PSYC 412 Lecture Notes - Lecture 4: Major Depressive Episode, Dysthymia, Choking Game
14 May 2018
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PSYC 412: Developmental Psychopathology
Mar 12th 2018
Lecture 17: Depression
Course of Depression:
• Course
o If a major depressive episode is left untreated it typically remits on its own
o Untreated MDD lasts between 8-12 months but will get better on its own
o Also true of dysthymic disorder (DD) lasting typically 2-5 untreated
o At the ed of the episode, peso o loge eets iteia, ou ofte see thee
still showing some symptoms, just not enough to meet diagnostic criteria
▪ If that is the case then it is a strong risk factor for recurrence
• MDD recurrence
o Extremely likely to recur (happen again at some point)
o Its eas to thik that oe depessio fies itself oue fie ad dot eed to
worry about treatment anymore
o But if ou dot do athig it is extremely likely to come back and the person
will have subsequent MDD episode
o The earlier the depression starts, the more likely it is to later reoccur
▪ Preschoolers with depression 4x more likely than those without
depression to meet criteria for MDD 2 years later
▪ Children/adolescents experiencing MDD episode:
• 25% of them have relapse in 1 year
• 40% within 2 years
• 70% within 5 years
• 30% deelop ipolar disorder BP sith
▪ Most adults with MDD date the onset of their first episode to
adolescence
• Ee people ho eet diagosed i adolesee
• Most will say they had their first episode like this as a teenager
• Kindling
o Hypothesis for why we see this recurrence in MDD
o Typically, first episodes of depression will follow significant stress in
somebodies life
o Most common event preceding the first depressive episode in adolescence: first
romantic breakup
▪ Having that experience leads to biological and physiological symptoms
that sensitize person to stress in the future (make them more reactive to
it)
▪ So later episodes might require even less stress to be onset
• Prognosis
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o Depression recurs
▪ Children/adolescents with depressive episode more likely to have one as
adults
▪ Girls more likely to experience recurrence than boys, but in adulthood
equal likelihood
▪ Earlier the first MDD episode the worse the prognosis tends to be
• Earlier onset tends to be followed by a more severe, chronic
course of depression and greater suicidality
o Depression shows large homotypic continuity: it tends to predict subsequent
depression
▪ Heterotypical continuity: does it predict other disorders in the future?
o Study of longitudinal cohort in New Zealand (Fergusson & Woodward 2002)
▪ Followed individuals through birth who met DSM-criteria for MD at 15-16
years old
▪ Examined psychopathology, educational and social outcomes in early
adulthood
▪ Found that major depression predicts subsequent major depression
• Also more likely to have anxiety disorders: when controlling for
anxiety disorders in adolescents (i.e. depression was contributing
uniquely)
▪ These analyses took into account a number of factors we know are
associated with adolescent depression and outcome:
• Lower SES, experiencing abuse, etc.
• Depression not associated with a lot of other outcomes (like
substance abuse problems) because those could have already
existed
• So if someone has a substance abuse problem, then gets
depressed, then continues to have the substance abuse problem
and someone wants to study the effects of post-depression, they
would have to control for prior problems and thus could not
count the later sustae ause as a esult of the depessio
• Co-morbidity
o For MDD
▪ Major comorbid condition seen is anxiety
▪ Also at greater risk for dysthymia, ADHD, substance use
▪ In general the co-morbid conditions come first: typically, child develops a
significant anxiety problem then subsequently develops depression
o For dysthymia
▪ MDD
▪ Anxiety, conduct disorder, ADHD – these disorders tend to precede
dysthymia
• Cognitive functioning
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o Typically children and adolescents who have depression have IQs in the normal
range
o Children with depression, however, perform more poorly in school
o Symptoms of depression: poor concentration, low energy, fatigue could all
interfere with how well a person is able to do in their classes
• Suicidality
o Symptom of depression and major correlate
o Suicide is defined as actually, deliberately taken ones own life
o Suicidality is a broader construct that includes attempts, intent, and ideations to
take oes o life
o Suicide is 2nd leading cause of death among Canadian children & adolescents
aged 10-19 years old
▪ In 2008, 20.4% of all deaths in youth 10-19 were due to suicide,
compared to only 1.5% of the total deaths in Canada that were due to
suicide
▪ Significant public health problem for adolescents
o Significant risk factors for suicidal behavior include:
▪ Having a mood disorder
▪ Being a young female
o 60% of children and adolescents with MD report having suicidal thoughts and
approximately 30% will attempt suicide
o Girls are more likely to attempt suicide compared to boys
▪ But often choose less lethal means (like taking an overdose) and for that
reason they are less likely to complete suicide
▪ Boys are more likely to use firearms and other more lethal methods, so
they are more likely to complete suicide
▪ Among Canadian children and adolescents the most common method is
suffocation
• But important to note that a # of deaths classified may be
aidets… like the hokig gae hee ou dot eath fo a
protracted period of time
o Most ok doe ith adults has suggested that thees o assoiatio between
suicidal intent and lethality of the means chosen to commit suicide
o Brown et al., 2003, JCCP:
▪ Worked with adults who had survived suicide attempts
▪ People are not good judges of lethality: there was no relationship
between the perception of lethality and actual lethality, aka people are
not good at knowing how lethal a particular means is
▪ This doest a gede o depessie sptos
▪ Association between intent and lethality of method chosen is stronger
when people understand the lethality of the method and has an accurate
perception of the lethality of the method chosen, but in general there is
no association
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Document Summary
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