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Emotional Dis: Internalising - Anxiety + Depression (Aetiology (Teasing…
Emotional Dis: Internalising - Anxiety + Depression
Behaviour
Internalising
Maladaptive emotions + cognitions manifested in child's inner psychological environment, not external world
Social
anxiety
Generalised anxiety disorder
Separation anxiety
Panic disorder
Phobias
PTSD
OCD
PTSD
(contains internalising/externalising elements)
Depressive
disorders e.g. Major depressive disorder
Bipolar disorder
Diagnostic Criteria
Social Anxiety
Persistent fear of one/more social or performance situations - exposed to unfamiliar people or possible scrutiny
Fears act in a way that will be embarrassing/humiliating
Recognises that fear is unreasonable/excessive
Exposure to feared situation provokes anxiety
Feared situations = avoided or else are endured with intense anxiety/distress
Interferes w/ daily life and last 6+ mnths
Not due to another condition, or drugs/medication
GAD
Individual finds it difficult to control the worry
Associated with
Restlessness feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating/mind goes blank
Irritability
Muscle tension
Sleep disturbance
Seemingly not anxious behaviour but have as underlying cause
Interfere with daily life and not due to medical condition/drugs
Excessive anxiety + worry, occurring more days than not for at least 6 mnths, about number of events/activities
MDD
5+ symptoms over two week period
Depressed mood
Diminished pleasure in daily activities
Weight loss/gain
Insomnia/hypersomnia
Psychomotor agitation or retardation
Loss of energy
Feelings of guilt/worthlessness
Diminished ability to think/concentrate
Recurrent thoughts of death/suicide
Interferes with daily life, not due to another conditions, more episodes of mania
Prevalence
Diagnoses of depression in 15-16 yr olds has doubled since 1980s (increased diagnosis, changes in society - pressures/norms)
Gender ratio 2:1 (f:m), depression divergence ~ 13 yrs
Children 5-6yrs ~3% have anxiety, ~1% have MDD (clinically diagnosed, symptoms = more)
1970s 'the notion of a syndrome of childhood depression rests largely on surmise
Developmental?
Anxiety disorders typically onset in deve e.g. median age in US =13 yrs, with 75% of those with social anxiety disorder experiencing onset between 8-15
Depression onset more variable, but rate of onset accelerates in adolescence + often preceded by anxiety disorder
High prevalence in childhood + adolescence
Substantial amount during adolescence - seeds sown early on even if no diagnosis/expression
Comorbidity
Youth with anxiety: co morbid depression 10-15%
Anxiety often precedes depression rather than vice versa (more likely to have deve depression, anxious > isolate > depression)
Other common comorbidities: self harm, conduct disorder, ADHD, eating disorders
Youth with depression: comorbidity ~50% GAD that most common
Aetiology
Heritability
Twin studies: heritability estimates ~40-50% for depression, ~30-40% for anxiety
Heterogeneity
Depression
New genetic influences may become important during adolescence
Effects of GxE correlation may compound over time
E.g. learning thinking/thought patterns, e.g. predisposing genes lear to certain situations > effects may take time
Childhood onset depression = less heritable than adolescent onset
Anxiety
Greater heritability of anxiety in girls than boys
Family studies = increased incidence in children with a family history
Molecular Genetics
Focus on genes involved in neurotransmitter + hormone systems (candidate genes)
Anxiety
COMT, DRD4 (DA)
CRH (corticotrophin-releasing hormone: HPA stress response)
5HTT (serotonin transporter gene)
Depression
5HTT, MAON (serotonin, dopamine, norepinephrine)
BDNF (brain-derived neurotrophic factors)
5HTT = common gene
Enviro Risk
A lot of shared factors
Almost complete overlap in factors that affect onset
Physical, sexual or emotional abuse/neglect
Adverse life events
Peer group
Culture, birth cohort and gender effect
Diet
Family discord, exposure to domestic abuse
SES
Parenting style
Parent internalsing + other psychopathology
Anxiety only = specific antigenic event
Teasing apart G+E
Assisted conception 'natural experiment' method
Related (bio/enviro) + unrelated (just enviro) parent-child peers
BOTH = sig association between parent depression + child depression/anxiety
Lewis et al (2011)
Similar effects in both children + adolescents
Enviro = big impact, associations regardless of bio component
Link to enviro stronger for girls
Results not accounted for by shared adversity across the generations
GxE interaction: Depression
Short + severe = more likely to deve > interaction - explains why people maltreated don't always deve
Possible that effect stronger in adolescent females
Short variant reduced expression of 5HT transporter > greater concentration of 5HT in synaptic cleft
Childhood maltreatment was associated with later depression only with short form or 5HT transporter gene
But not always replicated
Latent Vulnerability
