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46 Cards in this Set
- Front
- Back
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Core symptomology of MDD and dysthymia (3) |
dysphoria- prolonged sadness irritability- excessive sensitivity, hostility, and moodiness (unique to children and ados!) Anhedonia - loss of pleasure or interest in activities |
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what is a symptom vs syndrome? |
sadness (common, 40% everyone at any given time)= symptom syndrom= cluster of symptoms like 'negative affect' |
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MDD DSM Diagnosis (2+7) |
- 5 symptoms total during same two week period at least one of: - depressed mood most of the day, nearly everyday OR irritability *in kids and adolescents only) - Anhedinia most of day nearly every day
PLUS.. nearly everyday: - sig weight loss/appetite - insomnia/hypersomnia - psychomotor agitation÷retardation- noticeable by others! - fatigue - worthlessness or guilt - cant concentrate or be decisive - recurrent thoughts of death /suicide ideation, plan or attempt |
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Dysthymia DSM Diagnosis (A, B (6) C) |
A) depressed or irritable mood dor most of the day more days than not as indicated my subjective or objective accounts for at least one year (in adults, mood must be depressed not irritable and last 2 years) B)) presence while depressed of two or more of: - poor appetite or overeating - insomnia or hypersomnia - low energy or fatigue - low self-esteem - poor concentration or difficulty making decisions - feelings of hopelessness C) during the 1 year person has never been without symptoms for more than 2 months |
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Specifiers for Dysthymia (3) |
1) persistent dysthymic syndrome- full criteria for MDD not met in past year 2) with persistent MDD episodes- criteria for MDD have been met throughout last year 3) with intermittent MDD episodes- has had one or more MDD episodes in preceding year |
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What is an issue with the categorical approach to depression? |
- you will have one group of people who won’t make the cut off -many children and ados will have subclinical depression- close, have significant number of symptoms but not quite there - these people show significant impairment and are at greater risk for going on to develop MDD and other disorders |
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Prevalence of MDD (2) + Gender prevalence differences (1) and possible explanations (3) |
1% preschoolers, 2% schoolchildren, 8% ados - higher rates in minority and low SES - no gender differences in childhood! 6-11 years, BUT 13-15 the ratio becomes 2:1 girls to boys and this remains stable throughout adulthood - higher experience of stressors and trauma: experience sexual trauma, heading single parent households, live in lower SES - maybe HPA becomes more easily dysregulated - Coping with stress: girls and women are more likely to have rumination |
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Luby et al: can preschoolers show the typical MDD symptoms or only masked ones (like aggression and somatic symptoms)? (methods, findings, specificity vs sensitvity) |
looked at masked and typical symptoms in kids with MDD, ODD/ADHD or no disorder - sadness seen in higher levels in MDD group - anhedonia ONLY seen in MDD group - masked symptoms also seen - typical symptoms showed high specificity the likelihood that child without the disorder will not have the symptom - and sensitivity- the likelihood that a child with the disorder will have the symptom (presence of anhedonia rules in the disorder= specificity, absence of sad or grouchiness rules out disorder= sensitivity) |
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what changes to the DSM criteria for MDD are made for preschoolers? (4) |
- sad and unhappiness vs sad and depression - activities and play vs work and school - themes of suicide/ death in play - maybe 2 week duration used for adults+older children not applicable |
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Describe the course of MDD/ dysthymia (4) |
- Untreated MDD lasts 8-12 months - untreated Dysthymia lasts 2-5 years - residual symptoms frequently present at end of episode - residual symptoms strong risk factor for recurrence |
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what are some stats on recurrence? |
- preschoolers with depression are 4 times more likey to have MDD again two years later - recurrence is common: 25% within 1 year 40% within 2 years 70% within 5 years 30% develop Bipolar disorder most adults with MDD date onset of first episode to adolescence |
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what is the "kindling" ? |
- first episode frequently follow significant life stress - biological changes that make you more reactive to stress in the future - thus, later episodes may require less stress to begin - earlier depression starts, the worse the prognosis! |
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Prognosis fro MDD study. What are the most common comorbidities for MDD and dysthymia? (3) |
- followed kids who met DSM criteria for MDD at 15,16 and looked at psychopathy SES etc in adulthood - many had MDD still, and also anxiety= can be a heterogeneous continuity! comorbidity - for MDD : anxiety! also dysthymia, conduct adhd and sub use - for dysthymia: MDD, then anxiety conduct, adhd - in general co-morbid conditions come first! |
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Suicide vs suicidality; prevalence in youth (4) |
Suicide: taking ones own life Suicidality: also includes attempts, intent, ideation
