Mood Disorders

depressive disorders

disorders characterized by dysphoria, anhedonia, and irritability

dysphoria

state of prolonged bouts of sadness

anhedonia

lack of joy and interest in nearly all activities

irritability

annoyance and touchiness

are mood disorders common?

yes, they are among the most persistent and disabling illnesses in young people

what is one of the most common co-occurring symptoms of depression in younger children and adolescents as opposed to adults?

irritability

3 Types of Depressive Disorders

1. Major Depressive Disorder (MDD)

2. Persistent Depressive Disorder (PDD)

3. Disruptive Mood Dysregulation Disorder (DMDD)

Major Depressive Disorder Criteria

• five or more symptoms with at least one being (1) depressed mood or (2) loss of interest/pleasure for at least a two week period

• symptoms cause significant distress or impairment in functioning

• presence of a major depressive episode (one that is not better attributed to schizophrenia disorders)

what type of depressive disorder requires the presence of a major depressive episode?

Major Depressive Disorder (MDD)

describe depressive disorders, specifically MDD, among the different stages of development (infants, preschoolers, school-aged children, preteens)

• infants: weeping, withdrawal, apathy, weight loss, sleep disturbance

• preschool: appear subdued, withdrawn, inhibited, and tearful with excessive clinging and whiny behavior around mothers

• school-aged children: increased irritability, tantrums, disruptive behavior, argumentative, combative, and complaints of feeling sick

• preteens: self-blame, low self-esteem, social problems, hopelessness, feeling misunderstood, problems with sleeping/eating/school

what features are common in all depressive disorders

• reduced interest or pleasure

• cognitive & motivational changes

• somatic & psychomotor changes

• sad, empty, or irritable mood

what differentiates between the three types of depressive disorders?

the duration, timing, associated features, and presumed causes

what percent of children between ages 4-18 experience MDD?

between 2-8%

describe the prevalence of MDD in children

• 2-8% of children between 4-18 have MDD

• relatively rare in preschool but prevalence increases two-to-threefold by adolescence (most likely due to biological maturation)

why do rates of MDD increase two-to-threefold by adolescence?

most likely due to biological maturation

what percent of young people with depression have one or more other disorders? what about two or more disorders?

• 90% have one or more

• 50% have two or more

what is the most co-occurring disorder with MDD?

anxiety (specifically separation anxiety, general anxiety, and specific phobias)

what are some co-occurring disorders with MDD?

anxiety disorder (most common), PDD, conduct problems, ADHD, substance use, borderline personality disorder

T or F: Although most children eventually recover from the initial episode, there is a high chance for future episodes.

true

children with MDD who have recovered from their initial episode have a __% chance of another episode within 1 year

25%

children with MDD who have recovered from their initial episode have a __% chance of another episode within 2 year

40%

children with MDD who have recovered from their initial episode have a __% chance of another episode within 5 year

70%

what is the single best predictor of MDD?

family history of depression

what have twin studies found regarding MDD and heritability?

family history is the best predictor of MDD

• 70-85% MZ concordance

• 19% DZ concordance

how long does an average MDD episode last?

8 months

when MDD onset occurs before age 15 and a recurrent episode occurs before age 20, what are some common outcomes?

• severe depression as a teen

• poor psychosocial outcome as an adult

are depression rates different among boys and girls?

they are equally common among preadolescents, but after age 13 the rate for females is higher

how do boys show depression as opposed to girls?

display more anger

how do girls show depression as opposed to boys?

display a greater number of symptoms, a greater likelihood of self-harm, and longer initial depressive episodes

what style of thinking increases the risk for depression among adolescent girls compared to adolescent boys?

ruminative thinking styles (focus on symptoms of distress rather than solutions)

what type of friendships puts girls at a higher risk for depression than boys?

friendships with other girls who have depression

how do rates of depression differ among the various ethnicities/cultures

non-white (black, hispanic, asian) adolescents report more symptoms of depression than white adolescents

what might explain why non-white adolescents report more symptoms of depression than white adolescents?

a low SES may increase vulnerability to stress thus increasing the likelihood of depression (higher among youths living in poverty)

what are the rates of depression in the following groups: (1) poverty, (2) middle-class, (3) affluent, (4) single-parent, (5) two-parent

1. poverty: 4.8%

2. middle class: 2.8%

3. affluent: 2.4%

4. single-parent: 5.9%

5. two-parent: 2.3%

which is more severe: PDD or MDD?

