Chapter 7 Mood Disorders TRUE OR FALSE 1. The classical, or orthodox, psychoanalytic perspective suggested that depression was a phenomenon where the superego acts as a “punisher” to the ego. Answer: True 2. Depression in childhood has long been viewed as similar to adult depression. Answer: False 3. The classical psychoanalytic perspective suggested that children could not experience depression. Answer: True 4. The concept of masked depression posits that sad mood is often not present in children and adolescents. Answer: True 5. In the DSM-IV, depression and mania are described in the category of Mood Disorders. Answer: True 6. The term bipolar refers to depression where one pole is mild and the other pole is severe. Answer: False 7. In the DSM-IV description of mood episodes, a mixed episode refers to an episode containing a mixture of depression and anxiety symptoms. Answer: False 8. Mania is described as a period of abnormally elevated (or irritable) mood characterized by features such as inflated self-esteem, high rates of activity, speech, and thinking. Answer: True 9. Hypomania is a more severe form of mania. Answer: False 10. According to the research by Kazdin (1989), diagnosing depression in young people can be impacted by the criterion or assessment device used and the informant. Answer: True 11. When diagnosing a depressive episode, irritability can be substituted for depressed mood in children and adolescents. Answer: True 12. Double depression means that a person has dysthymia and major depression. Answer: True 13. Many youngsters who exhibit depressive symptoms, but fall short of meeting the diagnostic criteria for a depressive disorder, may still exhibit impairment in their everyday functioning. Answer: True 14. Bipolar disorder is the most frequently diagnosed mood disorder among children and adolescents. Answer: False 15. Reported prevalence rates probably over estimate depression in youth. Answer: False 16. Research indicates that 40 to 70% of youth diagnosed with major depressive disorder have a co-occurring disorder. Answer: True 17. Gender differences in major depressive disorders probably emerge between the ages of 12 and 14. Answer: True 18. Lower socioeconomic (SES) status is associated with lower rates of depression. Answer: False 19. Given cognitive, language, and other developmental differences, it is unlikely that depressive behavior in children will be similar to those of adults. Answer: True 20. Studies indicate that relapse or re-occurrence of depressive episodes is common in youth. Answer: True 21. Genetic influences are generally thought not to play a role in depression. Answer: False 22. A common psychological explanation of childhood depression is that depression derives from separation or loss. Answer: True 23. The term anaclitic depression refers to the cognitive components of depression. Answer: False 24. Youth with high negative affect and low positive affect who experience parental warmth will still develop depression. Answer: False 25. Numerous studies have found that youngsters from homes with a depressed parent are at no greater risk for developing a psychological disorder. Answer: False 26. Frank and Joe in the case study from the textbook both came from homes where a parent experienced depression. According to this case study, parental depression is debilitating to the child regardless of the environment. Answer: False 27. Peer status has been found to be associated with adjustment difficulties, including depression. Answer: True 28. Self-report instruments are the most common measures of depression. Answer: True 29. Research indicates that there are low levels of correlation between parent and child reports of measures of depression. Answer: True 30. Antidepressant medications have been principally developed and marketed for American youth. Answer: False 31. Tricyclic antidepressants such as imipramine are the medications most likely to be recommended for the treatment of depression in children. Answer: False 32. The Treatment of Adolescent Depression Study found that rates of remission for depression were high. Answer: False 33. The Treatment of Resistant Depression in Adolescents Study supports previous research findings that cognitive behavioral therapy plus medication is superior to medication alone. Answer: True 34. Current research indicates that universal prevention programs for depression are highly effective. Answer: False 35. Mania may be expressed as irritability in children and adolescents. Answer: True 36. Recent data indicates that the rate of bipolar disorder is increasing in young people. Answer: True 37. The heritability estimate of bipolar disorder hovers around 50 percent. Answer: False 38. The primary treatment for bipolar disorder is pharmacotherapy. Answer: True 39. The majority of depressed youngsters do not attempt or commit suicide. Answer: True 40. Suicide among younger children is occurring at a lower rate than two decades ago. Answer: False 41. Research indicates that as many as 25% of adolescents engage in non-suicidal self-injury. Answer: True 42. A family history of suicidal behavior increases suicide risk. Answer: True 43. Suicide prevention programs have proven to be quite successful. Answer: False MULTIPLE CHOICE 44. The distinction between depression as a symptom and as a syndrome is A. a distinction between a negative mood state compared to the negative mood state plus certain other problems that lead to impaired functioning. B. depression as a symptom of some other disorder compared to depression as a separate disorder. C. depression as a disorder that occurs by itself compared to depression as a disorder that occurs along with other disorders (e.g., anxiety disorders). D. a distinction between depression as manifested in young children compared to depression as manifested in adolescents. Answer: A 45. The book reports a study by Kazdin where youth were designated as depressed or non-depressed using three methods (DSM interview, parent CDI or child CDI). On the self-report CDI, how did the depressed and non-depressed groups differ? A. The depressed group was more hopeless. B. The non depressed group had lower self-esteem. C. The depressed group made external attributions about negative events. D. The non depressed group believed that change was controlled by external factors rather than themselves. Answer: A 46. _________ is the primary DSM diagnostic category for depression in youngsters. A. Major depressive episode B. Major depressive disorder C. Child and adolescent depressive disorder D. Primary depressive disorder Answer: B 47. In diagnosing a major depressive episode in a child, DSM-IV requires that one of the symptoms present must be A. depressed (or irritable) mood or sleep problems. B. depressed (or irritable) mood or loss of interest/pleasure. C. sleep problems or feelings of worthlessness (or guilt). D. changes in weight (or appetite) or thoughts of death. Answer: B 48. Tommy exhibits symptoms of irritable mood, poor appetite, disturbed sleep, low energy, difficulty concentrating, and feelings of worthlessness. These symptoms are fairly severe and have been present for about one month. They are interfering with Tommy’s functioning at school and with his peers. Tommy would most likely receive a DSM-IV diagnosis of A. masked depression. B. bipolar disorder. C. major depressive disorder. D. dysthymic disorder. Answer: C 49. Jada exhibits symptoms of irritable mood, poor appetite, disturbed sleep, low energy, difficulty concentrating, and low self-esteem. These symptoms are not very severe but have been present for about one year. They are interfering with Jada’s functioning at school and with her peers. Jada would most likely receive a DSM-IV diagnosis of A. immature depression. B. bipolar disorder. C. major depressive disorder. D. dysthymic disorder. Answer: D 50. Which of the following statements regarding empirically derived syndromes and depression is accurate? A. None of the empirically defined syndromes of the Achenbach measures includes depressive symptoms (behaviors). B. A separate syndrome of depression has emerged in the Achenbach measures. C. A syndrome of mixed anxiety and depression symptoms (behaviors) has emerged in the Achenbach measures. D. The empirical approach has identified a separate category for childhood depression. Answer: C 51. The most prevalent form of affective disorder among children and adolescents is A. bipolar disorder. B. cyclothymia. C. dysthymia. D. major