbidly with ADHD, major depressive disorder, and anxiety disorders, but not if irritability only occurs within a depressive episode.
    • Also occurs with autism spectrum disorders and obsessive-compulsive disorder.

    Major Depressive Disorder (MDD)

    • Diagnosed by five or more symptoms:
      • Depressed mood most of the day, nearly every day
      • Loss of interest in activities
      • Significant weight loss or gain
      • Insomnia or hypersomnia
      • Psychomotor agitation or retardation
      • Fatigue or loss of energy
      • Feelings of worthlessness or guilt
      • Difficulty concentrating or making decisions
      • Recurrent thoughts of death or suicide
    • Requires at least one major depressive episode without a history of manic or hypomanic episodes.
    • A major depressive episode lasts at least 2 weeks, with at least 4 additional symptoms from the list above.
    • Symptoms must be present nearly every day for at least 2 weeks, except for thoughts of death and suicidal ideation, which must be recurrent, and suicide attempts or plans, which only need to occur once.
    • Mood is often described as depressed, sad, hopeless, discouraged, or “down in the dumps”.
    • May involve social withdrawal, changes in appetite and sleep, fatigue, feelings of worthlessness or guilt, difficulty thinking, concentrating, or making decisions, and thoughts of death or suicide.
    • Severity of impairment varies, but even in milder cases, there must be clinically significant distress or interference in social, occupational, or other important areas of functioning.
    • Associated with high mortality rates, with suicide being the most common cause.
    • Prevalence is approximately 7% in the United States, with marked differences by age group.
    • Higher prevalence in females, especially between menarche and menopause.
    • May first appear at any age, but the likelihood of onset increases markedly with puberty.
    • Course is variable, with some individuals rarely experiencing remission.
    • Many bipolar illnesses begin with one or more depressive episodes.

    Epidemiology of Depressive Disorders

    • Prevalence varies significantly across global geographic regions.
    • Prevalence in the United States increased from 2005 to 2015, with steeper rates of increase for youth compared with older groups.
    • Non-Hispanic Whites showed a significant increase in prevalence, whereas no significant change was observed among non-Hispanic Blacks or Hispanics.

    Major Depressive Disorder

    • Individuals with a "with mixed features" specifier in their diagnosis have an increased risk of future manic or hypomanic episodes
    • People with major depressive disorder, particularly with psychotic features, may transition to schizophrenia
    • High levels of negative affectivity increase the likelihood of developing depression in response to stressful life events
    • Past experiences of abuse, particularly during childhood, are risk factors for depression
    • Women are at higher risk of experiencing adverse childhood experiences, such as sexual abuse
    • Other social determinants of mental health include low income, limited education, exposure to racism, and discrimination
    • Women may be at risk for depression during certain stages of reproduction, like the premenstrual period, postpartum, and perimenopause
    • Major nonmood disorders increase the risk of developing depression
    • Depressive episodes alongside other conditions often follow a more refractory course
    • Chronic medical conditions, such as substance use, anxiety, and borderline personality disorders, also increase the risk of depression
    • Symptoms of depression often include social isolation/loneliness, anger, crying, and diffuse pain
    • There is evidence for sex and gender differences in treatment response and functional consequences to depression
    • Women experience more disturbances in appetite and sleep, including atypical features such as hyperphagia and hypersomnia
    • Men are more likely to report maladaptive self-coping and problem-solving strategies like alcohol/drug misuse, risk taking, and poor impulse control
    • Suicide rates have increased over the past two decades
    • The possibility of suicide exists at all times during a depressive episode
    • Major depressive disorder can lead to more pain and physical illness, decreased physical, social, and role-functioning
    • Depressed women experience greater functional impairment in their relationships than men
    • Differential diagnosis is important for major depressive episodes with prominent irritable mood
    • Major depressive episodes with a history of a manic or hypomanic episode indicate a diagnosis of bipolar disorder

    Persistent Depressive Disorder (PDD)

