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Child Psychopath
Final Exam: Affective Disorders
| Question | Answer |
|---|---|
| Mood: History | limited research: {early on thought not possible in children, "masked" form only, "normal" or transitory stage], DSM-IV maintains use of adult criteria although age-specific features |
| Mood Disorders: DSM-IV | Major Depressive Disorder (single episode or recurrent), Dysthymic Disorder, Depressive Disorder NOS, Bipolar I, Bipolar II, Cyclothymia, Bipolar NOS, mood disorder due to a GMC |
| Mood Disorders: DSM-5 - new categories/listings for depressive and bipolar | depressive d/o (new category), disruptive mood dysregulation d/o (controversial), Bipolar and related d/o (new category) |
| Mood Disorders: DSM-5 - new categories/listings for mood and substance | depressive d/o associated with another medical condition, bipolar d/o associated with anther medical condition, substance-induced depressive d/o, substance-induced bipolar d/o |
| DSM-IV Major Depressive Episode (not codeable disorder): Criterion A: 5+ during same 2-week period, change in functioning (depressed mood or loss of interest/pleasure): | depressed mood (child/adol = irritable), diminished interest/pleasure, sig weight loss or dec/inc in appetite, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue, worthlessness/guilt, diminished ability to think, recurrent thoughts of death |
| Major Depressive Episode DSM-5 proposed changes | elimination of bereavement exclusion criteria, addition of mixed features specifier for depressive episodes (and mania, hypomania), elimination of chronic specifier for MDD |
| DSM-IV Dysthymic Disorder: Criterion A (specify early onset, late onset, or with atypical features) | depressed mood most of the day, more days than not, for at least 2 years (in children/adolescents, mood can be irritable and duration at least 1 year) |
| DSM-IV Dysthymic Disorder: Criterion B: (presence while depressed, of 2+) | poor appetite or overeating, insomnia or hyposomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness |
| DSM IV Dysthymic Disorder: Criterion C | in past 2 years (1 year for children/adol) never without symptoms > 2 months |
| DSM 5 Dysthymic Disorder | no MDE present during the first 2 years (1 yr for children/adol), over last 2 yrs @least 1 period of 2 months full crteria for MDE not met, never been manic, mixed, or hypomanic episode nor cyclothymic d/o |
| DSM-IV Major Depressive Episode (not codeable disorder): Criterion B | do not meet criteria for mixed episode |
| DSM-IV Major Depressive Episode (not codeable disorder): Criterion C | clinically significant distress or impairment in social, occupational, or other important areas of functioning |
| DSM-IV Major Depressive Episode (not codeable disorder): Criterion D | not due to a substance or GMC |
| DSM IV Dysthymic Disorder: Criterion E | there has never been a manic, mixed, or hypomanic episode and criteria have never been meet for cyclothymic d/o |
| DSM IV Dysthymic Disorder: Criterion F | not occur exclusively during course of a chronic psychotic disorder |
| DSM IV Dysthymic Disorder: Criterion G | not due to a substance of a GMC |
| DSM IV Dysthymic Disorder: Criterion H | clinically significant distress or impairment in social, occupational, or other important areas of functioning |
| DSM-IV criteria for severity/specifiers for mood: Mild | few, if any, symptoms in excess of those required to make the diagnosis; minor impairment |
| DSM-IV criteria for severity/specifiers for mood:moderate | symptoms or functional impairment between "mild" and "severe" |
| DSM-IV criteria for severity/specifiers for mood: severe without psychotic features | several symptoms in excess of those required, and symptoms markedly interfere with functioning |
| DSM-IV criteria for severity/specifiers for mood: severe with psychotic features: delusions or hallucinations | mood-congruent psychotic features, mood incongruent psychotic features |
| DSM-IV criteria for severity/specifiers for mood: in partial remission | symptoms of MDE are present but full criteria are not met, or < 2 months without sig symptoms following an MDE |
| DSM-IV criteria for severity/specifiers for mood: in full remission | during the past 2 months, no sig symptoms |
| Epidemiology of Depression | prevalence (.4 - 7.8%, ages 4-18, 15% w/ initial MDE develop bipolar, <1% prek, 2-3% child (6-11), 6-8% adol, <12 M = F, >12 F > M, social class: mixed but associated with lower SES |
