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102 Cards in this Set

  • Front
  • Back
core features of depression:
at least one of the following most of the day nearly everyday for 2 weeks
dysphoria
irritability
anhedonia
prolonged sadness
Dysphoria
excessive sensitivity, hostility, and moodiness
unique to children and adolescents
irritability
loss of pleasure or interest in previously enjoyable activities
anhedonia
depression:
Feeling or emotion of sadness
Very common (40% at any given time)
symptom
depression:
disorder/diagnosis=
Syndrome with minimum duration
Syndrome with required impairment
depression:
Cluster of common symptoms
“Negative affect” and dimensional view of depression
syndrome
Major Depressive Disorder (3)
Presence of major depressive episodes
Not better accounted for by a psychotic disorder
No manic episodes
* can have single or recurrent (at least 2 months between episodes)
MDD diagnoses
-5 symtoms total
-during same 2 week period
-at least one of depressed mood OR irritability, anhedonia
-plus (look at slide for the list)
dysthymic disorder
-Depressed or irritable mood for most of the day, more days than not, as indicated by either subjective account or by observation by others, for at least 1 year
-Presence while depressed, of two (or more) of the following:(look at slide)
-During the 1 year period, the person has never been without the symptoms for more than 2 months at a time
double depression
Major depressive episode as well as dysthymia
Possible to meet criteria for both
Dysthymia first, and then have a major depressive episode
___% of preschoolers have MDD
___% of schoolchildren
___% of adolescents
1
2
8
higher symptoms of MDD in ___youths
-minority
*life stressors and daily hassles add to MDD (more hassles in low ses environments)
gender differences in MDD
-NO gender differences in childhood – between 6 and 11 years of age
-Between ages 13 and 15, ratio becomes 2 girls:1 boy
(maintains through adulthood)
possible factors causing the increased rate of woman that have depression compared to men (4)
higher experience of stressors and trauma
gender related expectations
biological
coping styles (more likely to ruminate)
rumination
Thinking about a problem constantly, but never moving to active problem-solving
may be hard for adults to see depression in kids because (3)
-Many of the symptoms of depression are internal
-Behavioral profile is hetergeneous
-Avoidance, reduced assertiveness, but some children are more aggressive and hostile
Luby et al 2003 tested if it was true that preschoolers would only show “masked” symptoms of depression
results?
we are gonna see typical symptoms in kids this young and these typical symptoms are gonna be better markers of depression than the masked symptoms
depression in preschoolers:
Typical symptoms often showed high ___
specificity
specificity
likelihood that child without the disorder will not have the symptom
ex) kids without depression will not have anhedonia, presence of anhedonia rules in the disorder
depression in preschoolers:
Some typical symptoms also show high ___
sensitivity
sensitivity
likelihood that a child with the disorder will have the symptom
ex) sadness/grouchiness, absence of symptom rules out the disorder
Note that for preschoolers, some modifications to DSM criteria need to be made what are they (4)
-sadness &unhappiness vs sadness & depression
-“Activities and play” versus “work and school”
-Themes of suicide and death in play
-Possible that 2-week duration used for older children and adults may not be applicable to young children
-Untreated MDD lasts ___ months
-Untreated dysthmic disorder (DD) lasts ___years
-Residual symptoms frequently present at ___ of episode
-Residual symptoms strong __ factor for recurrence
8-12
2-5
end
risk
-Preschoolers with depression are___times more likely than those without depression to meet criteria for major depressive disorder 2 years later
-For children and adolescences who experience a major depressive episode, recurrence is common:
__% within 1 year
__% within 2 years
__% within 5 years
__% develop Bipolar Disorder (“BP switch”)
-Most adults with MDD date onset of first episode to ____
4
25
40
70
30
adolescence
people with MDD episodes likely to have subsequent MDD episodes one reason why is due to ____
kindling
kindling
-First episodes 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
Children and adolescents who have a depressive episode are more likely to have depressive episodes as adults
T or F
T
Earlier it starts, the worse the prognosis is
T or F
T
*More severe, chronic course, greater suicidality
comorbidity for Major Depressive Disorder (5)
-Anxiety
-Dysthymia, conduct problems, ADHD, substance use
-In general, co-morbid conditions come first
comorbidity for dysthmia (4)
-MDD
-Anxiety, conduct disorder, ADHD
-Again, these usual precede dysthmia
Children with depression perform more poorly in school are their IQ normal
yes
symptoms of depression on cognitive functioning (3)
poor conc
low energy
fatigue
suicide=
suicidality=
-taking ones own life
-also includes attempts, intent, ideation
___ is the third leading cause of death among children and adolescents in the United States
Suicide
Two strongest predictors for suicidal behavior are
being young female
mood disorder
__% of children and adolescents with major depression report suicidal thoughts
60
*approx 30 % will attempt suicide
T or F
Girls are more likely to attempt suicide; however, they often use less lethal means (drugs, wrist cutting)
T
*Boys are more likely to use firearms, and as a result, are more likely to complete suicides
Deliberate, destruction of your own body tissue in the absence of intent to die
Non-Suicidal Self Injury (NSSI)
cutting, burning, biting
__% of adolescents report engaging in one of these behaviors
examples of NSSI
17
NSSI associated with a number of psychological disorders, including (2)
depression and anxiety
NSSI behaviour is reinforced by
intra- or interpersonal consequences
-->Way to regulate negative mood (Intrapersonal negative reinforcement, Intrapersonal positive reinforcement)
-->Way to obtain desired consequences in the environment (Interpersonal positive reinforcement, Interpersonal negative reinforcement)
lecture 16 Etiological and Maintenance Models of Depression
..
