Internalizing Disorders Study Guide Part 2 .docx

**[Overview of Mood Disorders]** The spectrum of mood disorders ranges from severe depression to extreme mania.\ \ DSM-5 divides mood disorders into two general categories: Depressive disorders and Bipolar disorder.\ \ Depressive disorders are characterized by excessive unhappiness (dysphoria) a...

**[Overview of Mood Disorders]** The spectrum of mood disorders ranges from severe depression to extreme mania.\ \ DSM-5 divides mood disorders into two general categories: Depressive disorders and Bipolar disorder.\ \ Depressive disorders are characterized by excessive unhappiness (dysphoria) and loss of interest in activities (anhedonia).\ \ Bipolar disorder involves mood swings from deep sadness to high elation (euphoria) and expansive mood (mania).\ \ Depression in children affects their daily routines, social relationships, school performance, and overall functioning.\ \ Depression in children is often accompanied by anxiety or conduct disorders, and frequently goes unrecognized and untreated.\ \ Depression in young people is common, with almost all young people experiencing some symptoms of depression.\ \ Experience and expression of depression in children change with age, from diffuse and less easily identified symptoms in infants to self-blame, low self-esteem, and social inhibition in preteens.\ \ The anatomy of depression includes symptoms, syndromes, and disorders, such as Major Depressive Disorder (MDD), and Dysthymic disorder.\ \ Major Depressive Disorder (MDD) is diagnosed in children and is associated with depressed mood, loss of interest, and significant impairment in functioning. **[Major Depressive Disorder]** Same criteria for school-age children and adolescents\ \ Depression is easily overlooked because other behaviors attract more attention\ \ Some features (e.g., irritable mood) are more common in children and adolescents than in adults\ \ Diagnostic criteria for Major Depressive Disorder include five (or more) symptoms present during the same 2-week period, with at least one symptom being depressed mood or loss of interest or pleasure\ \ Symptoms such as depressed mood, loss of interest or pleasure in activities, significant weight loss or gain, insomnia or hypersomnia, fatigue, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicide\ \ Symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning\ \ The episode must not be attributable to the physiological effects of a substance or to another medical condition\ \ Responses to a significant loss (e.g., bereavement, financial ruin) may resemble a depressive episode, but the presence of a major depressive episode in addition to the normal response to a significant loss should be carefully considered. **[Major Depressive Disorder (MDD)]** The occurrence of a major depressive episode requires clinical judgment based on the individual\'s history and cultural expressions of distress.\ \ MDD is not better explained by other specified schizophrenia spectrum and other psychotic disorders.\ \ MDD prevalence in children ages 4-18 is between 2% and 8%.\ \ Depression increases two- to threefold in adolescence, possibly due to interactions between biological maturation and developmental changes at puberty.\ \ As many as 90% of young people with MDD have one or more other disorders, with 50% having two or more, commonly anxiety disorders, specific phobias, and separation anxiety disorders.\ \ MDD may coexist with dysthymia, conduct problems, ADHD, substance-use disorder, and personality disorders, especially borderline personality disorder.\ \ The onset of MDD symptoms may be gradual or sudden, with the average episode lasting eight months. Most children eventually recover from their initial episode, but about one-third may develop bipolar disorder within five years after onset.\ \ After puberty, females are two to three times more likely to experience depression than males.\ \ Persistent Depressive Disorder (P-DD), also known as Dysthymia, is characterized by symptoms of depressed mood that persist for at least one year. **[Chronic Depressive Disorders]** Persistent Depressive Disorder (P-DD)\ \ More chronic than Major Depressive Disorder (MDD)\ \ Characterized by poor emotion regulation, constant feelings of sadness, self-deprecation, low self-esteem, anxiety, irritability, anger, and temper tantrums\ \ Children with both MDD and P-DD are more impaired than those with just one disorder\ \ Prevalence\ \ Rates of P-DD are lower than those of MDD\ \ Approximately 1% of children and 5% of adolescents display P-DD\ \ Most common comorbid disorder is MDD\ \ 70% of children with DD may have an episode of major depression\ \ 50% of children with P-DD also have one or more nonaffective disorders that preceded dysthymia\ \ Onset, Course, and Outcome\ \ Most common age of onset 11-12 years\ \ Childhood-onset dysthymia has a prolonged duration (2-5 years)\ \ At high risk for developing MDD, anxiety disorders, and conduct disorder\ \ Associated Characteristics of Depressive Disorders\ \ Intellectual and academic functioning\ \ Difficulty concentrating, loss of interest, and slowness of thought and movement can affect intellectual and academic functioning\ \ May have problems on tasks requiring attention, coordination, and speed\ \ Cognitive Biases and Distortions\ \ Negative thinking, hopelessness, suicidal ideation, ruminative style, pessimistic outlook, and negative self-esteem\ \ Social, Peer, and Family Problems\ \ Few close friendships, social withdrawal, and ineffective coping in social situations\ \ Less supportive and more conflicted relationships with parents and siblings\ \ Depression and Suicide\ \ Most youngsters with depression think about suicide\ \ Young females with a mood disorder are at strong risk\ \ Ages 13 and 14 are peak periods for a first suicide attempt by those with depression\ \ Theories