    • PDD is a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder
    • It is characterized by a depressed mood for most of the day for at least 2 years, accompanied by symptoms like poor appetite, insomnia, low energy, low self-esteem, poor concentration, and hopelessness
    • PDD is a mood-related condition that occurs for at least two years (one year for children and adolescents)
    • The prevalence of persistent depressive disorder is higher among women than men
    • Early onset of PDD is often related to a high likelihood of comorbid personality disorders and substance use disorders
    • Risk and prognostic factors that worsen long-term outcomes include high levels of negative affectivity, greater symptom severity, poorer global functioning, and presence of anxiety disorders or conduct disorder.
    • Childhood risk factors for PDD include parental loss or separation and childhood adversity
    • Chronic depressive symptoms may be perceived differently across cultures, affecting both detection and treatment acceptability
    • PDD is associated with an elevated risk of suicidal outcomes and comparable levels of disability
    • The degree to which PDD impacts social and occupational functioning is likely to vary widely
    • Diagnosis is based on the presence of depressed mood for more days than not, along with two or more persistent depressive disorder Criterion B symptoms for 2 years or more.

    Premenstrual Dysphoric Disorder

    • Premenstrual dysphoric disorder (PMDD) is a condition that affects women during their menstrual cycle
    • Symptoms like marked affective lability, irritability, depressed mood, anxiety, tension, and feelings of being keyed up or on edge are present in the final week before menstruation, starting to improve within a few days after menstruation
    • Symptoms must cause clinically significant distress or interfere with work, school, social activities, or relationships
    • The 12-month prevalence of PMDD in the community has been estimated at 5.8%
    • Environmental factors associated with PMDD include stress, history of interpersonal trauma, seasonal changes, and sociocultural aspects of female sexual behavior
    • Cultural-related diagnostic issues have been observed in individuals in the United States, Europe, India, Nigeria, Brazil, and Asia
    • Diagnostic markers are appropriately confirmed by prospective symptom ratings
    • Functional consequences of PMDD include impairment in social functioning, problems in relationships, impairments in work and health-related quality of life

    Premenstrual Dysphoric Disorder (PMDD)

    • PMDD is a diagnosis distinct from a premenstrual exacerbation of another mental or physical disorder.
    • PMDD may be diagnosed alongside other mental or physical disorder if the individual experiences both hallmark symptoms of a premenstrual disorder and also symptoms that are markedly different from those of their ongoing condition.

    Substance/Medication-Induced Depressive Disorder (SIDD)

    • SIDD is diagnosed when symptoms of depression are prominent in the clinical picture and significant enough to warrant clinical attention.
    • SIDD is diagnosed instead of substance intoxication or withdrawal.
    • The name of the SIDD is based on the substance or medication causing the symptoms, and the diagnostic code is based on the drug class and the presence or absence of a comorbid substance use disorder.
    • Comorbid substance use disorder is noted in the diagnosis, with the specific substance use disorder listed first, followed by "with," followed by the name of the substance-induced depressive disorder, and the specification of onset (during intoxication, during withdrawal).
    • SIDD is distinguished from an independent depressive disorder by the onset or course of the symptoms, or by other factors associated with substance or medication use.
    • Risk factors for SIDD include a history of antisocial personality disorder, schizophrenia, and bipolar disorder, stressful life events in the past 12 months, prior drug-induced depressions, and a family history of substance use disorders.
    • The diagnosis of SIDD is based on a detailed clinical history and mental status examination.
    • SIDD is more likely to be diagnosed if the individual was taking high doses of the substance or medication and there is no past history of independent depressive episodes.

    Depressive Disorder Due to Another Medical Condition

    • This diagnosis is used to describe a prominent and persistent mood disturbance that is the direct pathophysiological consequence of another medical condition.
    • The mood disturbance must be etiologically related to the medical condition, through a demonstrable physiological mechanism.
    • The clinician must establish the presence of another medical condition and establish that the mood disturbance is etiologically related to the condition.
    • The diagnosis requires a careful and comprehensive assessment of multiple factors, with etiology being the key variable.
    • Medical conditions associated with depression include cerebrovascular accident (CVA), Huntington’s disease, Parkinson’s disease, traumatic brain injury (TBI), Cushing’s syndrome, hypothyroidism, systemic lupus erythematosus, and vitamin B12 deficiencies.

