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    E.1 Depression PowerPoint 20151

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    Ptrc Lbr Lp
    This document discusses depression in children and adolescents. It covers the definition, epidemiology, subtypes, risk factors, comorbidities, diagnosis, treatment and prevention of depression. Some key points include: - The prevalence of depression in adolescents is 5% and is higher in girls than boys. - Risk factors include genetics, family relationships, parental depression, and stressful life events. - Common comorbidities are anxiety disorders, conduct problems, and ADHD. - Treatments include CBT, IPT, antidepressant medication, and electroconvulsive therapy for severe cases. Combination treatment is often most effective. - Prevention efforts aim to improve social and coping skills through programs targeting at-risk youth

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    © All Rights Reserved
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    E.1 Depression PowerPoint 20151

    Uploaded by

    Ptrc Lbr Lp
    187 views38 pages
    This document discusses depression in children and adolescents. It covers the definition, epidemiology, subtypes, risk factors, comorbidities, diagnosis, treatment and prevention of depression. Some key points include: - The prevalence of depression in adolescents is 5% and is higher in girls than boys. - Risk factors include genetics, family relationships, parental depression, and stressful life events. - Common comorbidities are anxiety disorders, conduct problems, and ADHD. - Treatments include CBT, IPT, antidepressant medication, and electroconvulsive therapy for severe cases. Combination treatment is often most effective. - Prevention efforts aim to improve social and coping skills through programs targeting at-risk youth

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    IACAPAP Textbook of Child and Adolescent Mental Health

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    This document discusses depression in children and adolescents. It covers the definition, epidemiology, subtypes, risk factors, comorbidities, diagnosis, treatment and prevention of depression. Some key points include: - The prevalence of depression in adolescents is 5% and is higher in girls than boys. - Risk factors include genetics, family relationships, parental depression, and stressful life events. - Common comorbidities are anxiety disorders, conduct problems, and ADHD. - Treatments include CBT, IPT, antidepressant medication, and electroconvulsive therapy for severe cases. Combination treatment is often most effective. - Prevention efforts aim to improve social and coping skills through programs targeting at-risk youth

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    187 views38 pages

    E.1 Depression PowerPoint 20151

    Uploaded by

    Ptrc Lbr Lp
    This document discusses depression in children and adolescents. It covers the definition, epidemiology, subtypes, risk factors, comorbidities, diagnosis, treatment and prevention of depression. Some key points include: - The prevalence of depression in adolescents is 5% and is higher in girls than boys. - Risk factors include genetics, family relationships, parental depression, and stressful life events. - Common comorbidities are anxiety disorders, conduct problems, and ADHD. - Treatments include CBT, IPT, antidepressant medication, and electroconvulsive therapy for severe cases. Combination treatment is often most effective. - Prevention efforts aim to improve social and coping skills through programs targeting at-risk youth

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 38

    MOOD DISORDERS

    Chapter E.1

    Depression
    in Children
    and
    Adolescents
    Joseph M Rey, Tolulope T Bella-
    Awusah & Jing Liu
    DEPRESSION IN CHILDREN AND
    ADOLESCENTS

    Adapted by Julie Chilton


    The “IACAPAP Textbook of Child and Adolescent Mental Health” is available at the
    IACAPAP website http://iacapap.org/iacapap-textbook-of-child-and-adolescent-
    mental-health

    Please note that this book and its companion powerpoint are:
    · Free and no registration is required to read or download it
    · This is an open-access publication under the Creative Commons Attribution Non-
    commercial License. According to this, use, distribution and reproduction in any
    medium are allowed without prior permission provided the original work is
    properly cited and the use is non-commercial.
    • Definition
    • Epidemiology
    • Age of Onset and Course
    • Subtypes of Depression
    • Etiology and Risk Factors
    • Comorbidity
    • Diagnosis
    • Differential Diagnosis
    • Rating Scales
    • Treatment
    • Cross Cultural Perspectives
    • Barriers to Care
    • Prevention
    • Definition
    • Core symptoms
    • Associated symptoms
    • Variations
    • Appropriate terms
    Depression in Children and Adolescents

