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Depression in Children and Adolescents

Emotion

  • affect: how we’re feeling right now
    • intensity
      • expression: constricted, flat, expansive
      • variability: labile
    • appropriateness to context
  • mood: enduring emotional state

Facets of depression

Depression (like anxiety, anger, and other emotional states) can be thought of in different ways (and hence measured in different ways)

  • Physiological–how our body reacts when we are depressed
    • disruption of sleep
    • decreased appetite
    • fatigue
    • decreased libido
    • anhedonia
  • Behavioral–how we act when we are depressed
    • decreased reinforcement seeking behavior
    • decreased speed of responding, psychomotor retardation
    • decreased activity
  • Cognitive–how we think when we are depressed
    • impaired attention and concentration
    • impaired learning
    • difficulties with recall and memory
    • negative expectations of reinforcement
  • Phenomenology (subjective)–how we feel when we are depressed
    • negative feelings: negative affectivity; feeling down, blue
    • negative attitudes: Beck’s cognitive triad — negative views of self, world, future

Level of analysis

Depression (like anxiety, anger, and other emotional states) can be considered as

  • Depression as a symptom
    • We can attend to a specific actions, behavior, response (crying or complaining of not feeling well or not playing with favorite toys)
  • Depression as a syndrome
    • We can attend to a pattern of behaviors (symptoms) that cluster and covary together
    • A major depressive “episode” is defined as a pattern of at least 5 symptoms (with much include either depressed mood or anhedonia), which lasts for at least 2 weeks
  • Depression as a disorder
    • Mood Disorders
      • Major Depressive Disorder
      • A Major Depressive episode that persists two weeks and causes significant personal distress or functional impairment
      • Major Depression: 5 of 9 symptoms which must include either:
        • Depressed mood nearly every day for most of the day, or irritable mood in children and adolescents or
        • Anhedonia (diminished interest in or pleasure from activities)
        • plus as least three or four (for a total of at least 5) of:
          • insomnia or hypersomnia nearly every day
          • significant weight loss or gain, increase or decrease in appetite nearly every day, or failure to gain expected weight in children
          • psychomotor agitation or retardation [observed, not reported]
          • fatigue or low energy nearly every day
          • feeling worthless or excessive guilt nearly every day
          • difficulty concentrating or indecisiveness nearly every day
          • recurrent thoughts of death or suicide
        • last at least two weeks, and cause either suffering or impairment in functioning
      • Dysthymia
        • Chronic (at least 2 years in adults, 1 year in children), milder depression than Major Depressive Disorder
      • Bipolar Disorder
        • A Manic Episode that persists one week and causes either significant personal distress or functional impairment
        • Manic Episode: period of elevated, expansive, or irritable mood including 3 of 7 symptoms
      • Cyclothymia
        • Chronic (2 years in adults, 1 year in children) of mood swings, milder than Major Depression or Mania
  • Morbidity
    • suffering
    • impairment
  • Comorbidity
    • Anxiety Disorders
    • Substance Use Disorders
    • other mental disorders
  • Mortality–suicide
  • Course
  • Treatment
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