    Depressive Disorder due to Multiple Medical Conditions

    • The onset of depression is often acute following a CVA, occurring within days of the event.
    • The duration of major depressive episodes following a stroke is often 9-11 months on average.
    • With Parkinson’s disease and Huntington’s disease, depression often precedes the major motor impairments and cognitive impairments associated with each condition.
    • Risk factors for major depressive disorder following a CVA are strongly correlated with lesion location, with the greatest risk associated with left frontal strokes.
    • Risk of depression after TBI has been associated with female gender, prior depressive disorder, early psychiatric symptoms following injury, lower brain volume, and unemployment.
    • The risk of depression in the setting of cardiovascular disease, particularly poststroke, is differentially higher for women.

    Unspecified Depressive Disorder

    • This diagnosis applies when symptoms characteristic of a depressive disorder have been adequately documented but do not meet the full criteria for any other depressive disorder.
    • Symptoms typically cause significant distress or impairment in social, occupational, or other important areas of functioning.

    Depressive Disorders With Specific Features

    • Anxious distress, is characterized by at least two of the following symptoms during the majority of days of the current major depressive episode:
      • feeling keyed up or tense
      • feeling unusually restless
      • difficulty concentrating because of worry
      • fear that something awful may happen
      • feeling that the individual might lose control of themselves
    • Mixed features are present when the following symptoms are present during the current or most recent major depressive episode:
      • elevated, expansive mood
      • inflated self-esteem or grandiosity
      • more talkative than usual
      • flight of ideas or subjective experience that thoughts are racing
      • increased energy or goal-directed activity
      • increased or excessive involvement in activities with high potential for painful consequences
      • decreased need for sleep -Melancholic features, during most severe period of the episode:
      • loss of pleasure in all or almost all activities
      • lack of reactivity to usually pleasurable stimuli
      • profound despair and/or moroseness
      • depression that is regularly worse in the morning
      • early-morning awakening
      • marked psychomotor agitation or retardation
      • significant anorexia or weight loss
      • excessive or inappropriate guilt

    Major Depressive Episodes: Specific Clinical Presentations

    • Atypical depression:
      • mood reactivity
      • significant weight gain or increase in appetite
      • hypersomnia
      • feelings of heaviness or "leaden paralysis"
      • long-standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment
    • With atypical features:
      • mood reactivity
      • increased appetite or weight gain
      • hypersomnia
      • "leaden paralysis"
    • With psychotic features:
      • delusions and/or hallucinations
      • Specify if mood-congruent or mood-incongruent.
    • With catatonia:
      • catatonic features are present during most of the episode
    • With peripartum onset:
      • mood symptoms occur during pregnancy or in the 4 weeks following delivery
      • Approximately 50% of postpartum major depressive episodes begin prior to delivery.
      • The best estimate for prevalence of a major depressive episode between birth and 12 months postpartum is just below 7%.
      • Postpartum mood episodes with psychotic features appear to occur in from 1 in 500 to 1 in 1,000 deliveries and may be more common in primiparous women.
      • The risk of postpartum episodes with psychotic features is particularly increased for women with prior postpartum psychotic mood episodes but is also elevated for those with a prior history of a depressive or bipolar disorder (especially bipolar I disorder) and those with a family history of bipolar disorders.

    Postpartum Psychotic Features

    • The risk of recurrence for postpartum episodes with psychotic features increases by 30% to 50% with each subsequent delivery.
    • Postpartum episodes must be differentiated from delirium.

    Major Depressive Episodes

    • Major depressive episodes can be classified into four categories: atypical, with atypical features, with psychotic features, and with peripartum onset.
    • The postpartum period is a critical time for the development of depressive disorders.
    • "Maternity blues" or "baby blues" are characterized by sudden changes in mood that don't cause functional impairment and are likely caused by physiological changes after delivery.
    • Maternity blues are temporary and self-limited, improving within a week without treatment.
    • Perinatal women may be at higher risk for depressive disorders due to thyroid abnormalities and other medical conditions.
    • If depressive symptoms are caused by another medical condition related to the perinatal period, depressive disorder due to another medical condition should be diagnosed instead of a major depressive episode with peripartum onset.

