Download F2 depression

Quiz 1: Tuesday February 10
• 20 m.c. questions
– Emphasis on concrete details, can come from
text, or interface of text and lectures
• 40 points of short answer
– Emphasis on class lectures and activities,
including material highlighted from text
• Total: 60 points/4 = 15% of final grade
Child Psychopathology
Negative Affectivity
Depression in children
First two presentations
Reading for today: Chapter 8
Negative Affectivity
• Definition: The tendency to experience aversive
emotional states; best predicted by Trait Anxiety
and internalizing behavior problems
• Evidence: Comorbidity of child anxiety and child
Dx of
depression
Depression
Yes
Dx of
Anxiety
R=.75
Anxiety Scores
Yes
No
No
50
10
25
150
Depression in children
• Mood disorders underdetected because other
problems may be more obvious, e.g., conduct,
substance abuse, general malaise of youth
• Debate over whether it even exists, or whether it
pervasively accounts for other disorders
• How does it differ from adult forms of depression?
Is the same neuroendocrinology in place?
• Importance of family factors
Assessment
• Observations
• Report measures: CBCL items
• RADS overhead: Self report for
adolescents
• Cognitive triad: Negative thoughts and
attributions
– Devalue world, self, and future
Major depressive disorder in children
• Feelings of sadness, irritability, guilt, shame
• Restlessness, agitation, reduced activity & speech,
withdrawal, aggression
• Feelings of worthlessness and low self esteem
• Self-critical and self-conscious; pessimism,
distorted views of the future, difficulty
concentrating or remembering, self-blame
• Disruptions in eating or sleeping; physical
complaints; diffuse physical symptoms
• Prevalence: 2 to 8% of children age 4 to 18; more
common in late adolescence, females > males
Early onset depression is related
to other problems
Youth under stress who experience a loss or who have attention,
learning, or conduct disorders are at a higher risk for depression.
(American Academy of Child & Adolescent Psychiatry [AACAP],
1995)
Almost one-third of six- to twelve-year-old children diagnosed with
major depression will develop bipolar disorder within a few years.
(AACAP, 1995)
Four out of every five runaway youths suffer from depression. (U.S.
Select Committee on Children, Youth & Families)
Clinical depression can contribute to eating disorders. On the other
hand, an eating disorder can lead to a state of clinical depression.
(Stellefson, Medical University of South Carolina, 1998)
Depression and Conduct Disorders
Jennifer Vickery
Depression and Conduct Disorder
• There is a similarity in symptoms
– Drop in school performance, physical symptoms, lying,
deceitfulness, acting out
– Unexplained irritability, drug use
• Cognitive processing problems in both disorders
– Attributional style – attributing positives to external factors,
negatives to internal factors
• Family Factors and perceived negativity with parents
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–
–
–
Distressed verbal affect is common to anger and conduct problems
Development within distressed family is common to both
Siblings behave much like the target child
Negative impact on family from the clinical problem
• Restricted range of emotional expression, esp. poor
positive affect
Causes
• Psychodynamic theory not useful
• Attachment theory: parental separation and
anxious attachment as predisposing factors
• Behavioral theories: Lack of positive
reinforcement or uncontrollable negative events
• Cognitive theories: Negative perceptual and
attributional styles, learned helplessness
• Self-control theory: Behavior and long-term goals
• Diathesis-stress models: biological strata and
environmental stressors
• Fitting theories together: Figure 8.3
Peer Relationships and Depression
Crystal Barr
Peers and depression in children
• Peer behavior towards children, as well as children’s
perceptions of peer behavior is important
• Rejected children are prone to depression
• Social status is related to measures of cognitive processing
– unpopular children are more prone to focus on more
negative words
• Popularity and self perceptions are negative in depressed
children
• Aggressive children see themselves as better accepted than
they really are or than depressed children
• Deviant peer affiliations predict depression indirectly
Treatment for depression
• Depression
• Cognitive-Behavior Therapy
has shown most short-and longterm success
• 70% of children with MDD
respond to treatment
• imipramimine (tricyclic) and
prozac (SSRI) are used, but
there has been a failure to show
advantage of antidepressants
over placebo in carefully
controlled studies
• What is a double-blind study?
• Family therapy, Interpersonal
Behavior Therapy
• Bipolar Disorder, marked by
manic and depressive stages
• Lithium is the first treatment of
choice
• High genetic loading of biploar
disorder
• No research on psychosocial
interventions with biploar
disorder
• Regarding all depressive
disorders, what communitybased interventions are useful?