biological factors
-Children of depressed parents are more likely to be
depressed *strongest risk factor for childhood depression
-
Children with a parent who was depressed as a child are __x more likely to become depressed before age 13
14
Overall, rates of depression in the school-aged and
adolescent children of depressed mothers have been
reported to be between _____
20% and 41%
reasons for biological factors (2)
genetics
stress re-activity
Twin studies suggest heritability rates between___
35% and 75%
*Variability is due to differences in measurement and sampling
Which Genes?
serotonin transporter gene 5-HTTLPR
*Having a short allele conferred a risk for depression, only in the presence of maltreatment ie genotype doesn't matter if you weren't maltreated
Stress reactivity=
Early exposure to stress which may sensitize person
to later stress
Depression in moms is associated with increased
levels of ____
Will this effect fetus
cortisol
possibly
T or F
Number of months a women is depressed during
pregnancy predicts elevated levels of cortisol when
children are 6-7 years of age
T
Prenatal depression:
Elevated cortisol associated with ___
problems
internalizing
describe postnatal depression and stress reactivity
-Infants develop rapidly
-Early experiences with mom may have profound influence
-Maternal depression is associated with parenting behaviors that may be problematic ex)less responsive
-May contribute to dysregulation of stress responses
postnatal depression:
Although findings are not unequivocal, studies have shown that children exposed to depression in the postnatal period show higher levels of ___at age 3, age 4.5, and age 13
cortisol
postnatal depression:
Suggestion that maternal depression earlier in child’s life (first 1 to 2 years) shows greatest association with children’s later ___functioning
HPA
is encoding affected in depressed children/teens
-There is not a lot of evidence that youth depression is
associated with encoding biases
-depressed children and adolescents do not seem toshow an attentional bias for sad or negative material
is interpretation affected in depressed children/teens
-yes
-show tendency to draw negative conclusions from
ambiguous events (hostile attribution bias) contributes to low mood
Dearing and Gotlib (2009)
purpose of this study
-Interested in whether daughters of mothers who had
depression showed interpretation biases
-to see if cognition is a risk factor
Dearing and Gotlib (2009) participants
Compared girls (aged 10 to 14) who
(a) had a mother with a history of depression (at risk)
(b) had no maternal history of depression (control)
Dearing and Gotlib (2009):
results for the interpretation involving pairing
-When pairing was neutral-negative, at risk girls showed a bias for the negative words, control group did not
*specific to depression-related negative words (e.g., sad), did not see it for social-threat related negative words (e.g.hated)
-When pairing was neutral-positive, control group
showed a bias for the positive word, at risk group did
not
Dearing and Gotlib (2009):
results for story completion task
-At risk girls responded more quickly than control girls
when ending was negative
-No difference on positive words
is response search/decision affect in depressed children/teens
-yes
-they identify less assertive strategies
-report themselves less able to carry out assertive
strategies
-evaluate avoidant strategies as more likely to result in positive outcomes and assertive strategies as less likely to result in positive outcomes
Interpersonal Theories of Depression:
behaviors of depressed children/teens (4)
-Less prosocial
-Less assertive
-More avoidant and withdrawn
-Some children with depression are also more hostile and aggressive
explain ideas behind Interpersonal Theories of Depression
-Children and adolescents may be responding to
challenging interpersonal situations in problematic ways
-We know, for example, that responding by aggressing or withdrawing when someone aggresses against you may result in continued experience of aggression
-We also know that being treated poorly by peers results in increased 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
Stress Generation Models
-Depression may lead indiviuals to generate stressful life events
-Difficulties in interactions may cause interpersonal problems
Rudolph et al. 2000 looked at stress generation model
stressful experiences were rated by researchers along (3) dimensions
-Severity (No stress/impact to severe stress/impact)
-Extent to which child contributed to the event (independent or dependent)
-interpersonal or non-interpersonal
Rudolph et al. 2000 results:
depression associated with (2)
dependent,interpersonal stress
*this is continuous with the stress generation model
stress generation model:
Youth with depression more likely to generate problematic interpersonal circumstances, these interpersonal circumstances, in turn, many exacerbate depression. See similar patterns for (2)
Life hassles
--> Internalizing symptoms predicts life hassle, and life hassles predict subsequent internalizing symptoms
Victimization
--> Internalizing symptoms predict victimization, and
victimization predict subsequent internalizing symptoms
Interpersonal Theories of Depression:
-Friends are a critically important part of development
-Protect children from feelings of loneliness and
depression
-Children with friendships are less likely to be
victimized by peers
-Provides an opportunity to develop important social
skills
..
