childhood depression Flashcards
what is a significant risk factor for childhood depression
family history
Biochemical factors for childhood depression
neurotransmitter systems {dopamine, serotonin}
what are some core symptoms of depression related to hypothalmic functions
- appetite changes
- sleep pattern changes
* * are tied to the pituitary gland
Is there a relationship between a particular mindset or approach to perceiving external events and a predisposition to depression
- assumption of personal blame
- expectation that one negative experience is part of a pattern of negative events
- general pessimism
Childhood depression range
from mild to severe and can lead to significant dysfunction
Childhood depression is associated with
increased risk of suicide and risk-taking behavior
Childhood depression is often recognized when
only after noticing difficulty in school and social functioning
Clinical presentation of depression in children
varies with developmental level;
must look at child/adolescent from developmental perspective
Infants and young children presentation of depression
- pattern of depressed affect, lack of pleasure;
- patterns should be noted across settings, activities, and relationships
- failure to thrive
- developmental delays such as speech and motor
- repetitive self-soothing behaviors such as rocking
- poor attachment behaviors
- loss of developmental skills
Toddlers and preschoolers and presentation of depression
- lack of energy
- eagerness to please, tendency to cling
- separation problems that are persistent and intense
- sadness, irritability, lack of pleasure
- poor appetite and weight loss
- sleep issues
- loss of developmental milestones or regression of behavior
- increased physical complaints
- overall behavior problems
school-age children presentation of depression
- irritability, anger, hostility
- hyperactivity, reckless behavior
- difficulty handling feelings
- frequent absences, school phobia
- feelings of anger, upset, sadness
- loss of interest and pleasure in usual activities
- describe themselves negatively
- feeling guilty about behaviors
Adolescents and depression
- stress about separation from family, college decisions, school pressure, behavior choices;
- mood shifts are common
- capable of abstract thinking and recognizing feelings {piaget}+
Adolescents and presentation of depression
- despair
- blame
- guilt
- self-hate
- decreased interest or pleasure
- withdrawal
- hopelessness
- changes in weight or appetite
- changes in sleep patterns
10 substance abuse or slef-medication
What is the most important part of diagnosing depression in children and adolescents
history
Standardized screening tools for depression in childhood
- Child behavior checklist for age 4-18 yesars
- Children’s depression rating scale-revised for age 6-12 years
- Beck depression inventory for adolescents and adults
- PHQ-9 {PHQ-2}
HEADSS Assessment
- can serve as guide to address important areas
- relies on effective, nonjudgmental interviewing
- must preserve confidentiality when possible
- can serve as framework for history taking
what does HEADSS stand for
Home Education, employment Activities Drugs/alcohol Sexuality Suicide
What should be included with the history
- current problems
- family hx of medical/pshyciatric illnesses
- pharmacologic or psychologic treatment
- prior psychologic functioning
- peer/family relationships
- suicide ideations or attempts
- substance abuse
- developmental level and functioning
- recent stressors or losses
- sexual and reproductive history
- abuse
What is the strongest predictor of suicide
previous attempt
Physical assessment for depression
- hx is important for diagnosis
2. must perform a physical assessment
Differential diagnosis for depression
- anemia
- chronic fatigue
- eating disorder
- endocrine disorder
- hypothyroidism
- chronic infection
- substance abuse: alcohol, marijuana, cocaine
- medications: antihypertensives, clonidine, phenobarb
Management of depression in children
- on first visit, assess for suicide risk
2. difficult in referrals d/t lack of specialists and insurance restraints
Treatment of depression in children
- psychotherapy
- cognitive behavior therapy
- social skills training
- medication
Antidepressants in children
black box warning for those under the age of 25
Treatment for adolescents with depression {TADS}
- NIMH multicenter clinical trial
- best response was combination of medication and CBT
- rate of suicidal thought decreased in all groups
Pharmacologic therapy for depression in children is most often used for children when
they experience significant impairment in day-to-day functioning
Factors to consider when prescribing medication for depression
- safety
- abuse
- selling
- comorbidities
- side-effect profiles
- concurrent medical issues
What is first line for treatment of depression
SSRIs
- effective
- well tolerated
- few side effects
Guidelines for treatment with antidepressant
- if no benefit after 4 weeks consider different med
- mild response - continue for 10 weeks to optimize response
- monitor closely d/t 40-50% relapse within 2 years
duration for treatment with antidepressants in children/adolescents
up to 1 year
When do you consider decreasing dose of antidepressant
if symptom free for 3 months
how long do you treat depression in child/adult
- usually 6-9 months but up to 12 months until child demonstrates a normal mood level
- taper antidepressants slowly
What are complicating factors for treating adolescent depression
comorbidities
common comorbidites in many adolescents
- conduct and behavior disorders
- anxiety
- ADHD
- ADD
2/3 of child/adolescents with MDD have what
another mental disorders
Comorbidities with depression in adolescents can
- affect progonsis
- has negative ramifications
- increases recurrence
- increases suicide attempts
- affects outcome
- affects response to treatment
Early-onset depression in the young is associated with
a protracted course, poorer outcome, and probability of functional impairment
What is the first-line treatment for mild to moderate depression
Psychotherapy
What is the only FDA-approved medication for depression in children and adolescents
Prozac
In children with depression you should educate family to watch for and report
increases in agitation, behavior changes, suicidal thoughts or behaviors