| Depression: presentation varies by age | younger (somatic complaints, apathy, disinterest, irritability; appear depressed) older (more sleep prob, inc cog symptoms, dec depressed appearances and somatic symptoms) |
| Depression: infants/toddlers (0-2) symptoms: no prevalence | lethargy, feeding/sleep problems, irritability, sad/flat affect, dec affective responsitivity/curiosity, inc frowning |
| Depression: preschoolers (3-5): prevalence <1% | anger/irritability, sad facial expression, labile mood, somatic complaints, feed/sleep issues, lethargy, excessive crying, over/under activity, dec socialization, tantrums, separation anxiety, anhedonia |
| Depression: middle childhood (6-11), prevalence 2-3%, male = female or male > female: early years (6-8) | prolonged unhappiness, dec socialization, sleep problems, irritability, lethargy, poor school perf, accident proneness, phobias, separation anxiety, attn seeking b |
| Depression: middle childhood (6-11), prevalence 2-3%, male = female or male > female: later years (9-12) | verbalize low self-esteem/helplessness, irritability, depressed mood, sad expression, agg, lethargy, guilt, poor school perf, phobias and separation anxiety (may see: suicidal ideation, hallucinations, self-destructive bx) |
| Depression: adolescence (12-18), prevalence 6-8%, Female > Male | somatic complaints, social withdrawal, hopelessness, irritability, concern about future/pessimism, worthlessness, apathy, more lethal suicide attempts, substance abuse, eating d/o, antisocial bx |
| Depression: developmental course | earlier onset more severe (14.3 yrs - depression; 11.3 yrs - dysthymia); duration of MDE 16-36 weeks; course: majority recover w/in year, 21% stay depressed, recurrence common |
| Depression: environmental risk factors | low parental education, economic hardship, stress, family problems, racial discrimination, lack of opportunity, maternal depression, exposure to an aversive environment |
| Depression: associated features | hallucinations (typically auditory), social withdrawal, anxiety, oppositional/conduct, somatic complaints, negative body image, suicidal thoughts and attempts |
| Depression: Comorbid D/O | anxiety and disruptive behavior d/o most common (anxiety (30-75%), CD (17-79%), ODD (0-50%), ADHD (0-57%)), substance abuse disorders (23-25%) |
| Depression: etiology in children: biological models | genetic (family aggregation; 30-35% heritability), neurochemical (HPA axis, serotonin and other NTs, low growth hormone), neuroanatomic (frontal lobe and limbic system, but little research) |
| Depression: etiology in children: psychological models | behavioral model of depression (Lewinsohn 1974; low rate of response-contingent reinforcement and feelings of dysphoria); interpersonal theory (Coyne, 1976; transactional model focusing on social interactions) |
| Depression: etiology in children: cognitive models (Beck and Rehm) | cognitive (Beck, 1967; activation of depressive self-schemas leads to cog distortions and depression); self-control theory (Rehm, 1977; deficits in ability to self-evaluate, self-monitor, and self-reinforce in response to stress) |
| Depression: etiology in children: cognitive models: Seligman | theory of learned helplessness (Seligman, 1975; uncontrollable and aversive events result in beliefs of being unable to control aversive experiences) - attributional theory -hopelessness theory of depression (Abramson, 1989) |
| Depression: etiology in children: cognitive models: attributional theory | negative events to internal, stable, and global factors; positive events to external, unstable, and specific factors |
| Depression: etiology in children: cognitive models: Abramson 1989 | hopelessness theory of depression - attributional style is moderator of negative life events and hopelessness; hopelessness leads to depression |
| Depression: etiology in children: family models: parent-child relationships, contextual family variables (2 0f 3) | parent-child relationships (depressed mothers' neg affect & low task involvment predict child's depression), contextual family variables (higher family criticism, emotional overinvolvement & family stressors) |
| Depression: etiology in children: family models: Bowlby, 1981 (3 of 3) | Attachment theory (Bowlby 1981; insecure attachmt & faulty "internal working models" of relationships) |
