Overview of Mood and Anxiety Disorders

What is Major Depressive Disorder (MDD)?

The primary DSM category for defining depression, characterized by the presence of one or more major depressive episodes.

What are the symptoms required for a diagnosis of Major Depressive Disorder?

Five or more symptoms must be present for two weeks, including depressed mood, loss of interest, change in weight or appetite, sleep problems, motor agitation or retardation, suicidal thoughts, and feelings of worthlessness.

What is the epidemiology of Major Depressive Disorder?

80% experience MDD, 10% have dysthymia without MDD, and 10% have 'double depression.' Prevalence rates for MDD are about 12%, with children at 0.4-2.8% and adolescents at 0.4-8.3%.

How does Major Depressive Disorder manifest in infants?

Infants may show less activity, feeding and sleep problems, irritability, less positive affect, and sad facial expressions.

What symptoms of depression are observed in preschoolers?

Irritability, sad facial expressions, mood changes, feeding and sleep problems, lethargy, and excessive crying.

What developmental changes occur in middle childhood related to depression?

Children aged 9-12 may verbalize feelings of low self-esteem and hopelessness.

What is the median age of onset for adolescent depression?

The median age is 15.5 years, with differences noted between prepubertal and postpubertal onset.

What biological influences contribute to the etiology of Major Depressive Disorder?

Genetic influences from family, twin, and adoption studies, brain functioning, neurochemistry (neurotransmitters like serotonin and norepinephrine), and dysregulation of the neuroendocrine system.

What temperament and environmental influences are associated with Major Depressive Disorder?

Negative affectivity (sensitivity to negative stimuli) and positive affectivity (energy and sociability) are key influences.

What social-psychological factors can influence Major Depressive Disorder?

Factors include separation/loss, interpersonal skills, cognitive distortions, learned helplessness, and attributional/explanatory style.

How do age and sex differences affect the prevalence of Major Depressive Disorder?

After age 12, girls report depression more frequently, and depression is more prevalent in adolescents than in young children.

What is Persistent Depressive Disorder (Dysthymia)?

A chronic form of depression with symptoms similar to MDD but less severe, lasting at least one year in children/adolescents.

What are the symptoms of Persistent Depressive Disorder?

Same symptoms as MDD, including depressed or irritable moods, poor appetite or overeating, sleep disturbances, and feelings of hopelessness.

What is Disruptive Mood Dysregulation Disorder (DMDD)?

A new DSM-V category characterized by persistent irritability and frequent outbursts, added to address overdiagnosis of Bipolar Disorder.

What is the primary difference between Bipolar I and Bipolar II disorders?

Bipolar I involves periods of mania and possible depression, while Bipolar II involves periods of hypomania and depression.

What defines a manic episode?

A period of persistent elevated or irritable mood and increased energy or activity.

What similarities exist between MDD, PDD, and DMDD?

Epidemiology and etiology are similar across these disorders.

What is the significance of the symptoms for diagnosing Major Depressive Disorder?

The presence of specific symptoms helps differentiate MDD from other mood disorders.

How long must symptoms persist for a diagnosis of Persistent Depressive Disorder?

Symptoms must be present for at least one year in children/adolescents.

What role do neurotransmitters play in Major Depressive Disorder?

Neurotransmitters such as serotonin and norepinephrine are central to understanding the neurochemistry of depression.

What is the impact of negative affectivity on mood disorders?

Negative affectivity increases sensitivity to negative emotions and stimuli, contributing to the risk of developing mood disorders.

What is hypomania?

A milder form of mania that occurs for a shorter duration (about four days).

What is cyclothymia?

A chronic bipolar disorder characterized by mild fluctuations in mood that do not meet the criteria for mania or depression.

How is bipolar disorder epidemiologically characterized?

It is rarely diagnosed in children, has equal representation in males and females, and co-occurs with ADHD, conduct disorder, oppositional defiant disorder, and substance abuse/dependence.

What is the average duration of a manic episode?

10.8 months.

What is the heritability estimate for bipolar disorder?

60 to 90%, indicating a strong genetic component.

What is double depression?

Instances when dysthymia (persistent depressive disorder) and major depressive episodes are both present.

What factors contributed to the addition of DMDD to the DSM-5?

