This document discusses adolescent depression, including its history, scope, causes, clinical manifestations, suicide risk, and management. It notes that depression is a common and serious medical illness in adolescents, with a prevalence of 4-8% having experienced depression in the past year. Left untreated, adolescent depression can lead to suicide, which is a leading cause of death among youth. The document explores the complexities in diagnosing and treating depression in adolescents due to developmental factors and outlines approaches to assessing and managing adolescent depression.
This document provides an overview of post-traumatic stress disorder (PTSD) including its biology and management. It discusses the neurobiology of PTSD and how trauma affects the brain. Key points include:
- PTSD is an anxiety disorder that develops after a traumatic event and is characterized by re-experiencing, avoidance, mood/cognition changes, and arousal.
- Neuroimaging shows decreased hippocampal volume and hyperactivity in the amygdala in those with PTSD, reflecting altered stress responses.
- The hypothalamus-pituitary-adrenal axis is sensitized in PTSD, leading to low cortisol levels despite high corticotropin-releasing factor in the brain.
Hanipsych, functional recovery in depressionHani Hamed
This document discusses functional recovery in depression. It begins by providing statistics on the prevalence of depression and other psychiatric disorders worldwide. It then discusses various milestones in the treatment of depression such as response, remission, and relapse. While symptom remission is an important goal, it does not always translate to functional improvement. Factors like residual symptoms, impairment at work or home, and social/emotional functioning are important to patients. The document presents evidence that escitalopram treatment can significantly improve daily living and functional outcomes compared to other antidepressants.
The document provides an overview of adjustment disorders and mood disorders. It defines adjustment disorders as the development of emotional or behavioral symptoms in response to identifiable stressors that resolve within 6 months of the stressor ending. It notes the most common types are with depressed mood, anxiety, disturbance of conduct, or disturbance of emotion and conduct. For mood disorders, it focuses on defining major depressive disorder and bipolar disorder, their epidemiology, etiology, clinical presentation, course, and treatment options including medication and psychotherapy.
Major depression is more common in the elderly than younger adults. Factors involved in the etiology of depression in the elderly include degenerative processes, somatic comorbidities like cardiovascular disease, and psychosocial stressors such as bereavement, loneliness, and admission to assisted living facilities. Clinical characteristics of depression that are more frequent in the elderly include delusional depression, somatic complaints, and executive dysfunction. Treatment involves cognitive evaluation, basic medical testing, and neuroimaging. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are considered first-line antidepressant treatments, though dose adjustments may be needed and alternative therapies like psychotherapy, exercise, or electroconvulsive therapy can also be beneficial. Special
Adjustment disorder is a maladaptive reaction to an identifiable psychosocial stressor that occurs within 3 months of the stressor's onset and causes social or occupational impairment beyond what would be expected. It is a very common disorder, affecting about 10% of people in some studies. Adjustment disorder is diagnosed using the DSM-5 or ICD-10 and treated with psychotherapy, support groups, medication, or a combination. Developing strong social support networks and living a healthy lifestyle can help prevent adjustment disorder.
The document summarizes research on depression among medical students. Some key findings:
- Depression rates are similar entering medical school but increase disproportionately over the course of study, peaking as students prepare for clinical work. Long hours, stress, and insecurity about examinations contribute.
- Over 50% of medical students seek help for depression or other mental health issues. Females are more likely to experience depression than males.
- Depression can be effectively treated with antidepressants and psychotherapy. Untreated, it can lead to disability, absenteeism, suicide and economic costs.
- A study of Gulf Medical University students found depression in 25% of students. Rates varied by gender, nationality,
Diagnosis and management of major depressive disorderNeurologyKota
This document provides information on major depressive disorder and dysthymic disorder, including their symptoms, classifications, prevalence, risk factors, pathophysiology, diagnostic criteria, sleep abnormalities seen in depression, and treatment options. It discusses antidepressant medications like TCAs, MAOIs, SSRIs, SNRIs, augmentation therapies, psychosocial therapies, and ECT in the treatment of depressive disorders.
This document provides an overview of post-traumatic stress disorder (PTSD) including its biology and management. It discusses the neurobiology of PTSD and how trauma affects the brain. Key points include:
- PTSD is an anxiety disorder that develops after a traumatic event and is characterized by re-experiencing, avoidance, mood/cognition changes, and arousal.
- Neuroimaging shows decreased hippocampal volume and hyperactivity in the amygdala in those with PTSD, reflecting altered stress responses.
- The hypothalamus-pituitary-adrenal axis is sensitized in PTSD, leading to low cortisol levels despite high corticotropin-releasing factor in the brain.
Hanipsych, functional recovery in depressionHani Hamed
This document discusses functional recovery in depression. It begins by providing statistics on the prevalence of depression and other psychiatric disorders worldwide. It then discusses various milestones in the treatment of depression such as response, remission, and relapse. While symptom remission is an important goal, it does not always translate to functional improvement. Factors like residual symptoms, impairment at work or home, and social/emotional functioning are important to patients. The document presents evidence that escitalopram treatment can significantly improve daily living and functional outcomes compared to other antidepressants.