    Seasonal Pattern Specifier

    • The seasonal pattern specifier applies to recurrent major depressive disorder, requiring a regular temporal relationship between the onset of episodes and a specific time of year.
    • This pattern must have occurred for at least 2 years, without any nonseasonal episodes during that period.
    • Seasonal major depressive episodes significantly outweigh nonseasonal episodes over a person's lifetime.
    • Prevalence of winter-type seasonal pattern increases with higher latitudes, and younger persons are at higher risk for winter depressive episodes.

    Distinguishing Grief from MDE

    • Grief is characterized by feelings of emptiness and loss, while MDE is marked by persistent depressed mood and the inability to anticipate happiness or pleasure.
    • Dysphoria in grief decreases over days to weeks and occurs in waves, while in MDE, self-esteem is impaired and feelings of worthlessness and self-loathing are common.
    • Thoughts about death and dying in grief focus on the deceased, while in MDE, these thoughts focus on ending one's own life.

    Clinical Practice Insights

    • Depressive disorders are a class of mental disorders that involve a pervasive sad mood, elevated mood, or loss of interest or pleasure.
    • Children and adolescents may present with irritability, excessive sadness, and inappropriate crying, often accompanied by physical complaints.
    • Suicide is a concern for individuals with depression.
    • In elementary school children, depression is associated with fear, anxiety, behaviors, and physical symptoms.
    • In older children and adolescents, symptoms become more adult-like and often become more socially disruptive and isolating, with more destructive behavior, lowered self-esteem, and less academic enthusiasm.
    • Recent epidemiological surveys suggest that childhood and adolescent depressive disorders represent substantial global public health concerns.
    • Youth depression is a common and disabling condition in general pediatrics and pediatric mental health, often presenting as disruptive, impulsive, and noncompliant behaviors.
    • Depressive disorders encompass a collection of mood states with overlapping features, but also with state-related features that are distinctive and not shared by other depressive disorders.
    • Pediatric and developmental irritability as important aspects of the depressive disorders are significantly related to several factors, including language and speech development, intelligence, anger, hyperactivity, oppositionality, mania, suicidality, social cognitive recognition, and dysfunctional interactions.

    Major Depressive Disorder (MDD)

    • MDD is one of the most prevalent mental disorders in the world, increasing in all age groups in almost all countries.
    • Rates of depression in children and adolescents are particularly high, leading to diminished overall functioning and suicide.
    • Depressive disorders typically begin in adolescence or young adulthood and recur thereafter.
    • The neurobiological basis of these disorders is complex, with the brain being a soft tissue, making molecular research at a molecular level disproportionately limited.
    • Depressive disorders are typically characterized by sad, irritable, or manic moods, but other symptoms have similar or greater clinical importance.
    • Early identification and treatment of non-depressed symptoms is important for the overall prognosis of patients with depressive disorders.

    Bipolar Disorder

    • Bipolar disorder has major depressive episodes as primary outcomes, while manic or hypomanic disorders are associated with severe psychosocial and biological dysregulations.
    • Various neurotransmitter imbalances have been suggested to be related to depressive disorder, such as decreased brain activity, decreased motivation, and motor retardation.
    • These imbalances can induce symptoms, including motor and cognitive retardation, and may also be related to cases of suicidal attempts.
    • Higher fear associated with anxiety may be related to an impairment in the prefrontal cortex-amygdala circuit, while a higher change in life may affect the hippocampal volume and diminish the remission rate.