depressive disorder. Answer: D 52. Among youngsters with unipolar disorders, about _________ experience major depressive disorder. A. 1 percent B. 10 percent C. 30 percent D. 80 percent Answer: D 53. In the Oregon Adolescent Depression Project, Lewinsohn and his colleagues found that by age 19 approximately _________ of adolescents had experienced an episode of major depressive disorder. A. 2 percent B. 12 percent C. 28 percent D. 56 percent Answer: C 54. Which of the following statements regarding the relationship of age and gender to the usual findings regarding the prevalence of depression is correct? A. There are no gender differences in children (ages 6-12) or in adolescents. B. There are no gender differences in children (ages 6-12), but in adolescence, depression is more common in boys. C. There are no gender differences in children (ages 6-12), but in adolescence, depression is more common in girls. D. Depression is more common in girls in both age groups. Answer: C 55. In a study by Kistner et al. (2007), A. European American girls reported the highest rate of depressive symptoms. B. African American girls reported the highest rate of depressive symptoms. C. European American boys reported the highest rate of depressive symptoms. D. African American boys reported the highest rate of depressive symptoms. Answer: D 56. Depression with onset in _________ is most similar to adult forms of the disorder. A. preschool B. early school age C. preadolescence D. later adolescence Answer: D 57. In the text the case study of Amy, the preschooler with depression, highlights which of the following symptoms? A. Somatic symptoms and regression in toilet training B. Aggression C. Statements about wanting to die D. Disorganized attachment Answer: A 58. Regarding the duration of episodes of major depressive disorder among adolescents, it is probably the case that A. the median duration of an episode is 2 weeks among community samples, and about twice as long for clinical samples. B. the median duration of an episode is 2 weeks among community samples, and about the same length in clinical samples. C. the median duration of an episode is 8 weeks among community samples, and over three times as long in clinical samples. D. the median duration of an episode is 8 weeks among community samples, and about the same length in clinical samples. Answer: C 59. When the role of hormones in depression is discussed, the discussion concerns hormones such as A. prolactin. B. norepinephrine. C. imipramine. D. monoamine oxidase. Answer: B 60. _________ includes qualities such as the tendency to experience negative emotions, to be sensitive to negative stimuli and to be wary and vigilant. A. Paranoia B. Hypomania C. Dysthymia D. Negative Affectivity Answer: D 61. Behavioral theorists such as Ferster and Lewinsohn have suggested that separation-loss may lead to depression because A. of aggression turned inward. B. of the loss of a significant source of positive reinforcement. C. of objection to the loss. D. it may set in motion a chain of self-punishment. Answer: B 62. The statement, "research suggests that the link between loss and depression is indirect" means that A. the loss leads to anxiety or some other disorder and that these disorders, in turn, lead to depression. B. the loss may set in motion a chain of adverse circumstances that increase the risk for depression. C. the research shows a link to sadness and this indirectly suggests a link to depression. D. research indicates negative correlations. Answer: B 63. The _________ perspective attributes depression to low social competence, cognitive distortions, and low self-esteem. A. psychoanalytic B. cognitive behavioral C. biological D. family systems Answer: B 64. An explanatory style that blames negative events on _________, _________, and _________ attributes is hypothesized to be characteristic of depressed individuals. A. external, stable, and specific B. external, stable, and global C. internal, stable, and global D. internal, unstable, and global Answer: C 65. Susie’s mother abandoned her when she was 5 years old. Now at age 8, Susie thinks that she has little control over her environment. This is an example of: A. anaclitic depression B. learned helplessness C. hopelessness D. projection Answer: B 66. The hopelessness theory of depression would predict that youngsters with a negative attributional style, as compared to youngsters with a positive attributional style, would A. be more depressed under low stress conditions, but not under high stress conditions. B. be more depressed under high stress conditions, but not under low stress conditions. C. be more depressed under both high and low stress conditions. D. be less depressed under both high and low stress conditions. Answer: B 67. Depressed youth who catastrophize, overgeneralize, personalize, and selectively attend to negative events are exhibiting A. learned helplessness. B. cognitive distortions. C. anaclitic depression. D. hopelessness. Answer: B 68. A patient who challenges and changes problematic cognitions is performing A. cognitive refocusing. B. brain training. C. reparenting. D. cognitive restructuring. Answer: D 69. Which of the following have been associated with depression? A. Rumination and avoidance B. Problem solving and social support C. High levels of perceived competence and physical ability D. Distraction and talking to others Answer: A 70. The results of the research by Hammen and her colleagues comparing the long-term effects of maternal depression (MD) and maternal chronic illness (MCI) on children found that A. rates of psychological disorder in both MD and MCI children were higher than in children of non-ill mothers, but MD and MCI children did not differ from each other. B. rates of psychological disorder in both MD and MCI children were higher than in children of non-ill mothers and MD children had higher rates of psychological disorders than MCI children. C. rates of psychological disorders were higher only for the MD children compared to the MCI children and children of non-ill mothers. D. neither MD or MCI children differed from children of non-ill mothers in rates of psychological disorders. Answer: B 71. Weissman and her colleagues compared offspring of parents, neither of whom had a psychological disorder (low risk) and offspring of parents, one or both of whom had a diagnosis of major depressive disorder (high risk). These researchers found which of the following? A. High-risk offspring had increased rates of major depressive disorder. B. High-risk offspring had increased rates of major depressive disorder, particularly after puberty. C. Low-risk offspring had increased rates of phobias and alcohol dependence. D. Depressed offspring of depressed parents were more likely to receive treatment. Answer: B 72. Beardslee and his colleagues examined the impact of parental depression in a nonclinically referred population by conducting two measurements four years apart. Which of the following risk factors affected the likelihood of a youngster experiencing serious affective disorder in the time between the two assessments? A. Parental major depressive disorder B. Parental major depressive disorder and parental nonaffective diagnoses (disorders) C. Parental major depressive disorder and the number of earlier child diagnoses (disorders) D. Parental major depressive disorder and parental nonaffective diagnoses (disorders) and the number of earlier child diagnoses (disorders) Answer: D 73. Research on interactional patterns in families with a depressed parent or child suggest that A. depressed behavior by a family member may be maintained because it serves to avoid conflictual behavior among family members. B. depressed behavior by a family member is reduced where there is marital conflict. C. no association exists between marital conflict and depression. D. a child is less likely to be depressed when he/she can mediate the conflict between the parents. Answer: A 74. The notion that the depressed mother may be emotionally unavailable and insensitive to her young child is important to which explanation of the maternal depression/child depression association? A. Cognitive modeling B. Ineffective parenting practices C. Attachment D. Social network Answer: C 75. Research by Ivanova and Israel (2006) found A. family stability moderates the impact of parental depression in children’s internalizing problems. B. parental depression causes internalizing problems in children regardless of