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Childhood Depression
 

Childhood Depression

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psychiatry, Childhood Depression

psychiatry, Childhood Depression

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    Childhood Depression Childhood Depression Presentation Transcript

    • Childhood Depression 26.09.09 CAP,NIMHANS
    • Can children experience sadness
      • The experience and the expression of depression change with age.
      • Content- loss,rejection, failure
      • Processes- experiential,cognitive,vicarious
      • Mechanism-evolutionary,biological, social learning
    • Incidence
      • Incidence is much low in children compared to adults.
      • Adolescents F>M. children M=F
      • Pre adolescent depression less chance to lead on to adult depression when compared to adolescent depression
      • It overlap with other disorders, more associated with family dysfunction, less psychotic symptoms
    • DSM-Depression
      • 1. Depressed mood ( can also be an irritable mood)
      • 2. Diminished interest or loss of pleasure in almost all activities
      • 3. Sleep disturbance
      • 4. Weight change or appetite disturbance (can be failure to achieve expected weight gain)
      • 5. Decreased concentration or indecisiveness
      • 6. Suicidal ideation or thoughts of death
      • 7. Psychomotor agitation or retardation
      • 8. Fatigue or loss of energy
      • 9. Feelings of worthlessness or inappropriate guilt
    • Clinical Presentation
      • The age of a child and his or her psychological sophistication can play a major role in the depressed child's clinical presentation.
      • Language function not well developed age 7. Thus, it can be more difficult to diagnose depression prior to this age.
      • Attention to nonverbal communication can assist in making the diagnosis in younger children.
    • Clinical presentation
      • They look sad, are tearful, have slow movements, and speak in a monotone voice, in a hopeless and despairing manner.
      • They describe themselves as, “I'm dumb,” “I'm stupid,” “I'm a bad boy/girl,” and “Nobody loves me.”
      • Their school performance deteriorates, and they tend to drop out of favorite extracurricular activities.
    • Clinical presentation
      • Somatic symptoms often occur, the most common being stomachaches and headaches.
      • In late childhood, more often includes low self-esteem with disappointment with self, apathy, irritability, anxiety, and inability to concentrate.
      • Self-endangering behavior and suicide attempts are quite common
    • Assessment
      • Structured interviews such as the Diagnostic Interview for Children and Adolescents (DICA)
      • Semistructured interviews, such as the K-SADS
      • The Childhood Depression Rating Scale-Revised (CDRS-R) is modification of HDRS that rates severity of depression based on information obtained from child, parent, teacher, and clinician.
      • The Childhood Depression Inventory (CDI) a self-report scale similar to the BDI for adults
      • Structured pictorial questionnaire based on the DSM (Valla et al . 1994) and puppet interviews.
    • Evaluation
      • Organic etiologies that might mimic a depressive disorder must be ruled out
      • Infections, medications, endocrine disorders, tumors,neurologic disorders
      • Complete blood count (CBC) with differential
      • Electrolytes, BUN, creatinine clearance, creatinine,.LFT,TFT.
    • Evaluation -cont
      • Consideration to the developmental stage of children for determining if a behavior or symptom is abnormal
      • what is developmentally normal must be known.
      • onset of some psychiatric disorders may be related to age
      • one may consider neglect, abuse, failure to thrive, separation anxiety dis., and adjustment dis. with depressed mood in preschoolers.
      • Adjustment dis. with depressed mood in a school-age
      • Child drug or alcohol abuse, anxiety disorders, and early schizophrenia should be ruled out in adolescents
    • Co morbid illness
      • Conduct disorder 40%
      • Anxiety 34%
      • ICD & DSM different approach to it.
      • Difficulty in diagnosing, affect prognosis and may increase chance of suicide
    • Treatment- biopsychosocial approach
      • Psychotherapy (individual, family, or group), medication management, educational assessment and planning, evaluation of school placement, and social skills training.
      • The treatment setting must be determined before initiating any treatment plan. patient should be hospitalized if there is suicidal risk.
      • Other factors, such as ability to function or family stability, also might influence the decision of whether to hospitalize the child.
    • Psychotherapy
      • IPT,CBT
      • BT, Play therapy
      • Parental training, FT
    • Pharmacotherapy
      • FDA approval for fluoxetine, effective equally in childhood and adolescent .(to be beware of risk of suicide).
      • Others with proven efficacy are citalopram, sertaline.
      • TCA not much effective.
    • Conclusion
      • Childhood depression should be identified and treated because it has got a significant adverse effect on a youth’s emotional, social and cognitive development.
    • Reference
      • CTP
      • OTP
      • Melvin Lewis
      • Micheal Rutter.
      • Thank you.