Symptoms of persistent irritability and frequent outbursts, added to address the overdiagnosis of bipolar disorder.

What are the controversies surrounding antidepressant use?

Antidepressant use is controversial, with TCAs having questionable effectiveness and many side effects, while SSRIs have fewer side effects but limited research on effectiveness and concerns over a possible link to suicide in youth.

What are the components of Cognitive-Behavioral Treatment (CBT)?

CBT confronts maladaptive cognitions/attributions, increases pleasurable experiences, enhances social skills, and helps in improving communication and conflict resolution.

What is the ACTION Treatment Program?

A recent (2010) school-based CBT program that includes behavioral activation and parent training to support children when symptoms occur.

What does Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) focus on?

It focuses on interpersonal relationships, treating grief, interpersonal disputes, role transitions, and interpersonal deficits.

What does a manic episode entail?

A manic episode includes inflated self-esteem, decreased need for sleep, increased talkativeness, racing thoughts, distractibility, increased goal-directed activity, and excessive pleasurable activities that can lead to negative outcomes.

How does hypomania differ from a manic episode?

Hypomania is a milder form of mania with a euphoric mood lasting about four days, while a manic episode is more severe and longer-lasting.

What are the main treatments for bipolar disorder?

Treatment includes mood-stabilizing drugs (such as lithium), SSRIs, psychoeducation, cognitive behavioral interventions, and Dialectical Behavior Therapy (DBT).

What are some risk factors associated with suicide?

Prior attempts, family history of suicide, low parental monitoring, bullying, stress, depression, hopelessness, impulsivity, and poor interpersonal problem-solving ability.

What is the distinction between anxiety and fear?

Anxiety is an alarm reaction to future-oriented concerns, while fear is an immediate reaction to a current threat.

What are the three types of anxiety responses?

Behavioral, cognitive, and physiological responses.

Give an example of a behavioral response to anxiety.

Running away, trembling voice, or closing eyes.

What might be a cognitive response to anxiety?

Thoughts of being scared, self-deprecatory thoughts, or images of bodily harm.

What are some physiological responses to anxiety?

Changes in heart rate and respiration, muscle tension, or stomach upset.

What are common fears among children?

Parents often underestimate fears in adolescents; girls exhibit more fear and intensity than boys; fears decline with age; worry becomes more prominent; certain fears coincide with different stages of development.

What is Separation Anxiety?

Developmentally inappropriate and excessive anxiety about separation from home or major attachment figure, with symptoms including distress during separation, worry about losing attachment figures, and prevalence of 3 to 12%.

What characterizes Specific Phobia?

Persistent fear in response to an object or situation, with immediate anxiety responses occurring almost every time, interfering with routine, and lasting at least 6 months, with a prevalence of 3 to 4%.

What is Social Anxiety (Social Phobia)?

Persistent fear of acting in an embarrassing way in social or performance situations, such as speaking or public performances, with many individuals meeting criteria for other anxiety disorders.

What is Selective Mutism?

A condition where children do not talk in specific situations, usually when peers are talking, typically onset between ages 2 to 4, with a large percentage meeting criteria for social phobia.

What defines Panic Disorder?

Characterized by recurring and unexpected panic attacks, which are intense fear or terror lasting about 10 minutes, followed by persistent concern about future attacks.

What is Agoraphobia?

Intense fear and anxiety in situations where escape might be difficult, leading to avoidance of public spaces such as crowded areas or public transportation.

What is Generalized Anxiety Disorder?

Excessive anxiety and worry about multiple life circumstances, with symptoms like nervous habits and sleep disturbances, prevalence of 2 to 14%, median age of onset at 10.

What are the components of Obsessive Compulsive Disorder (OCD)?

Obsessions are unwanted, repetitive, intrusive thoughts; compulsions are repetitive, stereotyped behaviors, with a prevalence of about 1%.

What is the distinction between obsessions and compulsions?

Obsessions are unwanted, repetitive thoughts; compulsions are repetitive behaviors performed to reduce anxiety.

What contributes to school refusal in children with anxiety?

Reluctance or refusal to go to school, often associated with separation anxiety, but may have other causes identified through functional analysis.

What is the difference between a Panic Attack and Panic Disorder?

A Panic Attack is an abrupt surge of intense fear or discomfort with four symptoms occurring, while Panic Disorder involves recurrent and unexpected attacks.