the family situation. C. inconsistency in family routines lead to internalizing problems in the child even if the parent was not depressed. D. family stability was not a statistically significant variable in regard to child adjustment. Answer: A 76. In the Kupersmidt and Patterson study of peer status and adjustment, A. peer status was not related to clinical difficulties for boys. B. rejected boys and girls had high rates of clinical difficulties. C. rejected boys, but not rejected girls, exhibited high rates of clinical level difficulties. D. rejected girls, but not rejected boys, exhibited high rates of clinical level difficulties. Answer: B 77. In the Kupersmidt and Patterson study of peer status and adjustment, the group exhibiting the strongest relationships between peer status and depression in the clinical range was A. neglected boys. B. rejected boys. C. neglected girls. D. rejected girls. Answer: C 78. Research on peer relation difficulties and depression indicates A. depression does not impact peer relationships until late adolescence. B. depressed youngsters still view peers positively. C. early disruptive behavior can affect peer relationships in childhood and lead to depression. D. depressed youngsters tend to be overconfident in their social skills. Answer: C 79. Self-report measures of depression in youngsters are particularly important because A. mothers frequently deny that their children are depressed. B. fathers frequently deny that their children are depressed. C. it is important that the child publicly acknowledges that he or she is depressed. D. many of the key problems that characterize depression are subjective. Answer: D 80. The Children's Depression Inventory A. is a structured interview employed to obtain a DSM diagnosis. B. is probably the most commonly employed self-report measure of depression in youngsters. C. is used to primarily assess the affective component of depression. D. lacks substantial research evidence for its usefulness. Answer: B 81. Measures of a youngster’s depression completed by both the youngster and the parent A. show low levels of correlation, and agreement is fairly constant across ages of youngsters. B. show low levels of correlation, and agreement may vary with the age of youngster. C. show high levels of correlation, and agreement is fairly constant across ages of youngsters. D. show high levels of correlation, and agreement may vary with the age of youngster. Answer: B 82. Regarding pharmacotherapy for childhood depression, A. research supports the superiority of antidepressant medications in prepubertal children and adolescents. B. antidepressant medications have well-established guidelines for administration with youngsters. C. antidepressant medications are established as being safe for youngsters. D. selective serotonin reuptake inhibitors are the medications most likely to be recommended. Answer: D 83. The Treatment of Adolescent Depression Study (2007, 2009) found that initially A. using SSRIs alone was the best treatment for depression. B. CBT alone was more effective than other types of treatment. C. the combined SSRI and CBT treatment worked best. D. the suicide risk was highest in the placebo (no treatment) group. Answer: C 84. In the Stark et al., studies where 9-13 year old girls received a school based treatment for depression (Action Program), which of the following is true? A. The girls were taught to use coping skills if they were unhappy and did not know why. B. Behavioral activation referred to efforts made to identify behaviors that triggered depression. C. The cognitive behavioral program alone was not as effective as the program using parent training and cognitive behavioral therapy combined. D. Improvements were initially strong but were not maintained at a 1-year follow up. Answer: A 85. The findings of the study by Lewinsohn and his colleagues on the cognitive-behavioral treatment of depressed adolescents suggest that A. treatment is effective only if parents are included. B. treatment is effective only if parents are excluded. C. post-treatment, only about 55 percent of treated youngsters, but 95 percent of control youngsters still met diagnostic criteria for depression. D. treatment gains are not maintained at two years following treatment. Answer: C 86. Research by Mufson and colleagues and by Rosselló and Bernal comparing the use of interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) with depressed Latino adolescents A. found that CBT was the most effective in treating depression. B. found that IPT, but not CBT, resulted in improvements in depression. C. found that both approaches were effective for depression, but IPT helped in additional ways. D. found that cultural influences were not relevant to the treatment of depression. Answer: C 87. Research on CBT in adolescents indicates A. the effectiveness rates are good immediately following the treatment, but diminish over time. B. the effectiveness rates are good immediately following treatment and at long term follow up. C. the severity of the depression appears unrelated to success. D. the treatment is more effective for teens with co-occurring disorders. Answer: A 88. The term bipolar disorder refers to A. the experience of both high and low levels of depression. B. the presence of mania as well as depressive symptoms. C. the presence of depression in the context of confusion regarding sexual identity. D. depression that may result from extreme changes in seasonal weather conditions. Answer: B 89. Ana is 17 years old and experiencing a persistent elevated mood. She feels like her thoughts are racing. Ana reports that she needs less sleep than she did before. She has been buying an extensive new wardrobe and has been involved in sexual relations with several older men. She is doing poorly in school and is in conflict with her family and friends. Ana would most likely be diagnosed, according to DSM-IV, as experiencing a A. major depressive episode. B. manic episode. C. dysthymic episode. D. masked depressive episode. Answer: B 90. Jake is 15 years old. Since about age 10, he has had periods of sadness, irritability and withdrawal. At times, he was so down that he could not get out of bed or make it to school. Recently, he has begun to experience times where he felt energized and needed less sleep. He got caught up on his homework, joined three clubs at school and tried out for the basketball team. He asked “the best looking girl in the school,” a senior, to prom. His parents describe him as arrogant and irritable at times. He seems annoyed that people can’t keep up with him in conversation. Which of the following best describes Jake’s symptoms? A. Bipolar I B. Bipolar II C. Cyclothmia D. Depression in remission Answer: B 91. The presentation of bipolar disorder in youth differs from the adult presentation in which of the following ways? A. Youth have more distinct episodes. B. Mixed mood episodes are rare in youth. C. Youth have periods of relatively good functioning in between episodes. D. Youth tend to have a rapid cycling pattern of episodes. Answer: D 92. Reported rates of bipolar disorders in children and adolescents range from _________ to _________ in clinical samples. A. 0-6 percent B. 3-9 percent C. 10-14 percent D. 17-30 percent Answer: D 93. Based on the work of Lewinsohn et al., and others, which of the following statements regarding bipolar disorders is correct? A. The median duration of the most recent manic episode was 10.8 months. B. Youngsters with a diagnosis of bipolar disorder had a later age of onset for their affective disorder than youngsters with major depression. C. The total amount of time with an affective disorder was longer for the youngsters with depression than for those with bipolar disorders. D. Approximately 2% of the adolescents had a chronic course (nonstop symptoms until age 24). Answer: A 94. Regarding the prevalence of suicide among children and adolescents, A. the rate of completed suicides among 5 to 14-year-olds decreased between 1980 and 2007. B. the rate of completed suicides among 15- to 19-year-olds increased considerably from 1980 to 2007. C. among 15- to 19-year-olds, the rate of completed suicides is higher for white males than for black males. D. risk of completed suicide is greatest for white females. Answer: C 95. The term “suicidal behavior” includes A. completed suicides. B. completed suicides and suicide attempts. C. completed suicides and suicidal ideation. D. completed suicides, suicide