Studies have observed children with depression
interacting with their friends, they've noticed that the friends’ affect becoming more negative over the course of the interaction why? (3)
reassurance seeking
co rumination
contagion
explain Reassurance Seeking
-Children want others to demonstrate that they care about them, tell them that they are okay, etc.
-Initially, people will do this
-Person thinks they don’t mean it, and seeks more
reassurance
-Overtime, this becomes irritating and/or invalidating
-Eventually, the child will be rejected
-Reassurance seeking is associated with unstable
friendships
-It also predicts lower-quality friendships, as perceived by the friend
Co-rumination
-Rumination is the tendency to dwell on problems and not solve them
-Co-rumination is when two friends do it together
paradox of corumination
Sharing and intimacy are associated with better friendships
Rumination and dwelling on bad things are associated with negative mood
Rose (2003):
Completed measures about: friendship, co rumination, symptoms of anxiety and depression
results?
-Co-rumination predicts positive friendship quality
(As co-rumination increases, children’s perception of the quality of their friendship increases (although friends’ perception of quality does not increase))
-also predicts increased anxiety and depression
Contagion of depression and attributional styles
-Depression of best friends predicts adolescents’ depression over time
-Depressive attributional style of best friends predicts
adolescents own depressive attributional style over time
summary:
-Biological predisposition for depression
Interacting with stressful life events
-Diathesis-stress model
A) Cognitive patterns associated with depression
B) Behavioral patterns associated with depression
A) and B) may combine to increase negative
experiences, which may increase depression
..
lecture 17: treatment
..
CBT Model of Depression (3)
1)underlying diathesis stress model
-->Personal diatheses interact with stressful life events to disrupt normal mood
-->Depression maintained by negative cognitive and behavioral processes
2)cognitive processing to target-->depressogenic thinking
3)behavioral process to target
-->low reinforcement/negative life event
-->skill deficits
Emotional Spirals and depression
-Depression may begin, or deepen, as part of a DOWNWARD EMOTIONAL SPIRAL
-But, moods do not have to just go down. We also experience UPWARD EMOTIONAL SPIRALS
Cognitive Techniques in CBT (3)
-goal is to help youth learn how to:
Observe their thoughts, feelings, and behavior
Consider alternative explanation
Solve problems and make rational decisions
-therapy as observation and experiment:
assess accuracy&affective consequences of their thinking, try correcting your thought and see what happens
-Match developmental level:
use concrete examples and cartoons
Behavioral Techniques in CBT (4)
Keep track of mood and activity
--> how do you feel?
--> what are you doing?
develop list of rewarding activities
-->activities that produce pride
-->activities that produce pleasure
change habits:
-->address env. obstacles & skill deficits
monitor IMPACT and refine plan
Developmental differences in antidepressent meds
-Many effective medications for adults
-Some do not work ___ in children
-Most do not work ___ in adolescents
-May be due to differences in(2)
at all
as well
brain development or metabolism
Antidepressant Medications (3)
Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants
Prevent the reuptake of norepinephrine and serotonin in the synapses or by increasing the responsiveness of receptors to these neurotransmitters
No evidence of efficacy in youth
..