    Epidemiology
    • Pre-pubertal children: 1-2%
    • Adolescents: 5%
    • Cumulative prevalence
    – Girls: 12%
    – Boys: 7%
    Depression in Children and Adolescents

    Differences According to Age


    • Recurring, spontaneously remitting
    • Average episode: 7-9 months
    • 40% probability of recurrence in 2 years
    • 60% likelihood in adulthood
    • Predictors of recurrence:
    – poorer response, greater severity, chronicity, previous
    episodes, comorbidity, hopelessness, negative cognitive style,
    family problems, low SES, abuse or family conflict
    TYPES OF DEPRESSION

    UNIPOLAR BIPOLAR disorder


    Depression
    Manic
    OR
    Non-melancholic Hypomanic
    Melancholic
    Psychotic
    •Anhedonia
    •Lack of reactivity
    •Worse in morning
    Mild
    •Early morning awakening
    •Psychomotor retardation or agitation
    Moderate
    •Anorexia or weight loss
    •Inappropriate or excessive guilt
    Severe
    Depression in Children and Adolescents

    Subtypes
    • Catatonic depression • Unipolar depression
    • Post-psychotic • Bipolar depression
    depression • Psychotic depression
    • Premenstrual dysphoric • Melancholic depression
    disorder • Dysthymic disorder
    • Seasonal depression • Double depression
    • Mood disorder NOS
    • Adjustment disorder
    with depressed mood
    • Minor depression
    Depression in Children and Adolescents

    Etiology
    • Genetics
    • Prenatal factors
    • Family relationships
    • Parental depression*
    • Cognitive style
    • Stressful life events
    • Lack of parental care
    • Anxiety disorders
    • Post Traumatic Stress Disorder
    • Conduct problems
    • Attention Deficit Hyperactivity Disorder
    • Obsessive Compulsive Disorder
    • Learning difficulties
    • Suicidal thoughts:
    – 1/6 girls
    – 1/10 boys
    • 100:1 ratio of attempts to completions
    • 60% depressed youth have thoughts of suicide
    • 30% depressed youth make a suicide attempt
    • Risk factors: family history, previous attempts,
    comorbidities, aggression, impulsivity, access to lethal
    means, negative life events
    • Core symptoms
    • Associated symptoms
    • Pervasiveness
    • Duration
    • Impairment or distress
    http://www.abc.net.au/austory/specials/leastlikely/
    • Medications
    • Substances of abuse
    • Infections
    • Neurological disorders
    • Endocrine
    • Unipolar vs. bipolar
    • Psychotic depression vs. schizophrenia
    • Depression vs. substance use
    • Depression vs. adjustment disorder with
    depressed mood
    • Depression vs. demoralization from disruptive
    disorders
    • CES-DC: Center for Epidemiologic Studies-Depression
    Scale
    • MFQ: Mood and Feelings Questionnaire
    • DSRS: Depression Self-Rating Scale
    • KADS: Kutcher Adolescent Depression Scale
    • PHQ-A: Patient Health Questionnaires-- Adolescent
    • SDQ: Strengths and Difficulties Questionnaire

    *See eTextbook for hyperlinks


    • Reduce symptoms and impairment
    • Shorten episode
    • Prevent recurrences
    What works?

    Robust evidence of effectiveness for:

    • Medication (moderate and severe


    depression)
    • Psychotherapy (milder depression)
    • Cognitive behaviour therapy (CBT)
    • Interpersonal psychotherapy (ITP)

    19
    SUPPORTIVE MANAGEMENT
    -Build rapport
    ESTABLISH
    SEVERITY -Psycho-education
    [clinical -Self-help
    assessment -Healthy lifestyle: exercise,
    CONDUCT A RISK +depression sleep hygiene
    ASSESSMENT rating scale]
    -Supportive psychotherapy
    (problem solving, stress
    management, pleasant events)
    ALL PATIENTS
    Admission?