MDD

which is more chronic: PDD or MDD?

PDD

Persistent Depressive Disorder (PDD)

chronic depression characterized by depressed or irritable mood most of the day, most days, for at least one year; symptoms include constant sadness, self-depreciation, low self-esteem, anxiety, irritability, anger, poor emotional regulation

are there higher rates of PDD or MDD?

MDD

what percent of children with PDD also have a co-occurring disorder?

50%

describe the co-morbidity of PDD

about 50% of kids with PDD have a co-occurring disorder (ex: anxiety, conduct disorder, ADHD, etc); symptoms of these co-occurring disorders usually show up before the PDD diagnosis

• MDD is the most common co-occurring disease

what is PDD’s most common co-occurring disorder?

MDD

what may be a warning sign of PDD?

symptoms of co-occurring disorders usually show up before a PDD diagnosis and therefore can serve as a warning sign

double depression

refers to when individuals have both MDD and PDD which causes more impairment

what percent of children with PDD may also have an episode of major depression?

70%

what is the most common age of PDD onset?

ages 11-12

While almost all kids with PDD recover, what almost always follows?

MDD and sometimes BP

why was Disruptive Mood Dysregulation Disorder (DMDD) created?

increasing rates of bipolar disorder diagnoses in children

which of the three types of depressive disorders do we know the least about?

disruptive mood dysregulation disorder (DMDD)

What is the central feature of Disruptive Mood Dysregulation Disorder (DMDD)?

severe, persistent irritability shown through

1. frequent verbal or physical temper outbursts

2. chronic, persistently irritable or angry mood

what are the two main clinical features of DMDD irritability?

1. frequent verbal or physical temper outbursts

2. chronic, persistently irritable or angry mood

which depressive disorder occurs predominantly in males and school-aged children?

Disruptive Mood Dysregulation Disorder (DMDD)

Which disorders does Disruptive Mood Dysregulation Disorder (DMDD) commonly co-occur with?

anxiety, mood, disruptive behavior disorders, MDD, ADHD, CD, substance use; NOT ODD OR BP

which disorders can Disruptive Mood Dysregulation Disorder (DMDD) not co-occur with?

ODD and BP

when can DMDD be diagnosed?

not before age 6 or age 18

when is the onset of DMDD?

by history or observation, the onset is before age 10 years old

Intellectual and Academic Functioning Characteristic of MDD, PDD, DMDD?

• difficulty concentrating, loss of interest, and slowness of thought

• interference with academic performance

• difficult to determine whether depression is a cause or an outcome of learning difficulties

is depression a cause or an outcome of learning difficulties?

hard to determine

cognitive bias

mental shortcuts/patterns of thinking that can cause individuals to perceive reality incorrectly

cognitive distortion

exaggerated or irrational though patterns that reinforce negative thinking/emotions

depressive ruminating style

thinking that focuses narrowly and passively on negative events for long period of time; leads to youth negative evaluation

negative self-evaluation

children view themselves as ineffective, devalue their performance, do not acknowledge their accomplishments, dismiss praise, and make inaccurate interpretations of their experiences

what kind of cues do children with depression more commonly notice?

depression-relevant cues such as sad faces

what is the strongest predictor of depression symptoms?

negative self-evaluation (predicts about 60% variability in scores)

does the frequency of negative self-evaluation thinking increase the severity of depression?

