Term
| Mood disorders and irritability |
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Definition
| it's a criterion/associated with most of the mood disorders, like a fever, doesn't discriminate b/t disorders |
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Term
| Depressive Disorders - time periods for MDD and Dysthmia |
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Definition
MDD - 2 weeks
Dysthymia - a year for children (2 years for adults) |
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Term
| What is major depressive disorder? |
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Definition
Presence of at least one major depressive episode
Not better accounted for by other things (bereavement, PTSD)
No mania, mixed, or hypomania
At least 2 week period of time of meeting criteria for MDE - you should reassess periodically to make sure you're not missing a manic episode |
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Term
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Definition
Kids 1 year, adults 2 yrs, more often than not down, depressed, not more than 2 months without symptoms
More long standing than MDD - discussed even as a personality disorder b/c so long-lasting |
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Term
| What is double depression? |
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Definition
| Dysthymia followed by MDD |
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Term
| Prevalence of depressive disorders |
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Definition
Community samples
o 1-3% school aged
o 5-6% of adolescents
Clinical Settings
o 8-15% children
o 50% adolescents |
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Term
| Gender difference in depressive disorders? |
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Definition
| No consistent gender difference in children but by 15 years rate for females more than double |
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Term
Onset of MDD and Dysthymia
Mean length of each
Recurrence rate |
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Definition
Onsets: both around 11-14 yrs
Mean length of MDD = 7-8 months – as a child
Mean length of DD = 48 months – people often don’t pick up on it b/c they are quiet and not bothersome
Recurrence = 40% over 3-5 years in community samples |
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Term
Continuity of depressive disorders
Heritability |
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Definition
1. Adolescent to adult…good predictor/continuity – good chance you will continue to have problems
2. Preadolescent to adult…much poorer - not as good of a predictor for specifically MDD as an adult
o Intersection/interaction with sex differences?
o Higher rates of disorders/maladjustment overall, just not MDD
– Higher rates of MDD among 1stdegree relatives
– Heritability around 30-35% for many studies |
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Term
| Parents and depressive disorders |
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Definition
- 1 of the strongest predictors of MDD is having a depressed parent
- Depression is associated with maladaptive parents |
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Term
| 2 patterns of mother-child interaction |
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Definition
Withdrawal, disengagement, flat
OR
Hostile, intrusive |
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Term
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Definition
| Someone with ODD or CD who has depression, gets overlooked |
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Term
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Definition
1. Random external stressors
o More rare? Ish – odds of exposure are less
o Accidents, disasters etc
2. Family-dependent stressors
o Internal family problems
o Internal strife, marital discord, parenting practices
3. Stress Generation
oYou’re locked in a feedback loop
- Depressed individuals “generate” stressful circumstances which trigger more depression
Diathesis-stress model |
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Term
| Cognitive/CBT model: depressed people have |
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Definition
o Systematic biases/thinking errors (automatic thoughts)
o Negative cognitive schemas (structures that guide thinking |
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Term
| Clark and Watson CBT model |
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Definition
o Negative cognitive triad
o Tripartite Model
o Comorbidity of depression and anxiety |
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Term
| Negative cognitive triad - clark and watson |
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Definition
| Perceive self, world, and future negatively |
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Term
| Tripartite Model - Clark and Watson |
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Definition
| General distress, anhedonia, physiologic arousal |
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Term
| Comorbidity of depression and anxiety |
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Definition
Differential diagnosis - de-emphasize general distress
Depression will have general distress and anhedonia
Anxiety will have general distress and physiologic arousal |
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Term
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Definition
Criteria varies but:
- At least one manic episode
- Possibly at least 1 major depressive episode (don’t have to have one)
- Not better accounted by any other disorders |
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Term
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Definition
- 1 or more MDE
- At least one hypomanic episode
- Has never had a manic episode or a mixed episode – rapid alternation b/t depression and mania, appearing together almost |
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Term
Manic Episode Criteria
Hypomanic Episode |
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Definition
- At least 1 week of “abnormally and persistently elevated, expansive, or irritable mood” (or any duration if hospitalized)
- 3 or more of
o Grandiosity
o Decreased sleep
o More talkative/pressured speech
o Flight of ideas
o Distractibility
o Increased goal setting
o Increased high-risk pleasurable activities
Hypomanic episode – generally same criteria just not sufficiently severe to caused “marked impairment in social or occupational functioning or to require hospitalization”
*** How does this translate in children? |
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Term
| Phenotypes of Bipolar Disorder |
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Definition
1. Narrow (think strict DSM-IV)
2. Broad (BD-NOS?)
o “…children with the “broad” phenotype constitute the majority of referrals to clinicians…”
o present with severe irritability, affective storms, mood lability, severe temper outbursts, symptoms of depression, anxiety, hyperactivity, poor concentration, and impulsivity with or without clear episodicity.”
- Irritability is emphasized and is considered by some to be the appropriate “core” symptom, even without other symptoms (e.g., grandiosity, elation, episodicity) (Pavuluriet al., 2005, p. 847). |
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Term
| How to diagnose Bipolar Disorder in children (or how to pervert the diagnostic process....) |
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Definition
- HOWEVER, BD can be “…differentiated from ADHD by the presence of grandiosity, elated mood, flight of ideas, hypersexuality, and decreased need for sleep” (p. 851)!
- “More often than not, children…with BD will present with other psychiatric disorders, particularly ADHD, ODD, CD, and anxiety disorders.”
- If we take out the episodes, what does that mean?
- What would an oppositional, anxious, inattentive, hyperactive child look like anyway? irritable without clear episodes….right?
- Assessments for bipolar disorder should be a long-term assessment |
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Term
| Implications of bipolar disorder diagnosis |
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Definition
- Yet another fad for parents to sort through?
- Contraindicated treatment? (e.g., lithium, anti-psychotics, psycho-stimulants)
o Antidepressants may worsen or precipitate a manic episode
o Need to be very careful with this |
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Term
| Youngstrom et al (2005) identified 3 camps of people in regards to the existence of bipolar disorder in children |
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Definition
1)BD does not occur in children
2)RTI -- Child has BD if fails a trial of psychostimulant. We’ve been here before, confuses ax with tx
3)Agnostic - Disorder occurs, but is rare in children |
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