Give three areas in which depressed individuals show cognitive problems, according to Aaron Beck
- Negative automatic thoughts - Information-processing biases/errors of thinking in specific situations
- Negative cognitive triad -
negative outlook in oneself, the world & the future - Negative cognitive schemata - stable memory structures that guide information processing aka self-critical beliefs & attitudes.
What is the role of the family in the development and maintenance of depression? (in young people)
Youngsters with depression have:
- Less supportive + more conflictual relationship w/ family.
- Feel socially isolated from family
- Prefer to be alone vs with them
Kid’s social isolation from family is them avoiding conflict vs a social skill deficit
Family relationship difficulties persist even when children aren’t clinically depressed anymore
Explain some of the concerns of treating young people with depression with medications
Concern for side effects:
- suicidal thoughts & self-harm
- lack of information about long-term effects on the developing brain
Bcz of it:
- SSRIs & young people decreased by 20%
- all manufacturers of antidepressant meds:
- label has a boxed warning & Patient Education Guide (says suicidal side effects)
What approach is used in “The Action” for treating children with depression and their families? Describe the “The Action” program.
youngsters can impact their: A - Always find something to do to feel better. C - Catch the positive. T - Think about it as a problem to solve I - Inspect the situation. O - Open yourself to the positive N - Never get stuck in the negative muck
What are some of the characteristics of a family with a depressed child? Of a family with a depressed parent?
Families :
- more critical & punitive behavior to depressed kid
- display more anger and conflict
- greater use of control
- poorer communication
- more overinvolvement
- less warmth & support
- Experience high levels of: stress, disorganization, marital discord, and lack of social support
Depression interferes with a parent’s ability to meet kid’s _____
physical and emotional needs (feeding, bedtime routines, medical care, and safety practices)
Depressed moms create a child-rearing environment w/
- negative mood & irritability
- helplessness
- less emotional flexibility
- unpredictable displays of affection.
When kids have negative emotions & distress, depressed moms:
- less likely to be supportive w/ comfort, empathy, or assistance
- more likely to disapprove, dismiss, punish, or ignore kids emotions
Depressed mothers also display less:
- less energy in stimulating play
- less consistent discipline
- less involvement
- poor communication
- lack of affection
- more criticism and resentment to kids
Distinguish between manic, mixed, and hypomanic episodes
Manic episode =
- week or more of ongoing, pervasive, and unusually elevated/irritable mood
- persistently increased goal-directed activity/energy.
- extra self-esteem, less need for sleep, racing thoughts, rapid/frenzied speech, attention to dumb details, increased activity, over-involvement in pleasurable/reckless/risky behaviours
- hallmark feature of BP
Hypomanic episode = manic episode but less intense
- mood disturbances & increased activity/energy
- less severe, shorter duration, & less impairment of functioning (vs manic episode)
Mixed features = current manic or hypomanic episode with sub-threshold symptoms of depression or dysthymia
- or when an episode of MDD includes sub-threshold symptoms of mania or hypomania.
What are some of the concerns or difficulties in diagnosing a child with bipolar disorder?
Can BP can be diagnosed in prepubertal children? Does it look the same in kids & adults?
- some label young children w/ unstable moods as ADHD or depression (cz less stigma)
- some use the label of BP too much, based solely on the presence of mood swings, irritability, and aggression = over-diagnosis concern
Thus, clinicians presented with identical diagnostic information vary widely in their assessment of BP in children, from 0% risk to 100% risk
What are some of the concerns with medications such as lithium in treating a child who has been diagnosed with bipolar disorder?
Lithium = common salt in nature/water Side effects of med doses of lithium can be serious, esp. in combo w/ more meds - toxicity (poisoning), - renal and thyroid problems, and - substantial weight gain
Not given to kids:
- in chaotic families
- kids unable to do multiple appointments to monitor side effects
Why do mood disorders in children frequently go undetected?
Irritability = not normally associated with depression
But some have irritable mood not feeling sad
Kids w/ depression express:
- feelings of sadness
- loss of interest/pleasure.