attempts, and suicidal ideation. Answer: D 96. Based on the longitudinal study by Lewinsohn and his colleagues, which of the following statements regarding suicidal ideation among adolescents is accurate? A. About 7 percent of adolescents had a history of suicidal ideation. B. Suicidal ideation was more prevalent in adolescent men than in adolescent women. C. The frequency of suicidal ideation was unrelated to future suicidal attempts. D. Mild and relatively infrequent suicidal thoughts increased the risk for a suicide attempt. Answer: D 97. Based on the longitudinal study by Lewinsohn and his colleagues, which of the following statements regarding suicide attempts by adolescents is accurate? A. The risk for a reattempt is significantly diminished weeks after the initial attempt. B. Attempts by females most often involved ingestion of harmful substances and cutting. C. Suicide attempts made before puberty were the most common. D. Approximately 2 percent of previous attempters reattempt suicide. Answer: B 98. Which of the following statements regarding suicide in youngsters is accurate? A. The rate of completed suicide in youngsters is low as compared to adults. B. Depression is a necessary condition for suicidal behavior. C. Diagnostic heterogeneity is not characteristic of suicide completers. D. Antisocial behavior/conduct disorders are rare among male adolescent suicide completers. Answer: A 99. Which of the following statements regarding suicide risk is accurate? A. A history of prior attempts is unrelated to risk for future suicide. B. There is no evidence that suicide is “contagious” in youth. C. There is no evidence for higher rates of completed suicides in gay and lesbian youth. D. The period 3 months after hospitalization for a suicide attempt is a time when youth are the safest (i.e., least likely to reattempt). Answer: C 100. According to the Add Health Survey, which of the following is true regarding youth with same-sex orientation and suicide? A. A vast majority of the youth reported no thoughts or attempts of suicide. B. The youth were no more likely to attempt suicide than their peers. C. The youth were no more likely to abuse alcohol or experience depression than their peers. D. The youth were no more likely to be victimized or have a family history of suicide. Answer: A BRIEF ESSAY QUESTIONS 101. What is masked depression? Why has the concept been important to the study of depression in children? Answer: Masked depression refers to a condition where the typical symptoms of depression are not easily recognizable or manifest differently than usual. This can make it challenging to diagnose because the symptoms may be concealed or expressed in atypical ways. In the context of children, the concept of masked depression has been crucial for several reasons: 1. Presentation Differences: Children may not exhibit classic depressive symptoms such as sadness or low mood. Instead, they might display behaviors such as irritability, defiance, or physical complaints (like stomachaches or headaches). These symptoms can easily be mistaken for other issues, such as behavioral problems or physical illnesses. 2. Diagnostic Challenges: Since the symptoms of masked depression in children can mimic other conditions, clinicians may overlook or misdiagnose depression. This delays appropriate intervention and treatment. 3. Impact on Development: Depression in children, whether masked or not, can significantly impact their social, emotional, and academic development. Early identification and treatment are crucial for preventing long-term consequences. 4. Treatment Considerations: Recognizing masked depression ensures that children receive appropriate mental health interventions. Therapy and support can help alleviate symptoms and improve their overall well-being. Therefore, understanding masked depression in children is important for accurately identifying and addressing mental health issues early on, ensuring better outcomes for their emotional and psychological development. It highlights the need for comprehensive assessment methods that consider a broad range of symptoms and behaviors beyond the typical adult presentation of depression. 102. Briefly describe the 4 mood episodes outlined in the DSM-IV. Answer: In the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), there are four primary types of mood episodes outlined: 1. Major Depressive Episode: • Characterized by a period of at least two weeks where there is either depressed mood or loss of interest or pleasure in nearly all activities (anhedonia). • Additional symptoms may include changes in appetite or weight, sleep disturbances, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, difficulty concentrating, and thoughts of death or suicide. 2. Manic Episode: • Defined by a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week (or any duration if hospitalization is required). • During the episode, individuals experience inflated self-esteem or grandiosity, decreased need for sleep, increased talkativeness, racing thoughts, distractibility, increased goal-directed activity or psychomotor agitation, and excessive involvement in pleasurable activities that have a high potential for painful consequences. 3. Hypomanic Episode: • Similar to a manic episode but less severe and typically not accompanied by marked impairment in social or occupational functioning, hospitalization, or psychosis. • Lasts at least four consecutive days and includes symptoms such as inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, and excessive involvement in pleasurable activities. 4. Mixed Episode: • Involves the criteria for both a manic episode and a major depressive episode nearly every day during at least a one-week period. • Individuals experience rapidly alternating moods of depression and mania, often feeling intensely agitated, irritable, and exhibiting symptoms such as insomnia, fatigue, racing thoughts, and suicidal thoughts or behaviors. These mood episodes are crucial for diagnosing various mood disorders, such as major depressive disorder, bipolar I disorder, bipolar II disorder, and cyclothymic disorder, based on the specific combinations and durations of these episodes. 103. What are the issues regarding how to best define and classify depression in children and adolescents? Answer: Defining and classifying depression in children and adolescents poses several challenges and issues due to the following reasons: 1. Developmental Differences: Children and adolescents may express depressive symptoms differently than adults. For example, instead of sadness, they may exhibit irritability, somatic complaints (such as stomachaches or headaches), social withdrawal, or behavioral problems. This variability in symptom presentation complicates diagnosis. 2. Comorbidity with Other Disorders: Depression often coexists with other mental health disorders in children and adolescents, such as anxiety disorders, ADHD, conduct disorder, or substance use disorders. Untangling these overlapping symptoms is essential for accurate diagnosis and treatment planning. 3. Diagnostic Criteria Adaptation: The DSM-5 criteria for major depressive disorder (MDD) were primarily developed based on adult populations. Adapting these criteria for younger individuals requires consideration of developmental differences in cognitive, emotional, and social functioning. 4. Assessment Challenges: Assessing depression in children and adolescents involves reliance on self-report, parent report, and clinician observation. Each method has its limitations, such as potential biases in reporting and difficulties in distinguishing normative mood fluctuations from clinically significant symptoms. 5. Stigma and Cultural Factors: Cultural norms and stigmas surrounding mental health can influence how children, adolescents, and their families perceive and report depressive symptoms. This can impact help-seeking behaviors and the validity of diagnostic assessments. 6. Dimensional vs. Categorical Approaches: There is ongoing debate about whether depression should be conceptualized using a categorical approach (meeting specific criteria for a disorder) or a dimensional approach (considering severity and range of symptoms). Each approach has implications for diagnosis, treatment, and research. 