- suicide is second leading cause of death among children and ados - in 2008 20.4% of all deaths for youth were to suicide compared to 1.5% of all deaths in canada - 60% of children and ado with major depression report suicidal thoughts, 30% will attempt - girls more likely to attempt and boys to use firearms and therefore complete |
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What are the strongest predictors of suicide? most common method? |
- two strongest predictors: mood disorder, being a young female - most common method is suffocation.. (accidents by “choking game” may be misclassified) |
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lethality vs intent |
research with adults found no relationship between persons perception of lethality and actual lethality no gender difference - no association between suicide intent and lethality- pills doesn’t mean they were less intending than those who use a gun - means chosen do not tell you about persons intent! |
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What is NSSI? What is the functional/behavioural approach to NSSI? (4) |
non-suicidal self-injury- deliberate destruction of your body tissue but not wanting to die - 17% of ados do this
behavioural approach: - its a way to regulate negative mood- self negative reinforcement- stops feelings or self positive reinforcement - generates desired feelings - way to obtain desired consequences: - interpersonal positive reinforcement- care + attention - Interpersonal negative reinforcement- less responsibility |
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Masked symptoms of depression |
it was thought that children displayed masked depression through behaviours like bed-wetting, separation anxiety, sleep problems, agression, running away. This has been generally rejected since its too broad to be helpful |
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3 types of depression |
1) MDD 2) dysthymia (Persistent depressive disorder) 3) disruptive mood dysregulation disorder (characterizd by sever temper outbursts and irritable mood) |
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two random differences in gender in expression of and prediction of MDD ; rates of dysthymia are____ than MDD |
- low birth weight has been found to predict depression in girls bot not boys - women have a much wider activation of the limbic system when asked to feel sad ; lower! 1% of children
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Neurocognitive/emotional Associations with Depression (4) |
- problems with performing speed, attention or coordination, but normal verbal skills and overall intelligence. do worse on standard tests. - cognitive biases such as noticing sad faces more. negative self belief - depressive rumination style (think about negative events over and over) and co-rumination (focusing with peers on emotions in a negative , destructive way) - negative self-esteem |
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Theories of depression (8) |
1) psychodynamic - loss of a loved object, severity of super-ego 2) attachment- insecure early attachments 3) behavioural- 4) cognitive- distorted cog structures and views 5) self-control- deficits in self monitoring, reinforcement 6) interpersonal- social withdrawl, inter deficit 7) socio-environmental- stressful life 8) neurobiological - neurochemical and physiological abnormalities |
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Behavioural models see depression as... cognitive models emphasize... People with depression show cognitive biases in which 3 areas? |
lack of response-contingent positive reinforcement; depressogenic cognitions (negative perceptual and attributional styles);
information-processing (negative automatic thoughts), negative cognitive triad (views about self, world and future) , and negative cognitive schemata |
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What does the biological model of depression entail? (2) (4) |
genetics: - 35-75% heritable -having short 5-HTTPLR gene AND maltreatment can increase risk** (no maltreatment no risk)
Stress reactivity: - early exposure to stress may sensitize people - HPA axis problems like hormonal response (cortisol associated with internalizing prob) - Prenatal depression: number of months a mother is depressed during pregnancy predicts elevated levels of cortisol when child is 6-7 - Postnatal depression: maternal depression associated with problematic parenting behaviours which may contribute to dysfunctions in stress response. findings vary but some have shown that this can cause higher levels of cortisol at 3,5,13, especially if the depression was early in childs life |
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What does the cognitive model of depression entail? (4) |
Encoding- not a lot of info, but depressed kids do not show attentional bias for sad or negative things Interpretation- hostile attribution bias- they tend to draw negative conclusions from ambiguous events= negative interpretations Response search- they identify fewer assertive strategies Response decision- report themselves less able to carry out assertive strategies and evaluate avoidant strategies as more likely to result in positive outcomes than assertive ones |
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What is the interpersonal theory of depression? |
-behaviours in depressed areless prosocial, less assertive, more avoidant and withdrawn, -some children with depression are also more hostile and aggressive - friendships important! they protect children from loneliness and depression and make kids less likely to be victimized and develop skills |