Monoamine oxidase inhibitors (MAOIs)
MAO is an enzyme that breaks down some neurotransmitters
MAO inhibitors stop this enzyme thus increasing the level of neurotransmitters in the synapse
Some mixed evidence of efficacy in teens
Potentially lethal side effects
Interacts with foods rich in a particular amino acid (tyramine) and can lead to a potentail fatal increase in blood pressure
Red wine, beer, chocolate, aged/ripened cheese
..
Selective serotonin reuptake inhibitors (SSRIs)
Inhibit the reuptake of serotonin so that more is available in the synapse
Similar to tricyclics, but more specifially focused on serotonin
Good evidence for fluoxetine (Prozac) in teens
Tend not to be fatal in overdose
Side effects: agitation, jitteriness, anger, hostility, nausea, stomach cramps
..
Antidepressants for Children and Adolescents:
___show some evidence of efficacy
suggestion that there's an increased risk of___with antidepressants
SSRIs
suicide
Appears on the package insert for medication
Warns of serious adverse side effects
Most serious warning the FDA gives
Named for the black border around the warning
Black-box warning by the FDA
T or F black box warning found on SSRI's as an Antidepressants for Children and Adolescents
T
A study found higher levels of suicidal thoughts and behavior in patients treated with antidepressants compared to placebos BUT studies not involving RCT's showed
use of antidepressants is associated with decreased suicidality
adolescent suicide rates in the US increased for the first time in 2004, after many years of decrease
Speculation that was this, in part, due to
adolescents not being treated for depression
Gibbons et al. 2012
Obtained complete longitudinal data from RCTs for Prozac (fluoxetine) from the drug companies and the TADs study
RESULTS?
Did not find higher rates of suicidal ideation in youth treated with Prozac compared to placebo
Antidepressant Use in Children and Adults:
Evidence for them is____
balancing risk and benefit why?
some evidence that some ____may confer acceptable benefit:risk ratio for adolescents
-mixed
-Possible increase of suicical ideation, Risk of suicidal ideation of depression is left untreated
-SSRI;s (ex prozac)
Treatment for Adolescents with Depression Study (TADS) is to adolescent depression at ___is to___
MTA is to ADHD in childhood
TADS, 2004
1) whats effectiveness of pharmacological treatment for depression in teens
2) whats effectiveness of CBT for treatment of teen depression
3) how do these treatments compare
results
-Overall, groups with active medication did better in terms of depression symptoms.
-But, CBT may be helpful for suicidality. SSRI + CBT recommended for moderate to severe MDD
-
outcomes of TAD:
Not a lot of support for CBT
CBT did not outperform a pill placebo
Contrasts with previous evidence
-Why?
Sample characteristics
-Some evidence that CBT may not work as well in a more severe sample
-TADS sample was very severe
*In less severe samples, CBT alone may work well
-Treatment manual
-Very flexible
-Therapists given a lot of latitude in picking from different “modules”
-May have resulted in participants getting fewer CBT techniques
TADS Follow Up:
Initial TADS results for 12 weeks of treatment
Actually conducted 36 weeks of treatment
After 12 weeks, SSRI and placebo groups unblinded (lost placebo group but still follwed them ,done for ethical reasons)
-Placebo non-responders got treatment
-Placebo responders were monitored
It is possible that the severity of sample may have meant that
Suicidal ideation is significantly ____ in those that were treated with medication alone, compared to both CBT and combined treatment
CBT alone took longer to work
more common
*people in CBT look same in terms of depressive symptoms as people in med only and med+CBT
summary:
-T or F CBT for child and adolescent depression can be effective
-Evidence for the effectiveness of SSRIs
-T (may not be best choice for severe cases)
-Have to weigh the risks and the benefits, TADS authors concluded that CBT in combination with SSRIs may prove protective against suicidality
Treatment for Depression in Preschoolers:
Diagnosis of depression in preschoolers is very new
Not much is known about effective treatments
As of 2006, no studies had examining the safety and efficacy of prescribing medication for preschool mood disorders
Also no psychotherapy trials
Note that prescribing occurs “off-label”
3-9/1000 U.S. preschoolers treated with psychotropic meds in the 1990s
Most common prescriptions are for stimulants
..
Treatment for Depression in Preschoolers:
Luby and colleagues have developed a version of parent-management training that focuses on helping parents learn to manage their children’s moods
Therapy is recommended as the first approach
If symptoms are severe and persist, fluoxetine (Prozac) has the best risk/benefit profile in older children and is recommended as the first choice in preschoolers
..