depression Flashcards
At what age do all lifetime mental disorders begin?
14
why does depression stand out (4 reasons)?
- affects growth and develop, school performance, family life, relationships, and adolescent adjustment
- has potential to influence long term functioning
- difficult to distinguish between depression and “normal” adolescent growth and development
- leading cause of suicidal behavior and suicide
major depression in adolescence is a psychosocial dysfunction manifested by (6 ?
- severe sadness
- withdrawn behavior
- boredom
- low self-esteem
- feeling helpless and hopeless
- sense that there is no meaning in life
How long must symptoms of MDD be present to meet the DSM-5 criteria for MDD
2 week period with at least on of the symptoms being depressed mood or loss of interest or pleasure
What are the symptoms of the DSM-5 criteria for MDD (9)?
- depressed or irritable mood
- diminished interest or pleasure in activities
- weight change or appetite disturbance
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings or worthlessness or guilt
- disturbed concentration or indecisiveness
- recurrent thoughts of death, suicidal ideation, or suicide attempt
What is an overwhelming, chronic state of depression?
dysthymia
T/F , dysthymia is a depressed mood most days for at least two years with baseline irritable or depressed?
True
persistent depressive disorder
dysthymia
DSM-5 criteria for dysthymia
must not have gone for more than two months without tow or more of the following symptoms:
- poor appetite
- insomnia or hypersomnia
- low energy
- low self esteem
- difficulty making decisions
- feelings of hopelessness
By age 14, depression is twice as common in boys or girls?
girls
what underlies the risk for depression?
Genetics. children with depressed parents have 3x the risk to be diagnosed, with peak incidence between 15 and 20 years old
what are reasons why the 70% of children/adolescents do not receive treatment (6)?
- stigma attached to mental illness
- atypical presentations
- lack of adequate mental health education about children and adolescents
- lack of providers
- insurance issues
- under diagnosis and tx are bigger problems for younger children; tendency to sometime, to present with general aches and pains; will usually see a school nurse
what biochemical factors are related to depression?
dopamine and serotonin
what abnormalities of pituitary function are causes of depression in adults and not well known in adolescent population?
increase in cortisol and hypo/hyperthyroidism
what are clinical presentations of depression in infants and young children (unable to verbalize feelings) ?
- pattern of depressed affect, lack of pleasure; should be noted across all 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
clinical presentation of depression in toddlers and preschoolers (unable to verbalize feelings) ?
- 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
Clinical presentation of depression in school age children (able to verbalize feelings, but not always willing to)?
- 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
- describing themselves in negative terms
- feeling futility about behaviors
Clinical manifestations of depression in adolescence?
- decreased interest or pleasure
- withdrawal
- hopelessness
- changes in weight or appetite
- changes in sleep patterns
- substance abuse or self medication
Why is the diagnosis of depression often missed in children and adolescence?
- symptoms are not recognized by parents, family, providers or school
- children may not accurately report mood symptoms, gather information from other sources such as school and family
what are standardized screening tools for depression?
- child behavior checklist, 4-18 year old
- children’s depression rating scale, revised (CDRS-R), 6 - 12 years
- Beck Depression Inventory, adolescents and adults
- PHQ -9 for adolescence (PHQ-2)
What assessment serves as a framework for taking hx ?
HEADSS assessment Home Education, employment Activities Drugs Sexuality Suicide
When do you assess for suicide risk in a child/ adolescent with depression?
on the first visit
what is the management of a child/adolescent with depression?
psychotherapy, cognitive behavioral therapy, social skills training, medication
True or False. Pediatric trials suggest that benefits of using anti-depressant medications outweigh the risks interns of suicide and suicidal thoughts.
True, benefits of using medication outweigh the risks in terms of suicide
What is the best treatment for adolescents with depression?
- best response is combination of medication and CBT with greatest reduction in suicidal thought
- medication alone or in combination with CBT is better than CBT alone
what are factors to consider when prescribing anti-depressants?
- safety
- abuse
- selling
- comorbidities
- side effect profiles
- concurrent medical issues
what are first line medications for depression?
SSRIs - effective, well tolerated and few side effects
Tricylics are second line and rarely used d/t side effects
If no benefit after 4 weeks of anti-depressant, what is the next step?
consider another med
if mild response of anti-depressant after 4 weeks, what is the next step?
consider continuing for 10 weeks
what is the duration of anti-depressant tx for children/ adolescents?
up to a year
When should a dose be decreased?
the pt should be sx free for 3 months before decreasing dose.
Forty to 50% of adolescents/ children relapse in how many years?
2 years, need close monitoring
T/F? Depression can be chronic enough that some children/ adolescents must remain on medications indefinitely?
True
how log do you treat depression?
usually 6-9 months, up to 12 months, until child demonstrates a normal mood level
taper slowly
Which type of ant-depressants are the drug of choice and should be reserved for tx of severe major depression?
SSRIs
These types of drugs SHOULD NOT be used for childhood/adolescent depression?
Tricyclic antidepressants
What is first line for mild to moderate depression?
psychotherapy/CBT
This in the only FDA approved medication in children/adolescents with depression
prozac (fluoxetine)
Is depression is common or uncommon?
depression is common and treatable
what are symptoms of early onset depression?
- irritability,
- rapid cycling,
- manic depression
- features of ADHD or other behavior disorders
- more severe than later onset
what are symptoms of later onset depression?
- classic manic symptoms
- severe mood changes
- inflated self esteem
- increased energy; decreased need for sleep
- distractibility
- physical agitation
- risk taking behaviors
- hypersexuality
what is the management for later onset depression?
- psychiatric referral
- lithium
- careful monitoring
- long term tx
- family based tx
What is the third leading cause of death in 15-24 age group?
suicide
about 2000 suicides per year
What is the strongest predictor of suicide?
previous attempt