    Disruptive Mood Dysregulation Disorder (DMDD)

    • The clinical presentation of DMDD involves three key points: the onset, typical duration, and timing of the outbursts.
    • Criterion A of the DMDD diagnosis stipulates that emotional and behavioral symptoms should not exclusively occur during an episode of major depression, persistent mood symptoms should not meet the criteria for mixed mania or mania, and symptoms are not better accounted for by another mental disorder.
    • Depressive disorders may present with non-specific signs such as irritability and anger, and may be hidden behind other psychiatric disorders such as mania, enuresis, personality disorders, or mixed states.
    • Self-esteem is usually impaired in dysphoric children, and in selected cases, a reactive behavior may be observed.
    • Other common depression symptoms include low energy, decreased appetite, decreased interest in usual activities, decreased initiative, daytime somnolence, isolation, agitation, or retarded psychomotor activity.
    • Overt anxiety coexists in more than 50% of children and adolescents affected by major depressive disorder, and comorbidity with substance abuse, attention-deficit hyperactivity disorder, oppositional defiant disorder, and other aggressive psychological disorders is very frequently seen.
    • DMDD is a common condition that often co-occurs with attention-deficit/hyperactivity disorder (ADHD), which can cause long-standing problems with oppositionalism and anger in children.
    • However, the child's ability to regulate mood and the degree of mood lability is out of proportion to what would be predicted by ADHD alone.
    • The prognosis for children with DMDD and comorbid ADHD appears to be worse than that for children with ADHD alone or for children with comorbid ODD/CD.
    • Common comorbid conditions include ADHD, which may cause the child to have long-standing problems with regard to oppositionalism and anger, and thus be the major target of treatment.
    • However, the child's ability to regulate mood and the degree of mood lability is out of proportion to what would be predicted by ADHD alone.
    • The prognosis for children with DMDD and comorbid ADHD appears to be worse than that for children with ADHD alone or for children with comorbid ODD/CD.
    • When assessing a child with recurrent temper outbursts, it is important to establish whether the behavioral profile of DMDD is met, and whether any other mood or anxiety disorder is present.
    • It is also important to clarify the circumstances in which the temper outbursts occur, and consider whether other factors, such as deterioration in the quality of natural or foster home care, changes in school placement, the child's social relationships, and life events that have triggered the onset plan, are contributory.
    • In addition to the irritability component of DMDD, it is more often associated with the later development of major depression than not.

    Assessment and Treatment of Depressive Disorders

    • Public screening tools for depressive disorders include questionnaires at the time of the session and for projective test observation at the first office visit.
    • Stimulation at home may be an innovatively guilt-free, manageable social therapeutic experience, such as a related home projective test.
    • Readier, salient screen openings for MDD with sleep disturbances may be more effectively elicited through use of the shorter questionnaire, allowing fuller diagnostic work-ups for these two groups to be accomplished more rapidly and economically.
    • Standardized instruments for depressive disorders include the Children's Depression Rating Scale Revised and the Beck Depression Inventory, as well as other scales for children and adolescents.
    • For use in clinical research, emotional and behavioral symptoms such as childhood-onset mood disorders and disruptive mood dysregulation disorder can be assessed with the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version, the UCLA PTSD in the past month versus the M-GAF-RA for health care coordination, and the IVE for childhood psychiatric disorders.
    • Depressive disorders are often associated with high levels of comorbidity and pharmacotherapy, making it crucial to address a broad range of cohabitating diagnoses.
    • Pharmacotherapy can be helpful in treating depressive disorders in children and adolescents, particularly when the results of comprehensive diagnostic assessments are used to inform treatment planning.
    • This chapter discusses pharmacotherapy, particularly focusing on the use of antidepressants to treat major depressive, manic, and/or hypomanic and disruptive mood disorders as they occur in children and adolescents.
    • Pharmacological treatment for DMD involves a wide range of medication types that treat depression and emotional dysregulation, targeting the brain's neurotransmitter system.
    • However, using medication for emotional symptoms without concurrent psychotherapy can result in poor compliance, high dropout rates from medication protocols, and a lack of sustainable changes after medication cessation.
    • Therefore, an interdisciplinary comprehensive treatment approach that involves psychotherapy and medications offers the best help and likelihood of longer-term success.
    • Effective psychosocial interventions exist for use in conjunction with medication to ameliorate symptoms of depression and foster growth and development.
    • These therapies can target depressive symptomatology through one of three primary mechanisms: teaching problem-solving skills for addressing everyday stressors, modifying negative cognitions about the self, others, and the future, or engaging in pleasurable activities.
    • One specific model may attend to all three general themes: the Pediatric Mood Disorders program uses concurrent family and individual therapy that incorporates tools from cognitive-behavioral therapy to help the adolescent decrease depressive symptoms and psychodynamic therapy to help the adolescent develop a coherent sense of self and their place in the world.
    • Some evaluative models exist in the treatment of depression in youths, but these are usually manualized and require highly supervised therapists for study design.
    • The workshop on Interpersonal Psychotherapy for Dysthymic Children demonstrated the capacity of specifically tailored interpersonal therapy approaches to improve depressive symptoms among dysthymic children.
    • Cognitive Behavioral Therapy (CBT) is generally considered an adjunctive treatment for disruptive mood dysregulation disorder (DMDD), encompassing many therapeutic approaches ranging from manualized, high-intensity to more general, ecologically valid school-based programs.
    • Selecting a specific CBT program for youths with DMDD is tricky and should be based on individual goals, availability, cost, and motivation for change.

