Your Sets

Depression: Symptom vs. Syndrome vs. Disorder

Symptom = low mood/sadness; Syndrome = group of co-occurring symptoms; Disorder = meets full DSM criteria with duration and functional impairment.

Major Depressive Disorder (MDD) Core Criteria

Requires 5+ of 9 symptoms for at least 2 weeks nearly every day; at least one must be depressed mood or loss of interest/pleasure (anhedonia).

Child & Adolescent MDD Variations

Children/youth may manifest depression as irritable mood rather than sadness and may fail to achieve expected weight gains.

Persistent Depressive Disorder (PDD)

Chronic depressed or irritable mood for at least 1 year in children/adolescents (2 years in adults), with less acute severity than MDD.

Disruptive Mood Dysregulation Disorder (DMDD)

Characterized by severe recurrent temper outbursts out of proportion to situation, alongside persistent chronic irritability between outbursts.

Historical Misconception of Youth Depression (Slide Note)

Until the 1970s, it was wrongly believed children couldn't experience depression; adolescent cases were dismissed as a normal "storm" and went undetected.

Top Evidence-Based Therapies for Adolescent Depression

Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) have shown the most empirical success for youth depression.

Black Dog Metaphor

A visual framing tool that personifies clinical depression as an enduring companion rather than a personal flaw or weakness.

Depression Associated Symptom Clusters

Affective (sadness/irritability), Physical (fatigue/poor sleep), Cognitive (poor concentration/negative self-view), and Behavioral (withdrawal/agitation).

Depression Comorbidity Pattern

Youth MDD frequently co-occurs with anxiety disorders, conduct problems, and substance use disorders.

Theories of Youth Depression

Textbook outlines 8 distinct theories, including Beck's cognitive triad, learned helplessness, attachment models, and biological vulnerabilities.

Suicidal Ideation vs. Attempt vs. Suicide

Ideation = thoughts/plans of ending one's life; Attempt = non-fatal self-directed behavior with intent to die; Suicide = fatal self-inflicted act with intent to die.

24-Hour Suicide Warning Signs (King et al., 2024)

Specific acute psychological distress, situational stressors, and behavioral warning signs present in the 24 hours immediately before a youth attempt.

Suicidal Behavior Sex Differences

Females report higher rates of suicidal ideation and non-fatal attempts, while males have higher rates of completed suicide due to lethal means.

Suicidal Behavior Associated Diagnoses

Most strongly linked with Major Depressive Disorder, Bipolar Disorder, Substance Use Disorders, and severe impulsivity/conduct problems.

Biological Risk Factors for Suicide

Includes family history of suicide, serotonergic system dysfunction, and underlying neurobiological vulnerabilities.

Psychological & Situational Suicide Risk Factors

Includes hopelessness, severe emotional dysregulation, acute peer/family crisis, bullying, and access to lethal means.

Facts & Misconceptions of Suicide (Dr. Schechter)

Myth: Asking about suicide triggers it; Fact: Open dialogue reduces isolation. Myth: Suicide occurs without warning; Fact: Most youth express warning signs.

Nonsuicidal Self-Injury (NSSI) Definition

Deliberate, direct destruction of body tissue (e.g., cutting, burning) performed without suicidal intent.

NSSI Sex Differences

Engagement is more frequently reported among female adolescents in clinical and community samples compared to males.

NSSI Developmental Pattern Across Adolescence

Rates typically peak in middle-to-late adolescence and gradually decrease into young adulthood.

Canadian Youth NSSI Cessation Factors

Empirical findings show youth stop NSSI as they develop adaptive emotion regulation, positive peer support, and professional therapy.

NSSI Associated Psychiatric Diagnoses

Commonly co-occurs with Borderline Personality Disorder, MDD, Anxiety Disorders, Eating Disorders, and PTSD.

NSSI & Suicidal Behavior Relationship

NSSI is a strong independent predictor of future suicidal behavior, though NSSI itself lacks intent to die.

Turner et al. (2024) Transition Timing

Examines the temporal sequence and age of onset between NSSI, suicidal ideation, and suicide attempts, showing ideation often precedes or coincides with NSSI.

Factors Linked to NSSI

Emotional dysregulation, high negative affect, interpersonal conflict, rejection sensitivity, and altered pain threshold/endogenous opioids.

Myths & Misconceptions of Self-Injury (Top 5)

Myths: NSSI is just attention-seeking, only females self-harm, NSSI always means suicidal intent, people who cut don't feel pain, NSSI cannot be treated.

Psychosis: Premorbid Stage

The period prior to illness onset; individual displays baseline functioning or minor non-specific vulnerabilities before prodromal changes.

Psychosis: Prodromal Stage

Early phase with subtle cognitive/perceptual shifts, subthreshold psychotic symptoms, social withdrawal, and vague emotional distress.

Psychosis: First Episode

The initial full clinical presentation meeting diagnostic criteria for a psychotic disorder (delusions, hallucinations, severe thought disorder).

Psychosis Recovery and Relapse Patterns

Course varies; early intervention improves long-term outcomes, but relapses often follow medication non-adherence or acute stress.

Psychotic Experience vs. Psychotic Episode

Psychotic Experience = isolated perceptual/belief anomaly without full impairment; Psychotic Episode = sustained cluster of symptoms meeting diagnostic thresholds.

Risk Associated with Psychotic Experiences

Non-clinical psychotic experiences in youth significantly elevate risk for later psychotic disorders, non-psychotic mental health diagnoses, and suicidal behavior.

Non-True Psychosis Indicators

Perceptual anomalies occurring during sleep transitions (hypnagogic/hypnopompic) or under acute drug intoxication do not indicate true psychotic illness.

Childhood-Onset Schizophrenia (COS) Definition

A rare, severe neurodevelopmental form of schizophrenia with onset occurring before age 13.

COS Core Characteristics

Characterized by two main domains: Positive symptoms (hallucinations, delusions) and Negative symptoms (flat affect, avolition, social withdrawal).

Impact of Negative Symptoms in COS

Negative symptoms severely impair long-term social, academic, and adaptive development, often more debilitating than positive symptoms.

COS vs. Psychosis

Psychosis is a broad symptom category, whereas COS is a specific, chronic psychotic disorder with onset before age 13.

Brief Psychotic Disorder vs. Schizophreniform vs. Schizophrenia

Differentiated by duration: Brief Psychotic Disorder (< 1 month), Schizophreniform Disorder (1 to 6 months), Schizophrenia (> 6 months).

COS Sex Differences & Comorbidity

Boys show earlier onset and higher prevalence in childhood; high comorbidity with ADHD, Autism Spectrum Disorders, and Language/Learning Disorders.

Biological Factors in COS

Strong genetic etiology, pronounced brain volume loss, progressive gray matter pruning, and neurodevelopmental abnormalities.

Environmental Catalysts in COS

Includes prenatal complications, maternal infection, severe early psychosocial stress, and obstetric trauma.

Favourable Outcome Factors in COS

Better prognosis associated with higher premorbid functioning, later age of onset, acute/sudden onset, and strong family support.

Non-Specific Preceding Factors of Schizophrenia

Early developmental delays, motor deficits, subtle language impairment, and social awkwardness preceding diagnostic onset.