Childhood Depression 26.09.09 CAP,NIMHANS
Can children experience sadness <ul><li>The experience and the expression of depression change with age. </li></ul><ul><li...
Incidence <ul><li>Incidence is much low in children compared to adults. </li></ul><ul><li>Adolescents F>M. children M=F </...
DSM-Depression <ul><li>1. Depressed mood ( can also be an irritable mood) </li></ul><ul><li>2. Diminished interest or loss...
Clinical Presentation <ul><li>The age of a child and his or her psychological sophistication can play a major role in the ...
Clinical presentation <ul><li>They look sad, are tearful, have slow movements, and speak in a monotone voice, in a hopeles...
Clinical presentation <ul><li>Somatic symptoms often occur, the most common being stomachaches and headaches.  </li></ul><...
Assessment <ul><li>Structured interviews such as the Diagnostic Interview for Children and Adolescents (DICA) </li></ul><u...
Evaluation <ul><li>Organic etiologies that might mimic a depressive disorder must be ruled out </li></ul><ul><li>Infection...
Evaluation -cont <ul><li>Consideration to the developmental stage of children for determining if a behavior or symptom is ...
Co morbid illness <ul><li>Conduct disorder 40% </li></ul><ul><li>Anxiety 34% </li></ul><ul><li>ICD & DSM different approac...
Treatment- biopsychosocial approach <ul><li>Psychotherapy (individual, family, or group), medication management, education...
Psychotherapy <ul><li>IPT,CBT </li></ul><ul><li>BT, Play therapy </li></ul><ul><li>Parental training, FT </li></ul>
Pharmacotherapy <ul><li>FDA approval for fluoxetine, effective equally in childhood and adolescent .(to be beware of risk ...
Conclusion <ul><li>Childhood depression should be identified and treated because it has got a significant adverse effect o...
Reference <ul><li>CTP </li></ul><ul><li>OTP </li></ul><ul><li>Melvin Lewis </li></ul><ul><li>Micheal Rutter. </li></ul><ul...
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Childhood Depression

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Childhood Depression

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

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