I. Depression
Criteria for major depressive episode- not a disorder, a symptom
A. Five or more of the following symptoms for
the same two-week period and represent a change from previous functioning
- (1) or (2) must be present
(1) depressed mood most
of the day
(2) markedly diminished
interest (amotivation) or pleasure in all activities (anhedonia)
(3) weight loss or gain
(4) insomnia or hypersomnia
nearly every day
(5) psychomotor retardation
or agitation
(6) fatigue or loss of
energy nearly every day
(7) feelings of worthlessness
or excessive or inappropriate guilt
(8) diminished ability
to think or concentrate, indecisiveness nearly every day
(9) recurrent thoughts
of death (not just fear of dying), suicidal ideation with or without specific
plan, suicide attempt or specific plan
II. Structure of mood disorders
A. Unipolar
mostly depression, manic
very rare
B. Bipolar
age of onset
Bipolar I - 18
Bipolar II - 22
can begin in childhood,
but this is rare
C. Dysphoric manic or mixed episode
elated but also depressed
or anxious
DEPRESSIVE DISORDERS
I. Major Depressive Disorder - Single or recurrent
Diagnostic criteria
A. Presence of a single Major Depressive Episode
(5 or more symptoms)
B. There has never been a Manic Episode, a Mixed
Episode, or a Hypomanic Episode and not better accounted for by Schizoaffective
Disorder and not superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, of Psychotic Disorder
C. Symptoms cause distress/impairment in functioning
in family, school, and with friends
D. Symptoms are not due to substance abuse or
a general medical condition
E. The symptoms are not better accounted for
by bereavement
*Grief - Normal or Abnormal
Depression
loss of loved one is not a disorder
1. pathological grief reaction - impacted grief reaction
II. Dysthymic Disorder
same as Major Depression but chronic and less severe - no suicide
in criteria
Diagnostic criteria
A. Depressed mood for most of the day for at
least 2 years (in children it can be an irritable mood and the duration
must be at least one year)
B. Presence of two or more of the following:
(1) poor appetite or
overeating
(2) insomnia or hypersomnia
(3) low energy or fatigue
(4) low self-esteem
(5) poor concentration
or difficulty making decisions
(6) feelings of hopelessness
C. During the 2-year period (1 for children and
adolescents), never been without the symptoms for more than 2 months at
a time
D. No Major Depressive Episode has been present
during the first 2 years
(no chronic Major Depression
or in remission)
III. Statistics and course
A. Major depression
1. Onset is usually between
the ages of 14-15
2. Only about 7%-14%
of kids report MDD before 15
3. The earlier the onset...
4. Rates of recovery
are anywhere from 75%-90%
B. Dysthymic Disorder
Earlier age of onset-
11-12 years
(1) greater chronicity/duration (2-5years)
(2) poor prognosis-longer to recover
(3) stronger familial pattern
C. Incidence
MDD- 2%-8% of kids between
the ages of 4-18
DD- low...6%-1.7% in
children, 1.6%-8% in adolescents
dysthymia more common
- bipolar more rare
D. Gender and ethnic
1. Major Depression and
Dysthymia
IV. Psychological Causes
A. Psychological dimensions
1. stress or trauma -
diathesis stress model
mood distorts memory of past events
Academic problem, intellectual functioning, family problems, loss
2. Learned helplessness
sense of helplessness - both anxiety and depression
sense of hopelessness - depression
depressive attributional style
Attributional styles - One's tendency to attribute one's behavior to internal or external factors, stable or unstable factors, etc.
Internal
external
stable
unstable
global
specific
3. Dysfunctional attitudes
- Aaron Beck
a. cognitive errors
Overgeneralizations
Arbitrary inferences
b. Depressive or cognitive triad
Negative thinking about self, world, future
c. Develop negative cognitive schema
Self-blame
4. Parenting Style and Family Management Practices
B. Relationship between anxiety and depression
1. Negative affectivity
V. Biological Causes of Mood Disorders
A. Equifinality
B. Biological - Familial and Genetic
1. family studies
2. adoption studies
Higher risk if biological mother depressed
3. twin studies
3 times as likely for the other twin
severe cases more likely to be due to genetics
C. Biological - Neurobiological influences
1. low levels of serotonin
2. hormones - cortisol
VI. Treatment
A. Drugs
B. Psychosocial treatments
1. Cognitive therapy
2. Interpersonal Psychotherapy
(IPT)
Resolving interpersonal problems and stresses in relationships
a. Dealing with interpersonal role disputes
b. Adjusting to the loss of a relationship
c. Acquiring new relationships
d. Identifying and correcting deficits in social skills
VII. Suicide
suicidal ideation - thoughts about committing suicide
*A child with MDD is 27 times more likely to kill himself than a child with no disorder at all. Young people with MDD and DD have higher rates of suicide than adults with these disorders.
A. Statistics
Suicide is the third
leading cause of death among young people aged 15-24.
The rate for this age
group has essentially tripled since the 1950's.
Every day, 14 young people
(ages 15 to 24) commit suicide, or approximately 1 every 100 minutes.
60-70% of youth
report suicidal ideation
In 1992, 21% of
high school students had seriously considered attempting suicide w/in the
past year and 8% had attempted suicide w/in the past year.
More than 90% of
adolescents who commit suicide have a psychological disorder.
84% of all suicide
attempts were found to occur for disorders with depressive features.
Gay and Lesbian teenagers
have a particularly high risk for suicide.
4 times as many males
as females commit suicide, but females are 4 times more likely to make
suicide attempts.
According to a recent
CDC study, the suicide rate of African American youth between the ages
of 10 and 19 has increased by 114% since 1980.
B. Recognizing Risk and Helping to Prevent it
1. assessing for possible
suicidal ideation
2. Draw the person out
3. Be empathic
4. Suggest that measures
other than suicide may solve the problem
5. Do not let people
threatening suicide that they are silly or crazy.
6. Do not insist on contact
with specific people, life parents or a spouse
7. suicide contract
8. hospitalization
C. Myths about suicide
1. people who threaten
suicide are only seeking attention
2. those who fail at
suicide attempts are only seeking attention
3. Discussion of suicide
with a depressed person may prompt suicide
4. only "insane" people
take their own lives
5. most people with suicidal
thoughts do not act on them