Mood Disorders PDF

problem in diagnosing -- children and adolescents are given multiple diagnoses along mood disorder diagnoses (f.e. depression and \...) A Historical Perspective - *orthodox psychoanalytic perspective* -- depression is when superego acts as a punisher on ego - **masked depression** -- chil...

problem in diagnosing -- children and adolescents are given multiple diagnoses along mood disorder diagnoses (f.e. depression and \...) A Historical Perspective - *orthodox psychoanalytic perspective* -- depression is when superego acts as a punisher on ego - **masked depression** -- childhood depression where sad mood and other symptoms are not frequently present (or are not as vivid in comparison to *hyperactivity, deliquency*, \...) - created distinction between *depression* as [symptom] and [syndrome] The DSM Approach - mood disorders = unipolar (one mood expressed) or bipolar (both moods experienced, f.e. depression and mania) Definition and Classification of Depression Defining Depression - feeling of hopelessness, lower self-esteem, control is due to external factors Depressive Disorder: The DSM Approach - **Major Depressive Disorder (MDD)** -- one or more major depressive episodes -  same for all ages (except in children+adolescents, irritable mood can be switched with depressed mood) -  depressed or irritable mood, loss of interest or pleasure, change in weight or appetite, sleep problems, motor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, difficulty thinking or concentrating or making decisions, thoughts of death or suicidal thoughts/behavior -  requires 5 or more symptoms (1 must be depressed/irritable mood OR loss of interest/pleasure) -  symptoms present for two weeks -  symptoms must cause clinically significant distress or impairment in functioning - **Persistent Depressive Disorder (Dysthymia)** -- chronic form of depression -  many symptoms of MDD are present (even in less severe form), but *chronic* (longer period of time) - *** double depression*** -- when both dysthymia and MDD are present - **Disruptive Mood Dysregulation Disorder (DMDD)** -- persistent irritability and frequent outbursts (f.e. extreme temper outbursts, physical aggression) -  onset -- 10yo (diagnosis between age 6-18) -  looks like bipolar disorder, but more likely to fall into *unipolar depressive disorder or anxiety* Depression: Empirical Approaches 188 - *syndromes* -- depressive symptoms also include symptoms of anxiety and withdrawn behavior (not unique syndrome for depression) - *classification and definition of depression*: -  youth may experience depression differently based on the developmental stage -  more dimensional than categorical Description of Depression - =pervasive unhappy mood - in childhood and adolescence -- also number of other problems (f.e. tears, outbursts, throwing things, inability to concentrate, poor schoolwork, \...) Epidemiology of Depression - =leading cause of disability in young people - MDD = most frequent diagnosis among children and adolescents1 in 4 people experiences depression in childhood or adolescence - **age** - less prevalent in younger children - **gender** - usually no gender differences (less than 12yo) - adolscence - more prevalent in girls https://lh7-rt.googleusercontent.com/docsz/AD\_4nXefeZf9BpmkA8c8va3B15YD4zJjkfpg0nrY7XdvlOsUSqKBf-TnqUMFI5et24YZf-3UznW5lgMTdP9AJ1Obdq1x3Gvki6E9gwtl\_ccwDpHDEGIoAp3oywvW-hqdiCTwf9VHOHIMDhQprQRBOji-FoDovnGiCBpFjfdYO5JC?key=Ig2Gppwg659I4xwRPl2kbQ - **socioeconomic status** - lower =\> higher depression - **ethnic** - higher depression rates among Latinx youth - **other difficulties** - f.e. other disorders (f.e. anxiety disorders, disruptive behavior disorders, eating disorders,...) Depression and Development - **infants and toddlers** =\> lack the cognitive abilities to be able to self-reflect and report any depressive thoughts - **preschoolers** - also difficult to assess (symptoms may show differently) - **middle childhood (6-12)** - patterns of depression might show up - **childhood (9-12)** - verbalizing hopelessness and low self-esteem - **early adolescence** - more resemblance to  symptoms of adulthood (onset of these symptoms) Etiology of Depression - **biological influences** - genetic (but also environment-dependent); neurochemistry and brain functioning (serotonin, norepinephrine, acetylcholine; hypothalamus, pituitary gland, adrenal glands) - **temperament** - how the environment influences affected development of predisposition - *negative affectivity (negative emotionality)* - tendency to experience negative emotions, being sensitive to negative stimuli - *positive affectivity (positive