7. Age-Appropriate Interventions: Effective interventions for depression in children and adolescents may differ from those used with adults. Tailoring treatments to developmental stages and understanding factors such as family dynamics and peer relationships is crucial. Addressing these issues requires interdisciplinary collaboration among clinicians, researchers, educators, and families to improve early detection, accurate diagnosis, and appropriate intervention strategies for depression in young populations. 104. Describe the experience of depression in children. What behaviors might adults report seeing in these children? What other disorders are often present? Answer: Depression in children can manifest differently compared to adults. Here are some key aspects: Experience of Depression in Children: 1. Emotional Signs: • Sadness or tearfulness: Children may appear consistently sad or prone to crying without an obvious reason. • Hopelessness or helplessness: They might express feelings of hopelessness about the future or believe they cannot change their circumstances. 2. Behavioral Signs: • Withdrawal: Children may withdraw from social activities they once enjoyed, preferring to be alone. • Irritability: Instead of expressing sadness, younger children might appear more irritable or easily frustrated. • Changes in sleep and appetite: Depressed children may experience changes such as insomnia or excessive sleep, as well as loss of appetite or overeating. 3. Physical Signs: • Fatigue: They might seem constantly tired or lacking in energy. • Complaints of physical symptoms: Children might frequently complain of headaches or stomachaches without a clear medical cause. 4. Cognitive Signs: • Poor concentration: They may have difficulty concentrating on tasks, leading to academic decline. • Negative thoughts: Children with depression might express negative self-talk or have a pessimistic outlook. 5. Suicidal thoughts or behaviors: In severe cases, children may express thoughts of suicide or engage in self-harm. Behaviors Adults Might Report Seeing: • Social withdrawal: Avoiding friends or family, not wanting to participate in activities. • Changes in school performance: Decline in grades, lack of interest in schoolwork, frequent absences. • Irritability: Easily becoming frustrated, short-tempered reactions. • Persistent sadness: Tears, expressions of feeling down or hopeless. • Changes in sleep or appetite: Significant changes in sleep patterns (insomnia or excessive sleep) or eating habits (loss of appetite or overeating). Other Disorders Often Present: Children with depression may also experience or be diagnosed with other conditions concurrently, such as: • Anxiety disorders: Anxiety commonly co-occurs with depression in children. • Attention-deficit/hyperactivity disorder (ADHD): Children with ADHD may also develop depression. • Behavioral disorders: Disorders like oppositional defiant disorder (ODD) or conduct disorder may be present alongside depression. • Substance abuse: In older children and adolescents, depression can coexist with substance use disorders. It's important to note that symptoms of depression in children can sometimes be subtle and may overlap with symptoms of other disorders. Early detection and appropriate intervention are crucial for managing depression effectively in children. 105. Briefly describe the developmental course of depression by describing features in three different developmental periods and how they compare to each other and to adult depression. Answer: The developmental course of depression varies across different stages of life, each characterized by unique features and challenges. Here’s a brief overview comparing three developmental periods (childhood, adolescence, and adulthood) with adult depression: Childhood (Ages 6-12): • Features: • Emotional expression: Children may not express typical sadness but rather irritability, clinginess, or physical complaints (e.g., stomachaches). • Behavioral changes: Withdrawal from activities, changes in sleep patterns (e.g., insomnia), and appetite disturbances (e.g., loss of appetite). • Cognitive symptoms: Poor school performance, difficulty concentrating, negative self-statements. • Social withdrawal: Avoidance of peers, reduced interest in play or social interaction. • Comparison to Adult Depression: • Symptoms may be less verbally expressed and more behavioral or somatic. • Children may not recognize or articulate feelings of sadness as clearly as adults. • Social and academic impairments are prominent indicators. Adolescence (Ages 13-18): • Features: • Emotional volatility: Mood swings, increased emotional intensity. • Behavioral changes: Risk-taking behaviors, substance use, self-harm, suicidal thoughts or attempts. • Cognitive symptoms: Persistent negative thoughts, difficulty with decision-making. • Social withdrawal: Increased isolation, conflict with peers or family members. • Comparison to Adult Depression: • Adolescents may exhibit more intense emotional reactions and higher rates of risky behaviors. • Social dynamics and peer influence play a significant role in the onset and course of depression. • Identity formation and academic pressures contribute to stressors unique to this age group. Adulthood (Ages 18 and beyond): • Features: • Emotional expression: Predominantly sadness, hopelessness, guilt. • Behavioral changes: Decreased interest in previously enjoyable activities (anhedonia), changes in sleep (insomnia or hypersomnia), appetite changes (weight loss or gain). • Cognitive symptoms: Persistent negative thinking, difficulty concentrating, memory problems. • Social withdrawal: Isolation from friends and family, reduced social interactions. • Comparison to Childhood and Adolescence: • Symptoms may be more stable and chronic compared to the episodic nature seen in younger age groups. • Adults may have developed more coping mechanisms but can still experience significant impairment in daily functioning. • Co-occurring medical conditions and life stressors (e.g., work, finances) often exacerbate depressive symptoms. Summary: Each developmental period exhibits unique features of depression influenced by cognitive, emotional, and social changes specific to that stage of life. Childhood and adolescence often present with more behavioral and somatic symptoms, while adulthood tends to manifest more classic emotional and cognitive symptoms. Understanding these differences is crucial for accurate diagnosis and effective treatment across different age groups. 106. Briefly describe the research findings on brain functioning and neurochemistry in relation to depression. How do these results apply to children and adolescents? Answer: Research on brain functioning and neurochemistry has provided insights into the biological underpinnings of depression. Here are some key findings and how they apply to children and adolescents: Brain Functioning: 1. Prefrontal Cortex (PFC): • Findings: Reduced activity and volume in the PFC, which is involved in decision-making, problem-solving, and emotional regulation. • Application to Children and Adolescents: Immature PFC development in youth may contribute to difficulties in regulating emotions and making decisions, exacerbating symptoms of depression. 2. Amygdala: • Findings: Increased activity in the amygdala, which processes emotions like fear and anxiety. • Application to Children and Adolescents: Heightened amygdala reactivity in youth may contribute to increased emotional sensitivity and difficulties in emotion regulation seen in depressive disorders. 3. Hippocampus: • Findings: Reduced volume and neurogenesis in the hippocampus, which is involved in memory and stress response. • Application to Children and Adolescents: Early-life stressors and depressive episodes may impair hippocampal development in youth, affecting memory function and stress regulation. Neurochemistry: 1. Serotonin (5-HT) System: • Findings: Dysregulation of serotonin neurotransmission implicated in depression; low levels associated with mood disturbances. • Application to Children and Adolescents: Similar patterns of serotonin dysregulation observed in youth with depression, influencing mood, sleep, appetite, and behavior. 2. Dopamine (DA) System: • Findings: Altered dopamine levels linked to reward processing and motivation, which are impaired in depression. • Application to Children and Adolescents: Changes in dopamine signaling may contribute to anhedonia (loss of pleasure) and reduced motivation in depressed youth. 