of Depression\ \ Psychodynamic: Actual or symbolic loss of love object (e.g., caregiver) that is loved ambivalently; anger toward love object **[Theories and Causes of Depression]** Psychodynamic Theories\ \ Depression is viewed as the conversion of aggressive instinct into depressive affect\ \ Results from the actual or symbolic loss of a love object\ \ Children and adolescents are believed to have inadequate development of the superego or conscience, leading to depression\ \ Behavioral Theories\ \ Emphasize the importance of learning, environmental consequences, and skills and deficits during the onset and maintenance of depression\ \ Depression is related to a lack of response-contingent positive reinforcement\ \ Cognitive Theories (1 of 2)\ \ Focus on relationship between negative thinking and mood\ \ Emphasize "depressogenic" cognitions including negative perceptual and attributional styles and beliefs associated with depressive symptoms\ \ Hopelessness theory: depression-prone individuals have a negative attributional style, blaming themselves for negative events\ \ Cognitive Theories (2 of 2)\ \ Beck's cognitive model: depressed individuals make negative interpretations about life events\ \ Biased and negative beliefs are used as interpretive filters for understanding events\ \ Focus on information-processing biases and a negative outlook regarding oneself, the world, and the future (negative cognitive triad)\ \ Other Theories of Depression\ \ Self-control theories\ \ Interpersonal models\ \ Socioenvironmental models\ \ Diathesis-stress model\ \ Neurobiological models\ \ Causes of Depression\ \ Due to the many interacting influences, multiple pathways to depression are likely\ \ Genetic risk influences neurobiological process and is reflected in early temperament characterized by oversensitivity to negative stimuli and high negative emotionality\ \ These early dispositions are shaped by negative experiences in the family, among other factors **[Influences on Childhood Depression]** Estimates range from 30 to 45% risk of children developing depression if their parents have depression\ \ Inherited vulnerability to depression and anxiety, with environmental stressors needed for disorders to be expressed\ \ Neurobiological influences include abnormalities in brain regions regulating emotional functions, HPA axis dysregulation, sleep abnormalities, and variants in neurotransmitters\ \ Family influences include more critical and punitive behavior toward depressed children\ \ Depression interferes with parents\' ability to meet the needs of the child\ \ Stressful life events as triggers for depression, including interpersonal stress, personal losses, life changes, and violent family environments\ \ Prolonged emotional distress in childhood can lead to problems regulating negative emotional states and a tendency toward depression\ \ Rates of receiving help for depression vary by racial/ethnic background, with fewer than half of children with depression receiving help\ \ Cognitive-behavioral therapy (CBT) has shown the most success in treating children and adolescents with depression\ \ Interpersonal Psychotherapy for Adolescent Depression (IPT-A) focuses on improving interpersonal communication and has been effective\ \ With the exception of SSRIs, medications have been less effective than CBT and IPT-A\ \ Treatments for youngsters with depression include Behavior Therapy, Cognitive Therapy, and Cognitive-Behavioral Therapy (CBT) aiming to increase positive behaviors and change negative thought patterns. **[Psychosocial Interventions, Medication, Prevention, Bipolar Disorder]** Psychosocial interventions combine elements of behavioral and cognitive therapies, including behavior therapy, cognitive therapy, and cognitive-behavioral therapy (CBT).\ \ Interpersonal Psychotherapy for Adolescent Depression (IPT-A) focuses on family and interpersonal interactions to explore the causes of depression.\ \ Medication, particularly selective serotonin reuptake inhibitors (SSRIs), is used to treat mood disturbances and other symptoms of depression, despite potential serious side effects.\ \ Cognitive-behavioral therapy (CBT) and interpersonal psychotherapy are the most effective preventative measures for lowering the risk of depression.\ \ Bipolar disorder features periods of elevated mood alternating with major depressive episodes, and can involve anger, hostility, and concurrent depression.\ \ Young people with bipolar disorder may display significant impairment in functioning, co-occurring disorders, and a history of psychotic symptoms and suicidal ideation/attempts.\ \ Bipolar disorder is categorized into three subtypes: Bipolar I disorder, Bipolar II disorder, and Cyclothymic disorder, each with a distinct set of symptoms. **[Bipolar Disorder in Children and Adolescents]** Atypical symptoms include volatile and erratic changes in mood, psychomotor agitation, and mental excitation\ \ Classic symptoms for children with mania include pressured speech, racing thoughts, and flight of ideas\ \ Prevalence of bipolar disorder in youths 7-21 years old ranges from 0.5 to 2.5%\ \ Rapid cycling episodes are common and extremely rare in young children\ \ High rates of co-occurring disorders such as anxiety disorders, ADHD, substance use disorders, and suicidal thoughts are extremely common\ \ Onset before age 10 is extremely rare, with a chronic and resistant course and a poor long-term prognosis\ \ Causes of bipolar disorder in children and adolescents include genetic vulnerability and environmental factors\ \ Brain-imaging studies suggest mood fluctuations are related to abnormalities in areas of the brain related to emotion regulation\ \ Treatment includes monitoring symptoms closely, educating the patient and family, administering medication (e.g., lithium), and addressing symptoms with psychotherapeutic interventions