yes

catastrophizing

cognitive distortion that involves imagining the worst possible outcome; leads to intense anxiety

overgeneralization

cognitive distortion where an individual believes if they fail at one thing they will fail at everything; leads to hopelessness

confirmation bias

tendency to seek information that supports existing fears

• ex: anxious individuals who only recognize embarrassing moments and ignore positive experiences, increasing anxiety

self-esteem in individuals with depression

almost all people with depression experience negative self-esteem

what symptom seems to be the most specifically related to depression in adolescence

negative self-esteem

does self-esteem fluctuate?

yes, self-esteem is highly reactive to daily life events and fluctuations may be due to exposure to major life stresses

do both low self-esteem and nonstable self-esteem play an important role in depression?

yes

in adolescent girls with depression, what are self-esteem problems often related to?

body image

young people seek feedback from others about their competence/incompetence in several domains (academic, social relations, sports, conduct, and physical appearance). what may this lead to?

negative self-view or positive self-view

why do those who have a negative self-view and are narrowly focused in one domain show instability in their self-esteem?

they lack alternate compensatory areas of functioning, making them vulnerable to developing depression when faced with stress in their primary domain

describe relationships of those with depression

they have few close friendships and feel liike other do not like them,; when they do have close friendships it is often with other depressed peers

what does chornic peer-related loneliness during childhood preduct?

depressive symptoms in early adolescence

those who have ___ at the time of depression referral have a reduced likelihood of recovery

poor friendships

co-rumination

negative form of discussion between peers focused narrowly on problems/negatives; uderlies females’ heightened risk of depression

what is the best predictor for a child’s risk for depression?

family history of depression

describe the characteristics of a family of a child with depression

less supportive, more conflicts, poor communication

why might a child with depression prefer to be alone than with their family?

they may feel isolated from their family or want to avoid conflict

prevalence of suicidal thoughts

most individuals with depression think about suicide

what fraction of individuals with depression attempt suicide?

1/3

what is the peak period for a first suicide attempt?

13-14

describe the prevalence of suicide attempts across the ages

peak period for a first attempt is at age 13-14, then the rate doubles during teen years but shows a decline after age 17-18

what are the most common methods of suicide attempts?

drug overdose and wrist cutting

what are the most common methods of completed suicides?

firearms, suffocation, poisoning

what are the strongest risk factors for committing suicide?

• mood disorders

• being a young female

describe treatment programs for suicidal behavior

prevention and treatment programs are intensive and emphasize intervening early after the initial suicidal crisis; focus on family involvement and support, intrapersonal relationships, improving parenting skills, and strengthening individual coping skills

what percent of youths with depression receive help?

50%

a combination of treatments are used for depression. what do these treatments emphasize?

eliminating depressive symptoms, maintaining positive outcomes, and preventing relapse

cognitive-behavioral therapy (CBT)

form of psychotherapy that helps individuals identify and change negative thought patterns and behaviors

what type of treatment has the most success in treating adolescents with depression?

cognitive-behavioral therapy (CBT)

describe the cognitive component of CBT

teaches youth to identify, challenge, and modify negative thought processes (misattributions, negative self-monitoring, short-term focus, high performance standards) and to replace these negative thoughts with positive thoughts

describe the behavioral component of CBT

believes that depression results from a lack of positive reinforcement; aims to increase pleasurable activities/events and provide youth with skills needed to obtain more reinforcement

• ex: daily monitoring, structuring activities, scheduling activities to help youths be more active

what are the 3 B’s of CBT?

three components that help children pay attention

1. body sensations

2. brain thoughts

3. overt behavior

cognitive restructuring and the power of non-negative thinking

process used in CBT that helps individuals with depression replace irrational thoughts with more positive ones

• what’s the evidence (provide support for thinking)

• alternative interpretations (consider other ways of thinking)

• what ifs (challenge unreasonable expectations)

Behavioral Activation for MDD & Dysthymia

increase the child’s physical and social activity to increase positive reinforcement by…

• activity scheduling (child commits to engaging in an activity to increase opportunities for positive reinforcement)

• stopping avoidance (increase physical aand social interactions)

what is Intrapersonal Psychotherapy for Adolescent Depression (ITP-A) based on?

the idea that adolescent depression affects relationships which in turn affect mood