What are common interventions for anxiety disorders?

Psychological treatments, modeling, pharmacological treatments, and contingency management.

What is the empirical approach to classifying anxiety and depression?

It describes subcategories of internalizing behaviors and suggests that anxiety and depression disorders tend to co-occur.

Is there a distinction between empirical and dimensional approaches to anxiety and depression?

There is no distinction between empirical and dimensional measures in anxiety and depression.

What are positive symptoms of schizophrenia?

Positive symptoms include hallucinations, delusions, and disorganized thinking.

What are negative symptoms of schizophrenia?

Negative symptoms include lack of motivation, emotional flatness, and social withdrawal.

What is the prevalence of Panic Disorder?

The percentage at risk for Panic Disorder is 10-15%.

What is the usual onset age for Selective Mutism?

The usual onset age for Selective Mutism is between 2 to 4 years.

What is the prevalence of Generalized Anxiety Disorder among all ages?

The prevalence of Generalized Anxiety Disorder ranges from 2 to 14%.

At what age does Obsessive Compulsive Disorder typically onset?

The mean age of onset for Obsessive Compulsive Disorder is around 10 years.

What are the positive symptoms of schizophrenia?

Delusions (false beliefs), hallucinations (erroneous perceptions), disorganized speech, disorganized behavior, catatonic behavior.

What are the negative symptoms of schizophrenia?

Flat affect, poverty of speech (alogia), lack of goal-directed behavior (avolition).

How do hallucinations and delusions change with age in children with schizophrenia?

They tend to become more elaborate with age.

What are the primary features of schizophrenia?

Hallucinations and delusions.

What are the secondary features of schizophrenia?

Motor problems, poor communication, borderline intelligence, shyness, withdrawal, depression, anxiety.

What is the prevalence of schizophrenia in children?

It is rare, occurring in about 1% of the population.

What demographic is most commonly affected by schizophrenia?

Most common in males.

What factors may influence the occurrence of schizophrenia?

Higher rates may occur in lower socioeconomic backgrounds.

What is the developmental course of childhood-onset schizophrenia?

It is gradual, with nonpsychotic symptoms appearing first.

What is the prognosis for individuals with schizophrenia?

Full recovery is uncommon, with about 20% having a good outcome.

What is the heritability percentage for schizophrenia?

81% heritability.

What are some prenatal factors associated with schizophrenia?

Prenatal and pregnancy complications.

What is the neurodevelopmental model of schizophrenia?

It suggests that schizophrenia arises from disruptions in brain development during early life and even before birth.

What are the diagnostic criteria for PTSD?

Exposure to a traumatic event and at least symptoms from 4 clusters: reexperiencing, avoidance, negative alterations in cognitions and mood, & arousal and reactivity.

What distinguishes reactive attachment disorder (RAD) from disinhibited social engagement disorder (DSED)?

RAD involves extremely underdeveloped attachment to caregivers, while DSED involves culturally inappropriate behaviors toward strangers.

What are posttraumatic stress symptoms (PTSS)?

Distress and interference with functioning that doesn't meet PTSD criteria.

What is the likelihood that a child exposed to a traumatic event will develop PTSD?

20-30% experience persistent symptoms and are diagnosed with PTSD.

What factors are associated with a worse prognosis for children with PTSD?

Children who use negative coping strategies, such as screaming and aggression, are more likely to develop persistent symptoms.

What is the treatment with the strongest evidence for PTSD in children?

Trauma-focused Cognitive Behavioral Therapy (TF-CBT).

What is the importance of parental involvement in treating PTSD?

Parental involvement is highly important in the treatment process.

What does the PRACTICE acronym represent in TF-CBT?

It describes components of the Trauma-focused CBT model.

Define physical abuse in the context of child maltreatment.

Injuries may be intentionally inflicted or result from extreme forms of discipline and physical punishment.

What constitutes sexual abuse in children?

Sexual experiences between youth and older persons or sexual exploitation, such as in pornographic films.

What is psychological/emotional abuse?

Persistent and extreme actions or neglect that damage the child's emotional needs and functioning.

What is neglect in the context of child maltreatment?

Failure to provide for a child's basic needs, sensitive to family and cultural values, and economic and social conditions.