    20
    Depending on severity:
    • Watchful waiting
    • Supportive management
    • Psychosocial interventions
    – Cognitive Behavioral Therapy (CBT)
    – Interpersonal Psychotherapy (IPT)
    • Medication
    • Cognitive Behavioral Therapy (CBT)
    • Interpersonal Psychotherapy (IPT)

    https://www.youtube.com/watch?v=DT6biKxqotw
    • Identify links between mood, thoughts,
    activities
    • Challenge negative thoughts
    • Increase enjoyable activities
    • Build skills to maintain relationships
    • Similar to CBT
    • Focus on the present
    • Premise=Interpersonal conflicts loss of
    social support depression
    • Improvement of interpersonal skills
    • Psychoeducation about depression
    • Increase enjoyable activities
    • Strong placebo effect
    • Evidence different for adults
    • Key aspects for informed consent
    • Undertreatment is common
    • Most evidence for Selective Serotonin
    Reuptake Inhibitors (SSRIs)
    – Fluoxetine: approved >8 year olds
    – Escitalopram: approved for adolescents in
    the US
    https://www.youtube.com/watch?v=m4PXHeHqnmE
    • Suicidality* • Gastrointestinal
    • Manic switch • Weight gain
    • Akathisia • Sexual
    • Bleeding
    • Agitation • Possible congenital
    • Irritability • Withdrawal syndrome
    • Disinhibition • Serotonin Syndrome
    • Nightmares/sleep
    disturbances
    • Electroconvulsive therapy (ECT): good evidence of
    effectiveness in severe cases
    • Transcranial Magnetic Stimulation (TMS)
    • Light Therapy (in seasonal mood disorder)
    • Complementary and Alternative Medicine (CAM)
    – St. John’s Wort
    – Omega 3 Fatty Acids
    – S-Adenosyl Methionine (SAMe)
    • Exercise
    • Mild: supportive management, CBT, or
    IPTno responseCBT, IPT, or antidepressant
    medication
    • Moderate: supportive management, CBT, IPT
    or medication no response–add medication
    • Severe: CBT/IPT and medication
    • Psychotic depression: CBT/IPT and medication
    and second generation antipsychotic drug
    • 1st Line: lithium carbonate or quetiapine
    • 2nd Line:
    --lithium or valproate with an SSRI
    --olanzapine and an SSRI, or
    --lamotrigine
    • No evidence for antidepressants alone
    • Lithium and valproate should be avoided in
    women of childbearing age
    • Two considerations: effectiveness and safety
    – SSRIs are safest
    – Fluoxetine is most effective
    • Begin fluoxetine
    – Start with 10mg of fluoxetine
    – Increase to 20mg after one week
    – 20mg for pre-pubertal children
    – 30 or 40mg for adolescents
    • If not fluoxetine try another SSRI (e.g., sertraline or
    escitalopram)
    • Continue treatment 6 months after recovery
    • Determining treatment resistance
    • Handling treatment resistance
    • Possible causes:
    – Patient factors
    – Family factors
    – Environmental factors
    – Clinician factors
    • Afghanistan
    • Japan
    • China
    • Turkey
    • Hispanic populations
    • Shortage of child psychiatrists and allied
    professionals
    • Few training programs
    • Stigma
    • Few medications
    • Minimal inpatient facilities
    • Cognitive restructuring
    • Social problem-solving
    • Interpersonal communication skills
    • Coping
    • Assertiveness training
    American Academy of Child and Adolescent Psychiatry
    (AACAP) 2007 Practice Parameter on depressive disorders
    http://www.jaacap.com/article/S0890-8567(09)62053-0/pdf

    National Institute for Health and Clinical Excellence


    (NICE) (2005) guidelinehttp://www.nice.org.uk/guidance/cg28 -
    guidelinereview

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