| Disruptive Mood Dysregulation Disorder (aka Temper Dysregulation Disorder with Dysphoria) - new DSM-5: Criterion A | disorder characterized by severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to situation |
| Disruptive Mood Dysregulation Disorder (aka Temper Dysregulation Disorder with Dysphoria) - new DSM-5: Criterion B | frequency: temper outbursts occur, on average, 3+ x/week |
| Disruptive Mood Dysregulation Disorder (aka Temper Dysregulation Disorder with Dysphoria) - new DSM-5: Criterion C | mood btwn temper outbursts: persistently irritable or angry (observable by others) |
| Disruptive Mood Dysregulation Disorder (aka Temper Dysregulation Disorder with Dysphoria) - new DSM-5: Criterion D + E | duration: Criteria A-C present for 12 or more months during which person has not had 3+ months w/o symptoms of criteria A-C; criterion A or C present in 2+ settings (must be severe in atleast 1 setting) |
| Disruptive Mood Dysregulation Disorder (aka Temper Dysregulation Disorder with Dysphoria) - new DSM-5: Criterion F-G | diagnosis should not be made for first time < age 6 or > age 18; onsent of criteria A thru E is < age 10 yrs |
| Disruptive Mood Dysregulation Disorder (aka Temper Dysregulation Disorder with Dysphoria) - new DSM-5: Criterion H | never been distinct period lasting > one day where abnormally elevated or expansive mood present most of day, and abnormally elevated/expansive mood accompanied by onset or worsening of 3 of B criteria of mania |
| Disruptive Mood Dysregulation Disorder (aka Temper Dysregulation Disorder with Dysphoria) - new DSM-5: Criterion I | bx do not occur exclusively during episode of MDD and not better accounted for by another mental disorder (diagnosis cannot co-exist w/ ODD or Bipolar, but can with ADHD, CD and substance use, if meet ODD and DMDD -DMDD trumps) |
| DSM-IV Manic Episode: Criterion A | 1+ week of abnormally and persistently elevated, expansive, or irritable mood (or any duration if hospitalized) |
| DSM-IV Manic Episode: Criterion B: 3+ symptoms (4 if mood is only irritable): | inflated self-esteem/grandiosity, dec need sleep, rapid pressured speech, flight of ideas/racing thoughts, distractibility, inc goal-directed activity/psychomotor agitation, excessive involvmt pleasureable activities w/ high potential for painful conseq |
| DSM-IV Hypomanic Episode: Criterion A | distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly differnt from usual non-depressed mood |
| DSM-IV Hypomanic Episode: Criterion B: 3+ symptoms have persisted (4 if only irritable mood) | inflated self-esteem/grandiosity, dec need sleep, more talkative/pressure to keep talking, flight of ideas, distractibility, inc goal-directed activity, excessive involvemt in pleasureable activites w/ high potential for painful conseq. |
| DSM-IV Hypomanic Episode: Criterion C | episode is associated w/ unequivocal change in functioning that is uncharacteristic of person when not symptomatic |
| DSM-IV Hypomanic Episode: Criterion D | disturbance in mood and change in functioning are observable by others |
| DSM-IV Hypomanic Episode: Criterion E | episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are not psychotic features |
| DSM-IV Hypomanic Episode: Criterion F | symptoms are not due to direct physiological effects of a substance or a GMC |
| DSM-IV Mixed Episode: Criterion A | 1+ week of a manic episode and major depressive episode nearly every day |
| DSM-IV Mixed Episode: Criterion B and C | marked impairment in social or occupational functioning, hospitalization, or psychotic features; not due to substance or GMC |
| DSM-IV Mixed Episode: DSM-5 change | considering removal and replacing with a "with mixed features" specifier |
| DSM-IV Bipolar Disorders: list | bipolar I, bipolar II, cyclothymia, bipolar NOS |
| DSM-IV Bipolar Disorders: bipolar I | mixed or manic episodes; may include hypomanic and depressive episodes |
| DSM-IV Bipolar Disorders: Bipolar II | hypomanic episodes and depressive episodes (never full manic or mixed) |
| DSM-IV Bipolar Disorders: Cyclothymia | hypomanic symptoms and subclinical depressive symptoms (2 years +) |
| DSM-IV Bipolar Disorders: Bipolar, NOS | atypical presentation with significant impairment |
| DSM-IV Cyclothymic Disorder: Criteria A | 2 years + (1 yr for child/adol); numerious periods with hypomanic symptoms and depressive symptoms that do not meet criteria for an MDE |
| DSM-IV Cyclothymic Disorder: Criteria B | during that period, not without symptoms for more than 2 months |