Threat processing + latent vulnerability
Predictive of IDs in mental health in those who have experienced maltreatment
Limited evidence to date
Neural responses to maternal anger mediated relationship between maltreatment + anxiety symptoms
Associated with relevant disorders
Hypersensitivty to threat strongly implicated in PTSD, anxiety + depression
Associated with maltreatment experience
Ps exposed to childhood maltreatment show hypersensitivity to treat
Behavioural + neural
Linking genes, enviro, brain, cog + behaviour
McCroy + Viding (2015)
Early maltreatment might heighten risk of psychiatric disorder
Vulnerability to mental health problems can be understood as changes in a cute of neurocog systems that reflect adaptation or altered calibration to early neglectful or maltreating enviro
Changes neurocog systems
Heightened neurocog vigilance to threat - calibration to early at-rsik envrio that becomes maladaptive in LT
Neurobiology
Neural Bases
Brain structure
Greater reduction in hippocampus in adults vs youth with depression
Reduced space volume in depressed youth with comorbid anxiety, compared with no comorbidity
Reduced grey matter vols in key limbic regions: hippocampus + subgenus anterior cingulate cortex in youth depression
Brain function
Some studies show +ive relationship between amygdala response + symptoms
Anxiety + depression associated with atypical function in amygdala + connected regions
As anxiety increased so does amygdala response to fear
Increased amygdala response to far in anxious youth
Brain connectivity
GAD group showed differences in connectivity in medial/ventrolateral PFC + insula
Consistent with theories of disrupted emotion processing + regulation involving amygdala PFC circuitry
Looked at resting state amygdala connectivity in youth GAD aged 12-17
Signatures predictive?
Rogers et al (2016)
Patterns of resting-state amygdala connectivity with mPFC, insular + posterior consulate predicted internalising symptoms age 2
Symptoms included inhibition to novelty, anxiety, withdrawal, separation distress
Suggets 'seeds' of future internalising may be present at birth - relates to early temperament?
Infants scanned within the first 4 days of life
Masten et al (2011)
Being rejected by peers is associated with internalising and externalising symptoms
space response to rejection in a Cyberball game age 12/13 was associated with depressive symptoms 1 yr later
Not accounted for by depressive symptoms at Time 1
Social rejection is point social stressor which is particularily prevalent in adolescence
Cognitive
Cognitive biases
Cognitive Theories of internalising
Beck (1976)
Cog triad of depression
Negative views of world, oneself, future
Charateristic ways of attending to, interpreting + remembering events contribute to deve/maintenance of psychopathy
But do these cognitions underpin adolescent anxiety + depression?
Negative interpretation bias: depression
Hypothetical ambiguous scenarios test for depression in adolescents
Orchard et al (2016)
Ps rate scenarios as =/-, and then give written description of their imagined outcome
Sig more -ive ratings/interpretations nin depressed group
Difference reduced when covarying for anxiety, but still sig
Interpretive bias: anxiety
Haller et al (2016)
Ambiguous pictures > chose interpretations > questions
Increased -ive (+ decreased +ive) attributions in high socially anxious youth
Not a clinical sample
Memory bias
Overgeneral autobiographical memory = feature of adult depression
Higher quality memories = important for sense of self esteem + high quality interactions
Rawal et al (2012)
Non-depresses who later became = greater memory overgeneralisation than control
Not just current but causal factor in later deve depression
Risk factor for onset of adolescent depression
Greater memory overgeneralisation in adolescents w/ depression
Depressed patients recall memories of extended periods/repeated events, instead of single
Biased attention in youth internalising
Hankin et al (2010)
Dot prode task - bias towards emotion
Looked at speed (RT) to detect probe
If quicker to detect emotional probe than neutral, suggests attentional bias
Results
Anxious youth biased towards angry faces - hyper vigilance towards harrm
Comorbid youth bias towards both
Depressed youth biased towards sad faces
Neurocog Deve
Dual Systems Models
Supported empirically and crossculturally
Could contribute to adolescent risk taking, as we ll as vulnerability to affective disorder but should also consider other factors
All have at their root the idea that normative deve involves a period of mismatch between affective + regulatory capacities
Mis-match of socioemotional/cog control systems
Gogtay et al (2004)
Brain underdogs protracted deve in childhood + adolescence (increase risk)
Could certain points in deve be windows of vulnerability for mental illness
Increased vulnerability to internally symptoms
Thinning of cortical grey matter between 4 + 21
Fine tuning regions of cortex in complex behaviours
Not until early 20s to reach adult levels