Mood presentations in children and adolescents

Flashcards covering clinical features, epidemiology, differential diagnoses, models, and risk assessment of depression, bipolar disorder, and self-harm/suicide in children and adolescents.

What are the estimated point and lifetime prevalence rates of depressive disorders among youth globally?

Approximately $3\%$ of youth have a depressive disorder at any one time (point prevalence), and the lifetime prevalence is $11\%$.

How do depression prevalence rates and sex distribution shift from childhood to adolescence?

Childhood and prepubertal rates are lower at approximately $1\text{--}3\%$, increase markedly during adolescence, and female rates exceed male rates following puberty.

What are the three core clinical symptoms of Major Depressive Disorder (MDD) in children and adolescents?

Depressed mood, irritability, and reduced interest or pleasure (anhedonia).

How does the developmental presentation of depression differ between children and adolescents?

Children typically present with irritability, somatic complaints, behavioural change, and school refusal, whereas adolescents present with hopelessness, self-criticism, rumination, social withdrawal, and self-harm.

What are the typical recurrence rates of depressive symptomatology following a first depressive episode in young people?

Approximately $20\text{--}60\%$ experience recurrence within $1\text{--}2\text{ years}$, and $70\%$ experience recurrence after $5\text{ years}$.

According to Rapee et al.'s conceptual model, how do adolescent developmental characteristics interact to influence the onset of social-emotional disorders?

Preteen risk factors (temperamental, cognitive/behavioural, family, and social) combine with visible pubertal changes, pubertal hormones, and sleep changes to affect self-concept, peer relationships, and emotional experiences, culminating in social-emotional disorders.

Which cognitive factors maintain depressive symptoms according to Beck and Nolen-Hoeksema's Cognitive Model?

Negative patterns of thinking (cognitive triad, cognitive biases, negative automatic thoughts [NATs]), hopelessness, self-criticism, self-comparison, and rumination.

How does Lewinsohn's Behavioural Model explain the maintenance of depression?

It proposes that depression is maintained by reduced access to rewarding activities and positive reinforcement via withdrawal, decreased participation, loss of enjoyable experiences, and increased avoidance.

What five systems must be evaluated when assessing adolescent depression according to Carr's developmental systems model?

Individual, Family, Peers, School, and Risk.

What percentage of young people with depression have a comorbid disorder, and which condition shows up to $70\%$ overlap?

Two-thirds ($\approx 67\%$) meet criteria for at least one other disorder, with anxiety disorders showing up to $70\%$ overlap.

What is the key distinguishing feature between normal adolescent distress and a depressive disorder?

In normal adolescent distress, symptoms fluctuate and remain linked to stressors, functioning is largely preserved, and capacity for enjoyment remains.

What is the prevalence of bipolar disorder in youth, and what is the mean age of onset for first-episode mania/hypomania/MDE in Bipolar 1?

The prevalence in youth is $1\text{--}2\%$, and the mean age of onset for Bipolar 1 is $18\text{ years}$.

What risk arises when an adolescent with unrecognized bipolar disorder is prescribed antidepressants for an initial depressive episode?

They may rapidly develop manic symptoms.

How do sleep patterns distinguish typical adolescent distress from a bipolar manic episode?

Typical adolescents have poor sleep and feel tired, whereas adolescents in a manic episode have a reduced need for sleep without feeling fatigue.

What are key features distinguishing ADHD from Bipolar Disorder in youth?

ADHD features chronic, lifelong, trait-like distractibility and persistent hyperactivity without grandiosity; Bipolar Disorder is episodic and state-like, featuring distinct periods of increased activity, distractibility during episodes, grandiosity, and a decreased need for sleep.

How does Disruptive Mood Dysregulation Disorder (DMDD) differ from Bipolar Disorder?

DMDD is characterized by chronic, persistent irritability between severe temper outbursts ($>3$ per week for at least $12\text{ months}$) with onset before age $10$, whereas Bipolar Disorder features distinct, episodic mood shifts rather than chronic baseline irritability.

How can Bipolar Disorder with psychotic features be differentiated from Schizophrenia or prodromal psychosis?

In Bipolar Disorder, psychotic symptoms occur exclusively during mood episodes; in Schizophrenia, symptoms have an insidious onset, feature negative symptoms and progressive social withdrawal, and psychotic symptoms persist outside of mood episodes.

What distinguishes Non-Suicidal Self-Injury (NSSI) from a suicide attempt?

NSSI is intentional self-inflicted injury without the intention to die, whereas a suicide attempt is a self-injurious act carried out with at least some intention to die.

How is Deliberate Self-Harm (DSH) defined?

Any intentional self-inflicted injury, regardless of suicidal intent (such as cutting, burning, or overdosing).

According to Nock and Prinstein's Four-Function Model, what are the automatic functions of self-harm?

Automatic negative reinforcement serves to reduce unwanted emotions, while automatic positive reinforcement serves to generate feeling when numb.

What sequence of phases constitutes the Self-Harm Cycle?

Trigger $\rightarrow$ Emotional Distress $\rightarrow$ Urge to Self-Harm $\rightarrow$ Self-Harm Behavior $\rightarrow$ Temporary Relief $\rightarrow$ Shame or Guilt $\rightarrow$ Return to Distress.

How does Chapman, Gratz, and Brown's Experiential Avoidance Model (EAM) explain deliberate self-harm (DSH)?

An emotional stimulus elicits an intense emotional response that an individual cannot regulate, prompting deliberate self-harm as an avoidance mechanism to escape unwanted arousal, which is then negatively reinforced by temporary relief.

According to Joiner's Interpersonal Theory of Suicide, which three constructs are required for lethal or near-lethal suicide attempts to occur?

Thwarted belongingness ("I am alone"), perceived burdensomeness ("I am a burden")—which combine to create the desire for suicide—and the capability for suicide.

How does an individual develop the "acquired capability" for suicide according to Joiner's theory?

Through repeated exposure to painful and provocative events, physical pain, fear-inducing experiences, and deliberate self-harm, which habituates them to pain and fear of death.

What warning signs indicate possible suicide contagion within a community or youth population?

Mass texting about a suicide or attempt, concerning social media activity, an increased incidence of attempts, heightened emotional atmosphere, links between individuals who died, more than $1$ suicide in one location, and makeshift shrines or mass youth gatherings.

What four domains should be explored when assessing suicide risk specifics in youth?

Intent (desire to die, expectation of death), Preparation (saving pills, writing notes, saying goodbye), Concealment (avoiding discovery, isolated locations), and Communication (telling others, suicide notes, indirect disclosures).

What are the five sequential steps of the SAFE-T suicide evaluation and triage framework?

Step 1: Identify Risk Factors; Step 2: Identify Protective Factors; Step 3: Conduct Suicide Inquiry; Step 4: Determine Risk Level & Intervention; Step 5: Document.

What three phases must be explored during a functional analysis of a self-harm event?

Before the event (triggers, emotions, suicidal thoughts), During the event (intent, expectations, method), and After the event (relief, regret, disclosure).

What are three critical steps to take immediately for managing high-risk suicidal behavior following an assessment?

Increase family supervision/monitoring, consider crisis services, and restrict access to lethal means (e.g., medication, ligatures).

What are the progressive stages of suicidal ideation along the severity continuum from lowest to highest severity?

General thoughts about death $\rightarrow$ wishes that had not been born $\rightarrow$ suicidal ideation $\rightarrow$ specific plans/means.