3. Norepinephrine (NE) System: • Findings: Dysregulation of norepinephrine associated with arousal, attention, and stress response. • Application to Children and Adolescents: Changes in norepinephrine levels can contribute to symptoms of irritability, anxiety, and disrupted sleep patterns seen in youth with depression. Application to Children and Adolescents: • Developmental Considerations: Brain regions involved in emotion regulation (PFC, amygdala) are still maturing during childhood and adolescence. Dysregulation in these areas can contribute to heightened emotional responses and difficulties in managing stress and emotions. • Impact of Stress: Early-life stressors can disrupt neurodevelopmental processes, affecting brain structures (e.g., hippocampus) and neurotransmitter systems implicated in depression. • Treatment Implications: Understanding neurobiological mechanisms helps tailor interventions, such as cognitive-behavioral therapy (CBT) and medication, to address specific symptoms and neurochemical imbalances in young patients. In summary, research on brain functioning and neurochemistry underscores the biological basis of depression across different age groups, highlighting the importance of early intervention and targeted treatments to support neurodevelopmental processes and alleviate symptoms in children and adolescents. 107. Briefly compare the psychodynamic and cognitive behavioral conceptions of the relationship between separation/loss and the development of depression. Answer: The psychodynamic and cognitive-behavioral perspectives offer distinct views on how separation or loss contributes to the development of depression: Psychodynamic Perspective: • Conceptualization: • Freudian Theory: Loss of significant others (e.g., through death or separation) can lead to unresolved grief and internal conflicts. • Object Relations Theory: Emphasizes early childhood experiences with caregivers (objects) and their internalized representations. Loss of these internalized objects or their unavailability can lead to depression. • Mechanism: • Unconscious Processes: Depression is seen as a result of unresolved grief or feelings of abandonment stemming from early relationships. • Defense Mechanisms: Regression to earlier stages of development, such as oral or anal fixations, as coping mechanisms in response to loss. • Therapeutic Approach: • Psychoanalysis: Focuses on exploring unconscious conflicts and working through unresolved grief or loss through transference and insight. Cognitive-Behavioral Perspective: • Conceptualization: • Cognitive Triad (Beck): Depression arises from negative cognitive schemas about the self, the world, and the future. Loss or separation triggers negative beliefs about one's worthiness, safety, and the predictability of future relationships. • Behavioral Activation (Lewinsohn): Loss disrupts reinforcement patterns (e.g., loss of social support or pleasurable activities), leading to decreased positive reinforcement and subsequent depression. • Mechanism: • Cognitive Distortions: Loss can trigger distorted thinking patterns (e.g., overgeneralization, personalization) that exacerbate feelings of sadness and hopelessness. • Behavioral Withdrawal: Loss can lead to social withdrawal and reduced engagement in activities, perpetuating feelings of depression. • Therapeutic Approach: • Cognitive Restructuring: Targets negative thought patterns and promotes more adaptive ways of thinking about loss and separation. • Behavioral Techniques: Focuses on increasing engagement in rewarding activities to counteract withdrawal and increase positive reinforcement. Comparison: • Focus: • Psychodynamic: Emphasizes unconscious conflicts and early relational experiences as underlying causes of depression. • Cognitive-Behavioral: Focuses on cognitive distortions and behavioral responses to loss as mechanisms contributing to depression. • Mechanism: • Psychodynamic: Views depression as stemming from unresolved grief and disruptions in internal object relationships. • Cognitive-Behavioral: Views depression as resulting from distorted thinking and behavioral withdrawal due to loss. • Therapeutic Approach: • Psychodynamic: Uses insight-oriented techniques to explore and resolve unconscious conflicts related to loss. • Cognitive-Behavioral: Uses structured techniques to challenge and modify maladaptive thoughts and behaviors related to loss. In summary, while both perspectives recognize the impact of separation and loss on depression, they differ in their underlying mechanisms (unconscious conflicts vs. cognitive distortions) and therapeutic approaches (insight-oriented vs. cognitive-behavioral techniques). Integrating aspects of both perspectives can provide a comprehensive approach to understanding and treating depression related to separation or loss. 108. Briefly describe three different mechanisms that may account for the link between parental depression and depression in a child. Answer: The link between parental depression and depression in a child can be understood through several mechanisms: 1. Genetic Vulnerability: • Mechanism: Children of parents with depression may inherit genetic predispositions towards mood disorders. • Explanation: Genetic factors contribute to susceptibility to depression, and offspring of depressed parents may inherit genes that influence neurobiological processes related to mood regulation and emotional stability. 2. Environmental Stress and Modeling: • Mechanism: Living with a depressed parent exposes children to chronic stressors and dysfunctional family dynamics. • Explanation: High levels of stress within the family environment, such as conflict, neglect, or inconsistent caregiving due to parental depression, can impact a child's emotional development and coping strategies. Children may also model maladaptive behaviors and negative cognitive styles observed in their depressed parent. 3. Psychosocial Factors and Attachment: • Mechanism: Parental depression can disrupt the parent-child relationship and affect attachment bonds. • Explanation: Children rely on secure attachment relationships with caregivers for emotional regulation and support. Parental depression may lead to disruptions in caregiving behaviors, emotional availability, and responsiveness, impairing the child's ability to develop secure attachments. This insecurity can contribute to emotional instability and difficulties in regulating emotions, which are risk factors for developing depression. Summary: These mechanisms highlight how both genetic predisposition, environmental stressors, and disruptions in attachment dynamics contribute to the intergenerational transmission of depression from parents to children. Understanding these mechanisms is crucial for early intervention and prevention strategies aimed at mitigating the impact of parental depression on children's mental health outcomes. 109. List 5 of the 11 categories that may be used to rate behaviors when observing a social interaction task. Answer: When observing a social interaction task, researchers or clinicians may use categories to rate behaviors based on specific criteria. Here are five of the 11 common categories that could be used: 1. Initiation of Interaction: • The degree to which a participant initiates or responds to social interactions with others. 2. Quality of Speech: • Assessing the coherence, fluency, and appropriateness of speech during interactions. 3. Social Anxiety or Withdrawal: • Observing signs of anxiety or withdrawal, such as avoiding eye contact, speaking softly, or appearing tense. 4. Use of Nonverbal Cues: • Evaluating the use of nonverbal communication, including gestures, facial expressions, and body language. 5. Engagement and Interest: • Assessing the participant's level of engagement, interest, or attentiveness during the interaction task. These categories are used to systematically evaluate behaviors and interactions, providing insights into social skills, emotional expression, and communication abilities in various contexts. 110. Describe the core elements of the Action program used to treat 9-12 year old girls with depression. Answer: The Action program is a structured intervention designed to treat depression in 9-12 year old girls. It incorporates several core elements aimed at addressing emotional regulation, cognitive restructuring, and social skills development. Here are the key components of the Action program: 1. Psychoeducation: • Purpose: Educating participants about depression, its symptoms, and how it affects emotions and behaviors. • Activities: Providing age-appropriate information through discussions, worksheets, and interactive activities to increase understanding and awareness. 