emotionality)* - approach, energy, sociability, sensitivity to reward cues - *effortful control* - can employ self-regulation - **social-psychological influences**  - *separation/loss* - f.e. separation from parents in childhood - *cognitive-behavioral/interpersonal perspectives* - how we relate to others, how we are viewed by others - learned helplessness - "i have little control over the environment - explanatory style of thinking about outcome - in depressed individuals (self-blame, negative events will be stable overtime) - attributional style -II- -moderator between hopelessness and negative life events  - - **impact of parental depression** - increased risk for developing psych. disorder - *mechanisms* - cognitive styles are put on children (f.e. limiting child\'s time outside) - **peer relations** - peer status (f.e. more risk when rejected) Assessment of Depression - *general clinical interview* - most common - *structures/semi-structured interviews* - f.e. DISC (Diagnostic Interview Schedule for Children), K-SADS (Schedule for Affective Disorders and Schizophrenia for School-Age Children) - *rating scales* - *self-report measures* - *direct observation* Treatment of Depression - **pharmacological treatments** - SSRI, antidepressants - more reliable/effective in adults - **psychosocial treatments** - CBT; behavioral activation; interpersonal psychotherapy (IPT) https://lh7-rt.googleusercontent.com/docsz/AD\_4nXd04T4ViIDtk910wrRi-DFYrmpgJxZjGJwnlWgulKLU0P\_2q7G3h-QwZavnJY\_M26LcU5aL6mDZFhlC0auuR5AMn2WPYJUmV-jxVY7tSMjMZl0bEP00Bq73UjH8YenQgIFHRp92FFSNeKi-DlTi-arCerj-h4A9-A9JDdO6?key=Ig2Gppwg659I4xwRPl2kbQ Prevention of Depression - prevention programs (f.e. school based) with follow-up Bipolar Disorder DSM Classification - presence of mania and depressive symptoms - **criteria for manic episode**: inflated self-esteem, decreased need for sleep, more talkative than usual, racing thoughts, distractibility, increased goal-directed activity or motor agitation, excessive activity that can lead to negative outcomes - results in *impairment in social or academic functioning* - **hypomania** - euphoric mood in shorter duration (less severe than manic episode) - number of challenges in definition according to age (f.e. euphoric mood is typical in youth) Description  - children: extremely happy or silly; irritable mood, intense outbursts of anger; mood swings (labile mood), grandiosity, flight of ideas (changing topics rapidly) Epidemiology of Bipolar Disorders - increase of BD -- 0.42% 6,7% - gender equally - less prevalent in youth - *comorbidity* -- ADHD, conduct disorder, oppositional defiant disorder, substance abuse, dependence Developmental course - youth -- early onset - symptoms come and go (f.e. relapse in youth) - high rates in comorbidity -- MDD after growing up - comorbidity =\> making symptoms worse Risk Factors and Etiology - **risk factors** -- family history, genetic influence (heritability 60-90%), environmental influences (stressful life events, family relationships, parenting styles) Assessment of Bipolar Disorder - developmental course of symptoms -- important in diganosis - clinical unstructured interviews - structured diagnostic interviews -- f.e. K-SADS - mania rating scales -- f.e. Young Mania Rating Scale (YMRS), The General Behavior Inventory Treatment of Bipolar Disorder - **multimodal approach** - *pharmacotherapy --* mood stabilizers (lithium, atypical antipsychotics) - *other treatment* -- psychoeducational psychotherapy, family-focused treatment, child and family-focused CBT; psychoeducation; dialectical behavior therapy; support groups, foundations Suicide - includes both completed and attempts and suicidal thoughts Prevalence of Completed Suicides - low in youth compared to adults; low in children compared to adolescents - rise -- from 1975 to 1990s - decline -- from 1990s to 2007 - sharp rise -- from 2007 to 2016 - after 2016 -- rates increased by 9% each year Suicidal Ideation and Attempts - ideation -- more prevalent in females(23.7% - 14.8%) - attempts -- more likely to happen to women (10.1% - 3.8%) - **nonsuicidal self-injury** -- harm to one without intent to die (burning, hitting, biting, cutting) Suicide and Psychopathology - symptom of depression, conduct disorder, substance abuse diagnoses Suicide Risk Factors - social environment, few weeks after psychiatric inpatient visit, history of suicide attempts, family history of attempts, bullying, contagion - *suicidal ideation* -- more frequent and severe than suicidal thinking Suicide Prevention - programmes for awareness - often through schools -- training and support for adults (to help young people)