Week 10 Depression

Question 1

Unipolar disorders are characterized by _______ and _________.

Answer 1

dysphoria

anhedonia

Question 2

What is dysphoria?

Answer 2

a state of prolonged bouts of sadness

Question 3

What is anhedonia?

Answer 3

Feeling little joy in anything one does and lose interest in nearly all activities

Question 4

What does irritability refer to?

Answer 4

easy annoyance and touchiness, characterized by an angry mood and anger outbursts

Question 5

According to the DSM-5, what are the features of MDD?

Answer 5

At least one of the symptoms is either depressed mood or loss of interest or pleasure

1) Depressed mood
2) Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day.
3) Significant weight loss when not dieting or weight gain
4) Insomnia or hypersomnia
5) Fatigue or loss of energy nearly everyday
6) Feelings of worthlessness
7) Diminished ability to think or concentrate or indecisiveness nearly every day
8) Recurrent thoughts of death/suicidal ideation

Question 6

How long must symptoms of MDD last for to qualify for a diagnosis of it?

Answer 6

2 weeks

Question 7

Which feature of depression is more common in children and adolescents than in adults?

Answer 7

irritable mood

Question 8

Why do depressive episodes re-occur and why does the length of time between episodes get progressively shorter?

think of stress sensitization

Answer 8

the first episode might sensitize the child to future episodes.

the first episode might be linked to a specific stressor and is accompanied by lasting changes in biological processes that heighten future reactivity to stress

the initially externally produced changes in the brain can be conditioned so that following the first depressive episode, individuals are increasingly vulnerable to stress, and even non-severe stress or minor events that resemble less or stress experiences may result in depression –> stress sensitization

Question 9

Are there any sex differences in how one would express depression?

Answer 9

boys - aggression
girls - sadness, slightly more girls report symptoms related to weight and appetite disturbances and feelings of worthlessness and guilt

but otherwise symptom presentation is around the same

Question 10

Why are females at a disadvantage during adolescence when it comes to developing depression?

Answer 10

hormonal changes in estrogen

greater orientation towards cooperation and sociality

ruminative coping styles to deal with stress

Question 11

What is dysthymia characterized by?

Answer 11

poor emotion regulation, which includes constant feelings of sadness, feelings of being unloved, and forlorn, self-deprecation, low self-esteem, anxiety, anger, and temper tantrums

Question 12

When does PDD occur?

Answer 12

P-DD develops about 3 years earlier than MDD, most commonly about 11 - 12 years of age

Question 13

What is DMDD characterized by?

Answer 13

1. Frequent verbal or physical temper outbursts

2. A chronic, persistently irritable or angry mood

Question 14

When is the onset of DMDD?

Answer 14

prior to age 10 years

Question 15

What are some associated characteristics of DMDD?

Answer 15

Reduced intellectual and academic functioning 
Cognitive biases and distortions 
Negative self-esteem 
Social and peer problems 
Family Problems 
Suicide

Question 16

How do cognitive biases and distortions put adolescents at a higher risk of depression?

Answer 16

1. commonly notice depression relevant cues
2. differential attention to negative emotional distractors

might contribute to adverse relationships with peers and fam

3. Might devalue own performance –> internal attribution to shit but external attribution to legit good shit

Negative thinking, faulty generalizations, sees no hope of gaining pleasure or satisfaction

4. think that no one can help them out of their misery

Question 17

What does psychodynamic theory propose about depression?

Answer 17

Depression is the conversion of aggressive instinct into depressive affect

Depression is presumed to have resulted from the loss of a love object, whether perceived or real.

Question 18

Is the psychodynamic theory supported? Why?

Answer 18

Not really.

Expected:
• The individual’s subsequent rage towards the love object is then turned against the self.
• Since children and adolescents were believed to have inadequate development of the superego or conscience, the hostility directed against internalized love objects that have disappointed or abandoned them does not produce guilt, so they do not become depressed

Actual:
• However, more recent studies have found that high levels of maladaptive guilt and shame are related to the onset of depression in children as young as 3 - 5 years of age.
• The fact that depression does occur in many youths who do not experience loss or rejection and doesn’t occur in many children who casts doubt on the psychodynamic model
Contrary to this theory, many children do experience clinical depression

Question 19

What does attachment theory propose about depression?

Answer 19

Parental separation and disruption of an attachment bond –> insecure attachment cos needs are always not met –> build faulty IWM –> place child at risk of depression in the context of stressful interpersonal relationships

Attachment relationships might also serve to regulate bio and behavioral systems related to emotion

Question 20

What does behavioral theory propose about depression?

Answer 20

Emphasizes the importance of learning, environmental consequences and skills and deficits during the onset and maintenance of depression.

Depression is related to a lack of response-contingent positive reinforcement

Question 21

Why is there a lack of response-contingent positive reinforcement?

Answer 21

○ A youth may be unable to experience available reinforcement, often because of interfering anxiety.
○ Changes in the environment, such as the loss of a significant person in the child’s life, may result in a lack of availability of rewards
A youth may lack the skills needed to have rewarding and satisfying relationships

Question 22

What do cognitive theories postulate about depression?