Symptomatic presentations of depression in preschoolers, school-aged children, preteens, and teens : differences & similarities
Kids express & experience depression diff. @ different ages :
- infant = passive and unresponsive
- preschooler = withdrawn and inhibited
- school-age child = argumentative & combative or complain of feeling sick
- teenager = feel guilt and hopelessness, sulk, or feel misunderstood.
^ Represents different stages in the developmental course of the same process.of depression
Distinguish between depression as a symptom, syndrome, and disorder
Symptom: feeling sad or miserable.
- without a serious problem, common at all ages.
Syndrome: more than a sad mood
- group of symptoms, occur together more often than by chance.
- extreme on a dimension of the number/severity of co-occurring symptoms
Sad plus:
- reduced interest/pleasure in activities
- cognitive and motivational changes
- somatic and psychomotor changes.
Disorder: 3 types (MDD, PDD, DMDD)
1. Major depressive disorder (MDD),
- 2 weeks min.
- low mood, loss of interest or pleasure,
- (plus sleep disturbances, difficulty concentrating, feelings of worthlessness),
- significant distress or impairment in functioning.
2. Persistent depressive disorder (PDD) aka Dysthymia,
- depressed/irritable mood
- fewer, less severe, symptoms
- longer-lasting symptoms (a year+)
- significant impairment in functioning.
3. Disruptive mood dysregulation disorder (DMDD),
- frequent & severe temper outbursts (extreme overreactions to the situation)
with
- chronic, persistent, irritable/angry mood present b/w severe temper outbursts.
Major depressive disorder (MDD),
- 2 weeks min.
- low mood, loss of interest or pleasure,
- (plus sleep disturbances, difficulty concentrating, feelings of worthlessness),
- significant distress or impairment in functioning.
- Persistent depressive disorder (PDD) aka
- dysthymia
- depressed/irritable mood
Vs MDD: - fewer, less severe, symptoms
- longer-lasting symptoms (a year+)
- significant impairment in functioning.
- Disruptive mood dysregulation disorder (DMDD), characterized by:
characterized by:
- frequent & severe temper outbursts (extreme overreactions to the situation)
with
- chronic, persistent, irritable/angry mood present b/w severe temper outbursts.
Reasons for the increase in depression from preschool to elementary school, and from childhood to adolescence?
- Preschool to Elementary school:
- moderate
- not biologically based
Reflection of the child’s:
- growing self-awareness and cognitive capacity
- verbal ability to report symptoms
- increased performance and social pressures.
Adolescence:
- sharp increase
- due to biological maturation at puberty
- interacting with important developmental changes
supported by:
- emergence of large sex differences in depression after puberty
- emergence of bipolar disorder & the relative stability in rates of depression through adolescence
Distinguish between major depressive disorder and dysthymic disorder.
(PDD) symptoms of depressed mood for most of the day, on most days, and persist for at least 1 year.
- unhappy or irritable most of the time. (Eeyore the donkey)
- Combined with chronic depressed (or irritable) mood
- at least two somatic (e.g., eating problems, sleep disturbances, low energy) or cognitive symptoms (e.g., lack of concentration, low self-esteem, feelings of hopelessness)
PDD symptoms = chronic, but less severe than MDD.
What role do cognitive deficits and cognitive distortions play in depression?
Children w/ depression have = thinking biases, deficits, and distortions
- they notice depression-relevant cues (sad faces) more than positive cues (happy faces)
- B/c reading emotional cues is key for successful social relationships = selective attentional biases can = adverse relationships with family members & peers
How is self-esteem related to depression in children?
- Almost all kids with depression experience negative self-esteem
- low self-esteem = symptom most specifically related to depression in adolescents
- both low self-esteem & unstable self-esteem are important in depression
- Self-esteem in children with depression is also highly reactive to daily life events, and such daily fluctuations in self-esteem appear to be related to depression following exposure to major life stresses