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Stress exposure Vs Stress generation models of depression. |
Stress exposure models of depression * depression results from exposure to stressful events* experience of stress precedes the experience of depression * peer rejection leads to an increase in depression * youth with depression more likely to generate problematic interpersonal circumstances which may in tern exacerbate depression * - internalizing symptoms predict life hassle and vice versa, and internalizing symptoms predict victimization and vice versa |
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Describe the Dearing et al study on whether there is an interpretation bias (negative interpretations) or response bias (picking more negative option on the page) |
- looked at performance-based measures of interpretation, interested in whether daughters of depressed mothers vs no depression showed interpretational biases - used two tasks: 1) acoustically blending 2 words: neutral-negative (cry-dry) and neutral positive (joy-boy) shown two choices and asked to select which word they heard - with neutral-negative at risk girls showed a bias for neg words, control did not. The opposite was true for neutral-positive words 2) "you are being picked for gym class you are certain you will be picked..." first, last, front - which is grammatically correct participants should be faster to respond to grammatically possible endings that are consistent with their hypothesized ending - at risk girls responded more quickly than control girls when ending was negative, no dif for positive
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Describe the study on stress generation model (methods and 4 findings) |
- looked at kids depression and externalizing problems - assessed life stress (objective) - stressful experiences rated by researchers along several dimensions : severity, extent to which child contributed to event (independent (dad got a new job) vs dependent (didn't study for test)), and interpersonal or non-interpersonal - depression was associated with dependent, interpersonal stress - it was NOT associated with independent stress - depressed youth NOT more likely to experience stressors they had more role in but WERE more likely to experience interpersonal stressors to which they contributed - youth with depression may be more likely than non-depressed to experience sig independent stressors - BUT this experience may not be specific to depression |
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studies observing children with depression interacting with their friends have found (3) |
- depressed kids engage in: a) reassurance seeking: children want others to demonstrate they care about them etc., depressed kids think they dont mean it, seek reassurance at first - this is associated eventually with unstable as well lower- quality friendships (as perceived by friend) b) co-rumination: sharing is associated with better friendships but rumination associated with negative mood= paradox co-rumination predicts positive friendship quality (in the opinion of depressed kid not friend) but it also predicts increased anxiety and depression 3) Contagion: depression and attributional styles are contagious between friends |
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What is the underlying diathesis -stress model of depression? what are the cognitive and behavioural processes we need to target with CBT? |
personal diatheses interact with stressful life events to disrupt normal mood. depression is maintained by negative cog and behavioural processes cog= depressogenic thinking behavioural= low reinforcement and neg life event, social skills |
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what are emotional spirals? |
downward: negative events may breed negative moods and this can breed negative behaviours and thoughts or expectations for future upward: positive triggers can start a chain of pleasant feelings, events and thoughts |
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what is the goal of CBT (3)? |
-observe thoughts feelings and behaviour - consider alternative explanations -solve problems and make rational decisions = observation (look at consequences) and experiment (try correcting and see what happens)
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cognitive restructuring |
what was I feeling bad about, what is the evidence for and against, what is a new thought? *Two key questions to get them to ask: is there any other way to look at this? Is there any there reason this might have happened?
- focuses on being aware of the negative thoughts, biases and self blame and form more positive ones |
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Behavioural techniques in CBT (4) |
- keep track of mood and activity - develop list of rewarding activities (pride and pleasure) - change habits: look at environ obstacles and skill deficits - monitor impact and refine plan |
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Describe the efficacy of tricyclic antidepressants, monoamine oxidase inhibitors, and SSRIs |
Tricyclic: - prevent reuptake of 5HT and NE by increasing responsiveness of receptors - no evidence of efficacy in youth
MAOIs: - stops MAO =, increasing neurotrans in synapse - mixed efficacy and potential lethal side effects as it interacts with red wine, beer, chocolat, aged cheese to increase blood pressure fatally -tend not to be prescribed to teens
SSRIs: - similar to tricyclics but focus on 5ht - good evidence for Fluoxetine (prozac) in teens - tend not to be fatal in overdose - side effects of agitation, jittery, anger, nausea
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Describe the black box warning fiasco. What did studies not involving RCTs find?