2. Cognitive-Behavioral Techniques: • Purpose: Teaching girls skills to identify and challenge negative thoughts and beliefs that contribute to depression. • Activities: Using cognitive restructuring techniques, such as cognitive restructuring worksheets, thought records, and role-playing exercises to practice changing negative thinking patterns. 3. Behavioral Activation: • Purpose: Encouraging participation in pleasant and rewarding activities to counteract withdrawal and low mood associated with depression. • Activities: Helping girls identify enjoyable activities, setting goals for engagement, and monitoring their mood and participation in activities over time. 4. Emotion Regulation Skills: • Purpose: Teaching strategies to recognize and manage emotions effectively. • Activities: Practicing relaxation techniques (e.g., deep breathing, progressive muscle relaxation), mindfulness exercises, and strategies for coping with intense emotions. 5. Social Skills Training: • Purpose: Enhancing interpersonal skills and improving social interactions with peers and family members. • Activities: Role-playing social scenarios, practicing assertiveness skills, and learning effective communication strategies. 6. Parental Involvement: • Purpose: Involving parents in the treatment process to support their child’s progress and reinforce skills learned in sessions. • Activities: Conducting parent education sessions, providing resources and strategies for supporting their child at home, and promoting open communication between parents and children about depression and treatment progress. 7. Relapse Prevention: • Purpose: Equipping girls with skills to recognize early signs of depression recurrence and prevent relapse. • Activities: Developing personalized relapse prevention plans, identifying triggers and coping strategies, and practicing problem-solving skills for managing difficult situations. Implementation: • Format: Typically delivered in group sessions led by trained therapists over a specified number of weeks (e.g., 12-16 weeks). • Setting: Sessions may take place in clinical settings, schools, or community centers, providing a structured and supportive environment for learning and practice. • Evaluation: Progress is monitored through assessments of depressive symptoms, behavioral changes, and functional improvements, adjusting the intervention as needed based on individual needs. The Action program integrates evidence-based approaches from cognitive-behavioral therapy (CBT), emotion regulation, and social skills training tailored to the developmental needs of preadolescent girls, aiming to empower them with effective tools for managing and overcoming depression. 111. Describe the differences between Bipolar I, Bipolar II and cylothymia. Answer: Bipolar disorder and cyclothymic disorder (cyclothymia) are mood disorders characterized by distinct patterns of mood swings and their severity. Here are the differences between Bipolar I, Bipolar II, and cyclothymia: Bipolar I Disorder: • Manic Episodes: • Definition: Characterized by at least one manic episode lasting for at least one week or requiring hospitalization. • Manic Symptoms: Symptoms include elevated or irritable mood, increased energy, decreased need for sleep, racing thoughts, grandiosity, and impulsivity. • Impairment: Manic episodes often lead to significant impairment in social, occupational, or other important areas of functioning. • Major Depressive Episodes: • Criteria: Episodes of major depression may also occur, characterized by symptoms such as persistent sadness, loss of interest in activities, changes in appetite or sleep, feelings of guilt or worthlessness, and thoughts of death or suicide. • Bipolar I vs. Bipolar II: Bipolar I disorder is differentiated from Bipolar II primarily by the presence of manic episodes. Bipolar I does not require a history of major depressive episodes for diagnosis. Bipolar II Disorder: • Hypomanic Episodes: • Definition: Characterized by at least one hypomanic episode lasting for at least four consecutive days. • Hypomanic Symptoms: Symptoms are similar to manic episodes but less severe in intensity and do not cause marked impairment in functioning. • No Psychosis: Hypomania does not involve psychosis (loss of touch with reality). • Major Depressive Episodes: • Criteria: Individuals with Bipolar II experience one or more major depressive episodes. • Diagnosis: Bipolar II is diagnosed if the individual has had at least one hypomanic episode and one major depressive episode. Cyclothymic Disorder (Cyclothymia): • Chronically Elevated Mood: • Definition: Characterized by chronic fluctuating mood disturbances involving numerous periods of hypomanic symptoms and depressive symptoms that do not meet criteria for major depressive episodes. • Duration: Symptoms must persist for at least two years (one year in children and adolescents). • Criteria: During the two-year period, symptoms must be present at least half the time and never completely absent for more than two months at a time. • No Full Episodes: Cyclothymia does not involve full-blown manic or major depressive episodes. • Functional Impairment: Individuals with cyclothymia may experience significant impairment in social, occupational, or other areas of functioning due to the chronic and fluctuating nature of their symptoms. Summary of Differences: • Bipolar I: Includes manic episodes that often require hospitalization. May also have major depressive episodes. • Bipolar II: Characterized by hypomanic episodes (less severe than manic episodes) and major depressive episodes. • Cyclothymia: Chronic fluctuating mood disturbances involving periods of hypomanic symptoms and depressive symptoms, without meeting criteria for full manic or major depressive episodes. These disorders vary in the severity and duration of mood episodes, as well as their impact on daily functioning, which influences diagnostic criteria and treatment approaches. 112. Briefly describe four characteristics of manic episodes or bipolar disorder in prepubertal youngsters or adolescents that indicate how they may differ from the presentation in adults. Answer: Manic episodes or bipolar disorder in prepubertal youngsters or adolescents can differ from presentations in adults in several key ways. Here are four characteristics that illustrate these differences: 1. Duration and Cycling Frequency: • Characteristic: Manic episodes in children and adolescents tend to be shorter in duration compared to adults. • Explanation: Episodes may last hours to days rather than the typical week-long duration seen in adults. Rapid cycling between mood states (e.g., switching rapidly between manic and depressive episodes) is more common in younger individuals. 2. Mixed Features and Irritability: • Characteristic: Youth with bipolar disorder often present with mixed features, where manic symptoms coexist with depressive symptoms simultaneously. • Explanation: Irritability is a prominent symptom in children and adolescents with bipolar disorder, often overshadowing euphoric or grandiose mood seen in adults. This can manifest as severe temper outbursts, mood lability, and chronic irritability. 3. Psychotic Symptoms: • Characteristic: Psychotic features, such as hallucinations or delusions, may be more prevalent in adolescents with bipolar disorder compared to adults. • Explanation: Psychotic symptoms can complicate the clinical picture, occurring during manic, depressive, or mixed states. Hallucinations may involve auditory or visual experiences, often linked to mood state fluctuations. 4. Comorbid Conditions and Behavioral Dysregulation: • Characteristic: Co-occurring psychiatric conditions and behavioral dysregulation are common in youth with bipolar disorder. • Explanation: Children and adolescents with bipolar disorder frequently have comorbid disorders such as ADHD, conduct disorder, or substance use disorders. Behavioral dysregulation, including impulsivity, aggression, and risky behaviors, is prominent and may precede the onset of mood symptoms. Summary: These characteristics highlight how manic episodes and bipolar disorder can present differently in prepubertal youngsters and adolescents compared to adults. Understanding these differences is crucial for accurate diagnosis and effective management, as the presentation may vary widely across different developmental stages. Early intervention and tailored treatment approaches are essential in addressing the unique challenges and symptoms associated with bipolar disorder in youth. 