| DSM-IV Cyclothymic Disorder: Criteria C | no MDE, Manic, or Mixed Episode present during first 2 yrs (1 yr child/adol) |
| DSM-IV Cyclothymic Disorder: Criteria D and E | not better accounted for by psychotic disorder; not due to substance or GMC |
| DSM-IV Cyclothymic Disorder: Criteria F | clinically significant distress or impairment in social, occupational, or other important areas of funcitoning |
| DSM-IV severity/specifiers for Manic: mild | minimum symptom criteria are met for a manic episode |
| DSM-IV severity/specifiers for Manic: moderate | extreme increase in activity or impairment in judgement |
| DSM-IV severity/specifiers for Manic: severe w/o psychotic features | almost continual supervision required to prevent physical harm to self or others |
| DSM-IV severity/specifiers for Manic: severe w/ psychotic features: delusions or hallucinations | mood congruent psychotic features; mood incongruent psychotic features |
| DSM-IV severity/specifiers for Manic: in partial remission | symptoms of a Manic Episode are present but full criteria are not met, or period w/o sig symptoms of a Manic Episode lasting < 2 months following end of Manic Episode |
| DSM-IV severity/specifiers for Manic: in full remission | during past 2 months no significant signs or symptoms were present |
| Reasons why more children are being diagnosed with bipolar disorder | professional recognition (early ident may lead to more benign course); inc research; misidentification may worsen but controversial (stimulants/antidepressants); media interest in disorder |
| Bipolar differs across age range: Adolescent onsent | most similar to adults; presentation (acute-onset mania, may inc psychotic features), course (chronic, but distinct episodes of depression and mania (clear onset/offset), with well intervals) |
| Bipolar differs across age range: childhood onset | initial episode (often depressed); nonepisodic/chronic (exacerbated mood states continuous or long); higher rate of "mixed" episodes; rapid cycling (few hours to a few days) |
| Bipolar: childhood onset: may lack | acute onset; periods of normal functioning; distinct episodes of elevated mood/irritability; classic adult symptoms (euphoria) |
| Bipolar: childhood onset: rather (have) | ongoing continuous mood disturbance w/ mix of mania and depression; may be episodic but long episodes and more Mixed than classic Mania; "classic" presentation does occur in prepubertal children but may be rare |
| Controversies in Child-Onset Bipolar | is severe, non-episodic irritability a developmental presentation of mania? how early can it be accurately diagnosed? can it be reliably distinguished from ADHD/ODD? |
| DSM-5 Bipolar (proposed changes) | create separate Depressive and Bipolar categories; add inc energy as required symptom of mania/hypomania; remove Mixed episode, add Mixed Features specifier; add Disruptive Mood Dysregulation Disorder |
| Justification for adding DMDD to DSM-5 | to address inc rates of children diagnosed with bipolar; parents of youth with BD more likel to have BD than parents of youth with SMD; evidence for differences in brain function btwn SMD and BD; BD equal rates in gender, SMD more common in boys |
| Bipolar Differential Diagnosis | ADHD (heightened energy/activity levles/restelessness/hyperactivity, pressured speech, distractibility, impulsivity), ODD, CD, sexual abuse, language d/o, medical d/o, schizophrenia (older adol), substance abuse (older adol) |
| Bipolar Comorbidity | ADHD (90% children, 30% adol), separation anxiety (child), ODD, CD (22% child, 18% adol), substance use d/o (adol), eating d/o (adol), anxiety (33% child, 12% adol) |
| Etiology of Bipolar: Biological (gemetic) | considered biggest influence but no twin or adoption studies |
| Etiology of Bipolar: Biological (family aggregation) | inc risk of bipolar d/o, affective d/o, and other psychopathology in children of bipolar parents, youths w/ BP parents have > double risk of mood d/o and greater risk of BP; lifetime rates of 10%; greater familial loading assoc w/ onset and severity |
| Etiology of Bipolar: Biological (Imaging studies - increasing) | inc ventricular size, dec thalamic size, dec intracranial vol, elevated glutamate frontal lobes/basal ganglia, not clearly differentiate schizo; mixed - dec amygdala volume (youth), enlarged (adults); FMRI - dif in emotion regulation/recognition tasks |
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ironchiet
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