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Black box warning began with concern about Paxil. DFA requested data from every RCT involving antidepressants- 9 dif drugs and 25 trials An independent team conducted analyses and found that higher levels of suicidal thoughts and behaviour in patients treated with antidepressants. Even though no actual suicides were completed- there was just an increase in suicidality
But... studies not involving RCTs have shown that use of antidepressants is associate with decreased suicidality - epidemiological data indicates that as use of antidepressants goes up, suicidality goes down - in 2004 after the warning, adolescent suicide rates increased, perhaps bc of ados not being treated for depression the black box warning is still there* |
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Gibbons et al study on black box issue |
obtained longitudinal data from RCTs for Prozac from drug companies and the treatment for Adolescents with Depression study - included additional data such as examination of association between treatment group and clinician ratings of suicidal ideation as well as adverse event reports - did NOT find higher rates of suicidal ideation in youth treated with Prozac compared to placebo |
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Luc et al study on media coverage and use of anti-depressants and suicide |
Investigated whether warnings and media coverage were associated with decreased use of anti-depressants and increased suicides - obtained data from 11 healthcare organizations - identified people who were prescribed antidepressants and identified suicide attempts (admitted to hospital for poisoning with psychotropic medication) - after the black box, there was a sharp decrease in antidepressants ad sharp increase in suicide attempts, but no difference in actual suicides - adults even saw a decrease in antidepressant use, but no change in suicidality or completed. |
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what were the goals of TADS? (3) what were the methods? |
find out - what is the effectiveness of pharm treatment for depression in ados? - what about CBT? - how do the treatments compare?
Methods: - 439 youths 12-17 with MODERATE to SEVERE MDD - 54% female - excluded people with psychosis, but allowed people with anxiety comorbid what depression bc this is common - random assignment NOT RCT : CBT group, SSRI, CBT+SSRI, pill placebo - treated for 12 weeks |
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What were the results of TADS? |
- groups that got active meds either by itself or with CBT showed improvement in terms of core depression symptoms over those that didn’t get meds. -This was true for self report and rating by clinicians. -CBT did not out perform pill placebo in terms of core symptoms. However, the CBT med condition did better than the other groups on suicidality, so CBT may be helpful for suicidality -the recommendation was that for moderate to severe, they recommend the combo |
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Describe the follow-up part to TADS and the question it addressed |
Why didn’t CBT work? - actual TAD was for 12 weeks, but actually conducted 36 weeks of treatment, but after 12 weeks the clinicians were unblinded - people who were getting placebo and not responding were monitored and treated - over time, the med group goes down, and the CBT group gains, and at 36 weeks they dont lok different. maybe CBT just takes longer to take effect. (BUT there was no control group after 12 weeks, so we dont know if this is just a natural remission line, we dont know if people left untreated placebo would also improve butttt we know from other studies that the natural remission rate is not this fast...) |
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children with depressed parents... (4) |
- are 3 times more likely to get depression and have an earlier onset (before puberty) - are more likely to have other problems like anxiety, phobias, sub abuse (later) and conduct - maternal depression during pregnancy related to right amygdala structure in babies and smaller PFC, hippo and thalamus - if the mother has an intrusive depressive style, the child will display avoidance and tune out, but if she is withdrawn, the child will have heightened sociability towards strangers |
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interpersonal psychotherapy ITP; PASCET primary and secondary control enhancement program |
looks at family and peer interactions that may be maintaining depression teaches the depressed child skills to have pleasant interactions ;
an individualized CBT program that looks at primary control skills (changing the objective things in like like relaxing and activities) and secondary control skills (altering the subjecting impact - neg thoughts and feelings) - you want to change what is changeable and change the subjective impact of what is not |
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ACTION program; Adolescent coping with depression program ; Interpersonal psychotherapy |
Always find something to do to feel better Catch the positive Think about it as a problem to be solved Inspect the situation Open yourself to positive Never get stuck in the negative;
one of the most well-established CBT treatments that focused on skill training to promote control of mood and enhancing coping ability;
Interpersonal psychotherapy- looks at problem solving and communication skills to increase independence and address problematic relationships |
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Criteria for DMDD disruptive mood dysregulation disorder (6) |
- severe recurrent temper outbursts - temper inconsistent with developmental level - occur 3+ times a week - mood between outbursts is irritable - symptoms present for 12 months and not diagnosed before age 6 or after age 18 - child has never met manic episode criteria (even just for one day!!) |