    Neurobiology of Major Mood Disorders

    • The neurobiology of major mood disorders has seen a significant increase in research over the past two decades, with the potential to have a greater impact on clinical practice than any biological revolution in psychiatry.
    • However, this promise seems idiosyncratic, and the main goal of this chapter is to translate these findings into the development of novel treatment strategies.
    • The monoaminergic neurotransmitter system plays a crucial role in the underlying pathophysiology of almost all major depressive disorders.
    • The diathesis-stress model of depression offers a strict monoamine model of depression, but it has begun to reveal key elements of depression's mysterious heterogeneity.
    • Depressions with prominent atypical features and classical lithium non-responders show drug response to norepinephrine, not serotonin antidepressants.
    • Psychomotor retardation, specific anxiety symptoms, circadian rhythm disturbances, and reactivity together have complementary relevance to the need for such idiosyncratic management.
    • Trial and error strategies in severely ill patients who have failed multiple trials with appropriate response are best illustrated by trial and error strategies in severely ill patients who have failed multiple trials with appropriate response.
    • An alternative possibility is to utilize azapirones and/or buspirone to uncover the necessity of adjuvant buspirone and/or azapirone therapy.
    • Doxapram, a known respiratory analeptic that rapidly raises mood, potently suppresses kynurenine signaling while effectively blocking the NMDA-enhancing influence.
    • Prompt symptomatic improvement and enhanced serotonin transporter binding might be expected based on the combined inhibition mechanisms.

    Transcranial Magnetic Stimulation (TMS)

    • TMS is an innovative treatment being used with increasing frequency for persons with depression and bipolar disorder.
    • TMS is safe and effective for many who have struggled with mood swings for years and have not had good responses to either psychotherapy or medications, or who are helped only partially by conventional approaches.
    • The main inhibitions of TMS are the cost, safety problems, electrodes, and materials

    Treatment-Resistant CMDD and SMDD

    • Much research is needed regarding the pharmacological and non-pharmacological treatment of CMDD and SMDD.
    • Treatment of treatment-resistant cases is manageable, but often has a moderate chance of response or remission.
    • Recent research suggests that SMDD benefits more from non-pharmacological interventions than medication therapy.
    • As new evidence-based guidelines are developed, treatment for difficult-to-treat CMDD and SMDD cases is likely to require a multimodal treatment plan and synergistic psychotherapeutic and family therapy approaches.
    • Future development of proper assessment measures for the CMDD and SMDD subtypes is warranted.
    • Efforts to coordinate the child’s treatment with other providers may help, including collaboration with specialists outside the family clinic.
    • Continued collaborative connections among multiple systems and sympathetic problem-solving are beneficial.
    • Additionally, front-line practitioners may find it helpful to inform contributors about the details of the diagnosis and treatment of difficult-to-treat CMDD and SMDD.

