Childhood depression


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Childhood depression

  1. 1. Childhood Depression Bivin Jay. B
  2. 2. Introduction • It comes under the broad category of affective and emotional disorders of childhood & adolescents • Includes childhood depression, anxiety disorders, adjustments disorders, PTSD & OCD. • Childhood depression widely vary from adult depression. • More recurrent, causing significant psychosocial impairment & scholastic functions. • Difficult to treat when suicidal ideations exist.
  3. 3. Epidemiology • Prevalence rates raises through adolescence with estimates in preadolescents of the order of 0.5-2.5% increasing up to 8% in adolescents. • Recurrence of depression within 5 years is 70% • 50% developed to have recurrent depression in the adulthood • After 15 yrs, girls are twice more risk than boys to develop depression.
  4. 4. Suicidal intent • Depression is associated with high risk of suicidal behavior among adolescents. • For every fatality there are at least 100 attempts. • Suicidal risk is high with depressed boys who have comorbid disorders such as CD or SUD’s • Among adolescents who develop MDD, 7% may commit suicide (NIMH report-1997). • 2% of high school students have made suicide attempts that have come to medical attention, with larger numbers making less serious attempts (Indian Report). • Completed suicide occurs in about 1/100 000 preadolescents and 13/100 000 adolescents, with boys exceeding girls by 4 to 1.
  5. 5. Risk factors • Biomedical factors – – – – – – Chronic illness (e.g., diabetes) Female sex Hormonal changes during puberty Parental depression or family history of depression Presence of specific serotonin-transporter gene variant Use of certain medications (e.g., isotretinoin [Accutane]) • Psychosocial factors – Childhood neglect or abuse (physical, emotional, or sexual) – General stressors including socioeconomic deprivations – Loss of a loved one, parent, or romantic relationship • Other factors – – – – – Anxiety disorder Attention-deficit/hyperactivity, conduct, or learning disorders Cigarette smoking History of depression
  6. 6. Clinical features of depression • Sad mood or loss of interest or pleasure. • Irritability. • Loss of weight, marked change in sleep pattern, loss of appetite. • Psychomotor agitation or retardation (inability to sit still, temper tantrums or inability to get started are characteristic). • Reduction in energy levels, fatigue, and boredom. • Feelings of worthlessness or guilt (in children and young people this is usually attributed to what others think of them). • Continues ….
  7. 7. • Impaired thinking, concentration or decision making with deterioration in schoolwork and school refusal. • Anhedonia (an inability to enjoy pleasurable activities). • Social withdrawal. • Combativeness with parents. • Loss of interest in schoolwork. • Delinquent behaviour. • Recurrent thoughts of death or suicide.
  8. 8. • Psychotic depression – Associated with apparent loss of reality – Delusions or hallucinations, with a depressive and self-critical or self punitive content, are prominent • Bipolar disorders – Occasional elevation in mood status such as excitability, irritability, excess energy, lack of judgment, and disinhibition.
  9. 9. Differential diagnoses • • • • • • Normal reactive feelings of sadness Anorexia nervosa Severe anxiety Disruptive disorder ADHD Medical disorders such as epilepsy, systemic lupus erythematosus, traumatic brain injury, space occupying lesion, endocrinopathies, and dementias • Adverse drug reactions, for example clonidine, stimulants and steroids • Substance abuse (in particular ecstasy, amphetamines, barbiturates, and cocaine) • Psychosis.
  10. 10. Risk factors for completed suicide and suicide attempts Suicidal ideation and/or attempts • Females • Previous suicide attempt and ideation • Major or minor depressive disorder • Substance abuse • Antisocial behaviour • Undesirable life events • Problems with parents, partners, school, or work Loss in males • Sexual or physical abuse Completed suicide • • • • • • • • • Males Previous suicide attempt and ideation Familial psychiatric disorder and completed suicide attempt. Mood disorder—60% Alcohol or drug abuse (particularly in males) Antisocial behaviour Acute life crisis Disciplinary crisis/dispute with friend or parent Legal or disciplinary problems in past year
  11. 11. Warning signs for suicide behaviour – In short term; • • • • • • • • Thoughts of suicide as a solution to a problem References to suicide in conversation Disciplinary crisis or expulsion from school Preparation in the form of writing a will or a final message Increase in help seeking behaviour Improvement of mood directly beforehand During the early stages of treatment the patient is particularly vulnerable to suicide Recurrence of a situation that preceded a previous attempt of self-harm
  12. 12. – In longer term; • Psychiatric morbidity • Previous suicide attempts of patient or parent especially when accompanied by a strong desire to die • Recent losses • Hopelessness • Lack of confiding friend and isolation • Learning disorder or academic underachievement • History of violent or impulsive behaviour • Social disadvantage: broken home, unwanted pregnancy, conflict with parents, sexual, and physical or emotional abuse. – Sexually abused girls are 20 times more likely and sexually abused boys 40 times more likely to commit suicide
  13. 13. Management • Encourage the child to avoid; – Alcohol, illegal drugs, sleep deprivation, academic & work pressure, or pretending that nothing is wrong. • Encourage the parents to avoid; – Self-blame – Exhaustion – Psychological cause hunting
  14. 14. Psychopharmacology • The first line drugs used are selective serotonin reuptake inhibitors & the new reversible monoamine oxidase inhibitors (RIMAs). • SSRIs are on the whole well tolerated and present minimal danger in overdose • Second line medications include venlafaxine and nefazadone • TCA’s are not recommended for the treatment of depression in this age group as they are less effective, have unpleasant side effects, and are dangerous in overdose
  15. 15. Psychosocial therapies • Interpersonal: relieve symptoms through resolution of interpersonal problems and improved social adaptation (role playing) • Analytic: personality reorganization, adoption of mature defences, realistic sense of self and resolve past traumas if any (development of transference relationships which helps in the development of insight. • Play: to understand wishes, fantasies & traumas. Discharging feeling via physical activities.
  16. 16. • Behavioral: reduced positive reinforcement from environment which produces stimulus for depression (modeling/shaping for appropriate prosocial behavior) • Family: positive reframing decrease blaming and scapegoating, altering unhealthy family rules, recognizing crossgenerational dynamics. • School based: diagnose & address spl needs rltd to language or learning difficulties, social inadequacies, etc. by altering class room envmnt or mode of
  17. 17. Thank You