113. Describe the symptoms that may be displayed by a youngster with bipolar disorder. What co-occurring problems are possible? Answer: Bipolar disorder in youngsters, also known as pediatric bipolar disorder or early-onset bipolar disorder, can present with a variety of symptoms that are often different from those seen in adults. Here are some typical symptoms that may be displayed by a youngster with bipolar disorder: 1. Manic Episodes: • Increased Energy: Abnormally high levels of energy and restlessness. • Elevated Mood: Feeling unusually euphoric or irritable. • Increased Activity: Engaging in multiple activities simultaneously, impulsively starting new projects. • Rapid Speech: Talking very quickly, with pressured speech. • Decreased Need for Sleep: Needing significantly less sleep than usual without feeling tired. 2. Hypomanic Episodes: • Similar to manic episodes but less severe. The child may still have high energy and be more productive but without the extreme behaviors seen in full manic episodes. 3. Depressive Episodes: • Low Mood: Persistent sadness or irritability. • Loss of Interest: Decreased interest in activities once enjoyed. • Fatigue: Feeling tired or lacking energy. • Changes in Appetite: Significant changes in appetite or weight. • Sleep Problems: Either difficulty sleeping or sleeping too much. • Feelings of Worthlessness or Guilt: Persistent negative feelings about themselves. 4. Mixed Episodes: • Symptoms of both mania/hypomania and depression occurring simultaneously or rapidly alternating. 5. Psychotic Symptoms (in severe cases): • Hallucinations (seeing or hearing things that aren't there). • Delusions (strongly held false beliefs). Co-occurring problems that are possible in youngsters with bipolar disorder include: • Behavioral Issues: Increased impulsivity, risk-taking behavior, or aggression during manic episodes. • Academic and Social Difficulties: Disruptions in school performance, trouble maintaining friendships, or conflict with peers due to mood swings. • Substance Abuse: Higher risk of substance use disorders, particularly during manic or depressive episodes. • Anxiety Disorders: Increased prevalence of anxiety disorders alongside bipolar disorder. • Attention Deficit Hyperactivity Disorder (ADHD): Symptoms of ADHD may overlap with symptoms of bipolar disorder, leading to additional challenges in diagnosis and treatment. • Self-harm or Suicidal Thoughts: Especially during depressive episodes, youngsters may experience thoughts of self-harm or suicide. Early identification and treatment are crucial for managing bipolar disorder in youngsters effectively. A comprehensive treatment plan typically includes a combination of medication, psychotherapy, and support from mental health professionals and family members. 114. What variables are involved in treating bipolar disorder? Answer: Treating bipolar disorder typically involves a combination of different variables, tailored to the individual's specific symptoms and needs. These variables include: 1. Medication: Mood stabilizers such as lithium, anticonvulsants (e.g., valproate, lamotrigine), and atypical antipsychotics (e.g., quetiapine, olanzapine) are commonly used to manage mood swings and psychotic symptoms. 2. Psychotherapy: Different forms of therapy, such as cognitive-behavioral therapy (CBT), psychoeducation, and interpersonal and social rhythm therapy (IPSRT), can help individuals understand their condition, manage stress, and improve coping strategies. 3. Lifestyle adjustments: Maintaining a regular sleep schedule, avoiding substance abuse, and managing stress are crucial in managing bipolar disorder. 4. Support systems: Family therapy and support groups can provide invaluable support and understanding for both individuals with bipolar disorder and their loved ones. 5. Monitoring and self-care: Regular monitoring by healthcare professionals, including psychiatrists and therapists, helps track symptoms and adjust treatment as needed. Self-care practices, such as maintaining a healthy diet and exercise routine, can also contribute to overall well-being. 6. Hospitalization or intensive treatment: In severe cases or during manic episodes with psychotic features, hospitalization may be necessary to ensure safety and stabilize symptoms. Effective treatment often requires a combination of these variables, as bipolar disorder can vary widely in its presentation and severity among individuals. Treatment plans should be individualized and regularly reviewed to optimize outcomes and minimize the impact of the disorder on daily functioning. 115. Review the risk factors associated with suicide. Answer: Suicide is a complex phenomenon influenced by a variety of factors, both individual and societal. Understanding these risk factors is crucial for identifying individuals who may be at higher risk and providing appropriate support and intervention. Here are some key risk factors associated with suicide: Individual Risk Factors: 1. Mental Health Disorders: The most significant risk factor for suicide is having a mental health disorder, particularly: • Depression: Major depressive disorder and persistent depressive disorder (dysthymia). • Bipolar Disorder: Especially during depressive episodes or mixed states. • Schizophrenia: Particularly during acute episodes or in the presence of command hallucinations. • Substance Use Disorders: Especially when combined with other risk factors. 2. Previous Suicide Attempts: Individuals who have previously attempted suicide are at higher risk of attempting again. 3. Family History of Suicide: A family history of suicide or suicide attempts increases an individual's risk. 4. Chronic Illness or Pain: Physical health problems, especially chronic illnesses or severe pain, can contribute to feelings of hopelessness and suicide risk. 5. Access to Lethal Means: Easy access to firearms, medications, or other lethal methods increases the risk of suicide. 6. Loss or Stressful Life Events: Recent loss (death of a loved one, divorce, loss of job), financial difficulties, relationship problems, or other stressful life events can trigger suicidal thoughts. 7. Social Isolation: Lack of social support or feeling disconnected from family, friends, or community increases vulnerability. 8. Hopelessness: Feeling trapped or believing that things will never get better. 9. Impulsive or Aggressive Tendencies: Impulsivity and aggression can increase risk, especially when combined with other risk factors. Societal and Environmental Factors: 1. Stigma: Stigma associated with mental health disorders or seeking help can deter individuals from seeking support. 2. Access to Mental Health Care: Limited access to mental health treatment or reluctance to seek help due to financial, cultural, or logistical barriers. 3. Exposure to Suicide: Knowing someone who has died by suicide, particularly if the person was a close friend or family member (suicide contagion). 4. Media Coverage of Suicide: Sensationalized or glamorized media coverage of suicide can contribute to increased risk. 5. Cultural and Religious Beliefs: Some cultural or religious beliefs may discourage seeking help for mental health issues or impose stigma on those who do. Protective Factors: While understanding risk factors is crucial, it's also important to consider protective factors that can mitigate suicide risk: • Effective Mental Health Care: Access to mental health treatment and support services. • Strong Social Support: Positive relationships with family, friends, and community. • Problem-Solving Skills: Ability to cope with stress and solve problems effectively. • Sense of Purpose: Feeling connected to something meaningful in life. • Cultural and Religious Beliefs: Supportive cultural or religious beliefs. • Restricted Access to Lethal Means: Limiting access to firearms or other lethal methods. • Healthy Coping Strategies: Adaptive coping mechanisms and resilience. Understanding and addressing these risk and protective factors can help in developing effective suicide prevention strategies at both individual and community levels. If you or someone you know is experiencing suicidal thoughts, it's important to seek help from a mental health professional or a crisis intervention service immediately. Test Bank for Abnormal Child and Adolescent Psychology Rita Wicks-Nelson, Allen C. Israel 9781317351344, 9780205036066, 9780205901128
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