    Refractory Depressive Disorders

    • Child-adolescent patients with severe depressive disorders often have attempted various medication, psychotherapeutic, or combination strategies before referral to a tertiary care center.
    • Steroids or atypical antipsychotics, in combination with an evidence-based psychotherapeutic strategy that specifically targets these disorders, often present the best initial approach in such cases.
    • However, some patients do not respond fully to evidence-based treatments, which are then considered refractory depressive disorders.
    • Reassessment of the approach selected by the clinician and, if warranted, engaging more intensive psychotherapeutic and/or medication strategies serves as the next phase.
    • Furthermore, it is crucial to enhance collaboration among mental healthcare professionals, individuals with diagnoses of childhood-beginning depressive disorders, and their families.

    Depressive Disorders in Children and Adolescents

    • Prevalence and Impact: Depressive disorders are increasingly common in children and adolescents, often leading to adult mood disorders. Early intervention is crucial to prevent long-term difficulties.
    • Treatment Options: Several treatments for severe depressive disorders in youth achieve high response or remission rates (60% or higher).
    • Family Involvement: Psychoeducation and family therapy techniques are essential to reinforce treatment motivation and improve outcomes.
    • Prevention and Early Intervention: Public health approaches that promote mental health awareness are important for all families, not just those with known mental health difficulties.
    • Screening: Evidence-based screening tools and key questions for identifying mental health issues are crucial for recognizing emotional distress in children and adolescents.
    • Cultural Considerations: Mental health professionals need to consider socio-ecological factors that may trigger or modulate depression.
    • Primary Care: Primary care providers have a critical role in delivering culturally sensitive care and promoting mental health awareness.

    ### Depressive Disorders in the Elderly

    • Challenges in Diagnosis and Treatment: Depression in the elderly presents unique challenges due to complex symptom presentation, comorbidity with medical conditions, reduced treatment compliance, and slow remission rates.
    • Neurological and Hormonal Changes: Aging is associated with significant physical and mental changes, including changes in brain function, hormonal shifts, and neurotransmitter activity.
    • Mental and Cognitive Compensation: Mental and cognitive compensation strategies can help counteract the natural changes associated with aging.
    • Long-Term Risk Factors: Identifying long-term risk factors for depression in later life is essential for preventive strategies.

    ### Gender-Specific Considerations

    • Traumatic Experiences: Women are more likely to experience trauma, violence, and pressures to succeed, leading to increased risk of depression.
    • Intersectionality: The intersection of gender with socio-cultural factors further increases the risk of depression in women, especially among Aboriginal and Torres Strait Islander Australian women, refugee women, and older women.
    • Hormonal Influences: The role of reproductive events and hormones in the expression of recurrent depression in women is an area of increasing research interest.

    ### Treatment Approaches, Strategies, and Ethical Considerations

    • Psychoeducation and Self-Management: Psychoeducation and self-management techniques empower patients to improve their mental health, enhance treatment adherence, and move towards a maintenance phase.
    • Risk Communication: Sharing risk estimates associated with different treatment options (including untreated or partially treated illness) is crucial for informed decision-making.
    • Family and Social Support: Strong family relationships are essential for child developmental health, and restorative programs that enhance these connections are critical for overcoming adversity.
    • Integrating Mental Health Services: Integrating mental health services into pediatric settings requires collaboration, planning, and careful attention to the needs of both children and families.
    • Shared Care Models: Shared care models, like the Coordinated Anxiety Learning and Management (BHS-CCS), offer promising solutions for providing mental health services in primary care.
    • Ethical Considerations: Respecting patient autonomy, privacy, and dignity is paramount, and ethical considerations guide all treatment decisions.
    • Informed Consent: The informed consent process must ensure mutual respect, equality, and full understanding of treatment options.

    ### Disruptive Mood Dysregulation Disorder (DMDD)

    • Challenges in Diagnosis: Many children with severe irritability do not meet the criteria for DMDD, leading to overdiagnosis of other conditions, such as ADHD, ODD, or CD.
    • Research Opportunities: Research on DMDD provides opportunities to expand knowledge about severe irritability in children, ultimately leading to more accurate diagnoses and effective treatments.

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    Test your knowledge on major depressive episodes and related disorders as covered in Psychology Chapter 5. This quiz includes crucial definitions, diagnostic criteria, and key distinctions among various depressive disorders. Perfect for students looking to solidify their understanding of this critical topic in psychology.

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