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CAM 2 > pediatric depression > Flashcards

pediatric depression Flashcards

1
Q

case reports on childhood depression date to

A

the early 17th century

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2
Q

___ in children was first reported in the mid-19th century

A

melancholia

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3
Q

the existence of depression prior to ___ was seriously doubted because ____

A

1960
it was felt that children’s immature superego would not permit the development of depression

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4
Q

in the ___ increased the awareness and acceptance of childhood depression

A

1970’s

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5
Q

psychoanalytic perspective

A
  • depression results from an intrapsychic conflict between the ego and a persecutory superego
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6
Q

psychoanalysis held that the superego ___

A

was formalized only after resolution of the Oedipus Conflict, which occurred by late adolescence

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7
Q

Thus, psychoanalytic perspective believes that children could not ___

A

experience intrapsychic conflict and could not develop mood disorders

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8
Q

what is incidence

A

number of new cases in a give ntime period
a 5% incidence means that in a given year 5% of the population is affected

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9
Q

what is prevalence

A

total number of cases in a population at any given time
a 5% prevalence means that at any given time 5% of the population is affected

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10
Q

what is ACUTE

A

an illness with a high incidence and low prevalence
common cold

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11
Q

what is CHRONIC

A

an illness with a low incidence and a high prevalence

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12
Q

12 month prevalence in the us among youth is about __

A

7%

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13
Q

generally accepted 1-year incidence is
preschool age
school age
adolescent age

A

1%
2%
4-8%

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14
Q

sex ratio of __ in childhood and __ by adolescence

A

1:1
2:1

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15
Q

lifetime prevalence of MDD among adolescents is __

A

15-20%

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16
Q

prevalence increases during adolescence, possibly due to

A

biological factors
environmental factors
psychological and cognitive factors

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17
Q

biological factors

A

sexual maturation

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18
Q

environmental factors

A

increased social and academic expectations
more change of exposure to negative events

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19
Q

psychological and cognitive factors

A

increased autonomy and abstract thinking

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20
Q

psychodynamic theory of depression

A

anger turned inward; severe superego

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21
Q

attachment theory of depression

A

insecure early attachment

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22
Q

behavioral theory of depression

A

inability to obtain reinforcement

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23
Q

cognitive theory of depression

A

depressive mindset - negative cognitions

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24
Q

self-control theory of depression

A

deficits in self-monitoring, self-evaluation, and self-reinforcement

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25
Q

interpersonal theory of depresison

A

characteristic to individual, roles and events

26
Q

socioenvironmental theory of depression

A

stressful life circumstances exacerbate vulnerabilities

27
Q

neurobiological theory of depression

A

neurochemical, endocrine, and receptor abnormalities

28
Q

children with a parent who suffered from depression as a child are up to __ more likely than controls to become depressed prior to age __

A

14x
13

29
Q

Children of parents with depression have about __ the risk of having depression

A

2-4x

30
Q

The lifetime history of MDD in mothers of children with MDD is also high, about

A

50-75%

31
Q

risk for anxiety disorders, major depression, and substance dependence were __ higher in the offspring of depressed parents

A

3x

32
Q

the time of greatest incidence was ___ y/0

A

15-20

33
Q

___ is associated with a reduction of anxiety, depressive, and disruptive disorders and symptoms in their offspring

A

effective treatment of mothers with MDD

34
Q

paternal mental health problems are independently associated with a ___ increased risk

A

33-70

35
Q

maternal mental health problems are associated with a ___ increased risk

A

50-350%

36
Q

among those with pervasive suicidal thoughts and intent, levels of the ____ are ____ in the CSF

A

major serotonin metabolite
lower

37
Q

adults with one or two copies of the _____ gene have been shown to exhibit _____

A

short allele o the 5-HT transporter gene
more depressive symptoms, diagnosable depression, and suicidality in relation to stressful life events

38
Q

____ leads to reduced transcription of the 5-HT receptor and less serotonin uptake

A

short allele

39
Q

cognitive disortions

A

such as overgeneralization, jumping to conclusions, should statements

40
Q

biogenic amine hypothesis

A

too much neurotransmitter causes mania and too little causes depression

41
Q

neuroendocrine markers

A
  • 70% of depressed adults don’t show normal suppression of cortisol secretion - alteration in stress response
  • blunting of normal growth hormone release
  • blunted production of thyroid stimulating hormone
  • depressed girls secrete more prolactin
42
Q

brain volume

A

less cortical gray matter
decreased cortical thickness

43
Q

DSM-5 criteria do not differ ___

A

for children and adolescents

44
Q

generally, children show ____ than adults

A

fewer neuro-vegetative signs

45
Q

___ may substitute for depressed mood

A

irritability

46
Q

diagnosis

A
  1. 5 of 9 symptoms for the diagnosis
  2. at least one symptom is either depressed mood or anhedonia
  3. at least two straight weeks
  4. not better accounted for by another illness
47
Q

neuro-vegetative signs

A
  1. decrease in appetite
  2. insomnia or hypersomnia
  3. fatigue or loss of energy
  4. diminished ability to think or concentrate or indecisiveness
    these are generally the first to improve with medication treatment
    are also targets of CBT
48
Q

developmetnal variants of MDD - children

A
  1. more symptoms of anxiety and auditory hallucinations, somatic complaints
  2. expressed as temper tantrums and behavior prob
  3. fewer delusions and serious suicide attempts
49
Q

developmental variants of MDD - adolescents

A
  1. more cognitive components
  2. guilt and hopelessness
  3. more sleep and appetite disturbances, suicidal ideation and attempts
  4. compared to adults, still more behavior problems and fewer neuro-vegetative difficulties
50
Q

clinical variants of MDD

A

unipolar
psychotic
bipolar
atypical
seasonal affective disorder
subclinical or subsyndromal depression
treatment-resistant

51
Q

relapse

A

an episode of MDD during a period of remission
40-60% of youth with MDD experience relapse after successful treatment of acute episode

52
Q

predictors of relapse

A

natural course of MDD
lack of compliance
negative life events
rapid decrease or discontinuation of therapeutic treatment

53
Q

recurrence

A

is the emergence of MDD symptoms during a period of recovery - asymptomatic period of more than 2 months

54
Q

predictors of recurrence

A

earlier age at onset
increased number of prior episodes
severity of initial episode
psychosis
psychosocial stressors
dysthymia and other comorbidities
treatment noncompliance

55
Q

risk of bipolar disorder

A

20-40% of depressed children and adolescents develop bipolar disorder within 5 yrs of index episode of MDD

56
Q

predictors of bipolar I disorder onset

A

early onset MDD
psychomotor retardation
psychotic features
family history of bipolar disorder
family history of psychotic depression
heavy familial loading for mood disorders
pharmacologically induced hypomania

57
Q

suicide risk factors

A

prior history of suicide attempts or threats
male sex for completion not attempts
over 15 yrs of age
being single or living alone
having prominent feelings of hopelessness
BPD
LGBT younger age in particular

58
Q

suicide crisis syndrome

A

75% of people don’t express si in the month prior to an sa
- frantic hoplessness and entrapment
- affective dyscontrol
- loss of congitive control
- overarounsal

59
Q

child suicide rates

A

suicide bef adolescence is very rare
almost always more common among whites than other races in the US

60
Q

implicit bias

A

10th leading cause of death in the US
2nd leading cause among adolescents

CAM 2 (4 decks)

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