Answer 22

focuses on the relation between negative thinking and mood

underlying assumptions is that how young people view themselves and their world will influence their mood and behavior and that cognitive vulnerabilities interact with negative events to increase depressive symptoms

Question 23

What does the hopelessness theory propose about depression?

Answer 23

Depression-prone individuals tend to make internal, stable, global attributions to explain the causes of negative events.

Question 24

What does Beck’s Cognitive Model propose about depression?

Answer 24

depressed individuals make negative interpretations about life events because they use biased and negative beliefs and interpretative filters for understanding these events

Question 25

List 3 ways in which depressed individuals have negative interpretations about life

Answer 25

1. They display information-processing biases or errors in their thinking in specific situations, called negative automatic thoughts. 2. Depression is believed to be associated with a negative outlook in the following 3 areas: negative views about oneself, the world and the future 3. Depressed youths have negative cognitive schemata that are rigid and resistant to change X biases X outlook X schemata

Question 26

What do family and twin studies suggest about depression?

Answer 26

Vulnerability to negative affect may be inherited and that certain environmental stressors may be required for these vulnerabilities to result in depression.

Question 27

What genes are linked to depression?

Answer 27

serotonin transporter genes | brain-derived neurotrophic factor gene (BDNF gene)

Question 28

Brain scan studies of youths with depression have identified multiple alterations in the structure and function of a) b) What do these result in?

Answer 28

medial prefrontal networks of the brain - anterior cingulate cortex, ventromedial and orbitofrontal cortex related subcortical regions - amygdala and ventral striatum Disrupts the processing of and regulation of responses to emotionally and motivationally salient stimuli and events

Question 29

In response to _____________, activity in parts of the brain's reward network

Answer 29

reward anticipation

Question 30

What is lowered reward system activity associated with? a) low mood b) anhedonia

Answer 30

b - anhedonia

Question 31

What findings might suggest a possible biological vulnerability for the development of internalizing problems? hint: cortical layer, volume

Answer 31

1. cortical thinning of right hemisphere - might produce disturbances in arousal, attention and memory for social stimuli that predispose the individual to developing a depressive disorder 2. amygdala, hippocampus and thalamus have been found to have smaller volumes in adols and adults with depressive disorders.

Question 32

In general, brain activity in youths is less active than normal in regions of the brain associated with with 3 areas?

Answer 32

attention executive function sensory processes

Question 33

Brain activity in youths is more active in regions involved in?

Answer 33

recognizing and regulating emotions mediating stress responses learning and recalling emotion-arousing memories

Question 34

How do a child's depressive symptoms perpetuate his disorder?

Answer 34

• Families of children with depression display more critical and punitive behavior toward their depressed child than toward other children in the family • These families display more anger and conflict, greater use of control, poorer communication, more overinvolvement and less warmth and support • They often experience high levels of stress, disorganization, marital discord and a lack of social support • Youths with depression describe their families as less cohesive and more disengaged than do youths without depression. • Strong link between childhood depression and family dysfunction: ○ Less support and more conflict in the family were associated with more depressive symptoms in adolescents both concurrently and prospectively over a one-year period ○ In contrast, more depressive symptoms did not predict a worsening of family relationships over the same time period Thus, family problems precede and may be directly related to the development of depressive symptoms

Question 35

How does a parent's depression influence their child's depression?

Answer 35

Depression interferes with a parent's ability to meet the basic physical and emotional needs of a child, including feeding, bedtime routines, medical care and safety practices • Mothers who suffer from depression also create a child-rearing environment teeming with negative mood, irritability, helplessness, less emotional flexibility and unpredictable displays of affection. • When their children display negative emotions and distress, mothers with a history of depression are less likely to respond supportively with comfort, empathy or assistance are more likely to disapprove, dismiss, punish or ignore their child's negative emotions. • Depressed mothers also display less energy in stimulating play, less consistent discipline, less involvement, poor communication, lack of affection, and more criticism and resentment of their children than mothers without depression • High levels of marital conflict, family discord and stress may also be present in the home when a parent is depressed • Critically, this type of negative family environment in combination with a child's genetic predispositions can adversely affect the development of stress regulatory systems and predispose the child to a lifetime of depressive illness and other negative health outcomes

Question 36

What does behavior therapy target and propose?

Answer 36

• Behavior therapy maintains that depression results from and is sustained by a lack of reinforcement due to a restricted range of potential reinforcers, few available reinforcers or inadequate skills for obtaining rewards. ○ Consequently, the treatment focuses on increasing pleasurable activities and events and providing the youth with the skills needed to obtain more reinforcement ○ Interventions, such as social skills training, teach children assertiveness, communication, how to accept and give feedback, social problem solving, and conflict resolution skills in order to increase positive social interactions Strategies such as daily monitoring, structuring activities, and scheduling activities are used to help youths with depression become more active, engage in rewarding experiences and solve problems

Question 37

What does cognitive therapy target and propose?

Answer 37

• Cognitive therapy teaches youths with depression to identify, challenge and modify negative thought processes such as misattributions, negative self-monitoring, short-term focus, excessively high performance standards and a failure to self-reinforce ○ They are taught to identify and eliminate negative thoughts and taught to replace them with positive thoughts ○ When youths are presented with specific situations and examples of irrational negative thinking, they are taught to substitute alternative logical explanations that are more positive.