The document provides an overview of adjustment disorders and mood disorders. It defines adjustment disorders as the development of emotional or behavioral symptoms in response to identifiable stressors that resolve within 6 months of the stressor ending. It notes the most common types are with depressed mood, anxiety, disturbance of conduct, or disturbance of emotion and conduct. For mood disorders, it focuses on defining major depressive disorder and bipolar disorder, their epidemiology, etiology, clinical presentation, course, and treatment options including medication and psychotherapy.
Major depression is more common in the elderly than younger adults. Factors involved in the etiology of depression in the elderly include degenerative processes, somatic comorbidities like cardiovascular disease, and psychosocial stressors such as bereavement, loneliness, and admission to assisted living facilities. Clinical characteristics of depression that are more frequent in the elderly include delusional depression, somatic complaints, and executive dysfunction. Treatment involves cognitive evaluation, basic medical testing, and neuroimaging. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are considered first-line antidepressant treatments, though dose adjustments may be needed and alternative therapies like psychotherapy, exercise, or electroconvulsive therapy can also be beneficial. Special
Adjustment disorder is a maladaptive reaction to an identifiable psychosocial stressor that occurs within 3 months of the stressor's onset and causes social or occupational impairment beyond what would be expected. It is a very common disorder, affecting about 10% of people in some studies. Adjustment disorder is diagnosed using the DSM-5 or ICD-10 and treated with psychotherapy, support groups, medication, or a combination. Developing strong social support networks and living a healthy lifestyle can help prevent adjustment disorder.
The document summarizes research on depression among medical students. Some key findings:
- Depression rates are similar entering medical school but increase disproportionately over the course of study, peaking as students prepare for clinical work. Long hours, stress, and insecurity about examinations contribute.
- Over 50% of medical students seek help for depression or other mental health issues. Females are more likely to experience depression than males.
- Depression can be effectively treated with antidepressants and psychotherapy. Untreated, it can lead to disability, absenteeism, suicide and economic costs.
- A study of Gulf Medical University students found depression in 25% of students. Rates varied by gender, nationality,
Diagnosis and management of major depressive disorderNeurologyKota
This document provides information on major depressive disorder and dysthymic disorder, including their symptoms, classifications, prevalence, risk factors, pathophysiology, diagnostic criteria, sleep abnormalities seen in depression, and treatment options. It discusses antidepressant medications like TCAs, MAOIs, SSRIs, SNRIs, augmentation therapies, psychosocial therapies, and ECT in the treatment of depressive disorders.
The term “psychosomatic disorder” is mainly used to mean “a physical disease that is thought to be caused, or made worse, by mental factors.” ... For example, chest pain may be caused by stress and no physical disease can be found.
This document discusses elderly depression, suicide risk, and treatment options. It notes that depression is a leading cause of disability worldwide. Late life depression prevalence is estimated at 1-3% of those aged 65 and older. Risk factors for late life depression include chronic illness, cognitive impairment, and lack of social support. Screening tools like the PHQ-9 and GDS can help assess depression severity. Treatment may include psychotherapy, pharmacotherapy, partial hospitalization, or inpatient care depending on symptom severity and suicide risk. Managing elderly depression requires considering medical comorbidities and choosing appropriate treatment.
Depression commonly occurs in medical settings and can be caused by medical illnesses or their treatments. It is important to thoroughly evaluate depression in medically ill patients, as their symptoms may overlap with medical conditions or be side effects of medications. Treatment of depression in this population requires considering any interactions between antidepressants and other drugs, and utilizing biological, psychological, and educational approaches. Managing both the medical and psychiatric conditions is needed to improve outcomes.
This document discusses depression in the elderly population. It finds that around 5% of community-dwelling elderly have major depression, while that number rises to 12-30% in institutional settings. Late-life depression is defined as major depressive disorder in adults aged 60 or older. Depression in the elderly often presents atypically with somatic complaints rather than mood changes. The document outlines risk factors, screening tools, differential diagnoses, treatment considerations, and types of depression seen in elderly patients.
This document discusses depression in older adults, including barriers to treatment, treatment goals and modalities, and considerations for providers and patients. It describes common psychotherapies and pharmacotherapies used to treat depression at different phases. The goals are to resolve current episodes, prevent relapse and recurrence, and improve quality of life and functioning. Barriers include inadequate treatment, lack of accessible care, and limited specialty mental health use.
The correct answer is C. Apnea is not a symptom of depression. It denotes pause or absence of breathing during sleep and is not included in the DSM criteria for depression.
This document discusses mental health issues affecting older women. It covers demographics showing increasing life expectancy. Having a early-onset mental illness brings additional challenges with aging like interacting medications. Late-life mental illnesses discussed are dementia, delirium, and depression which are underrecognized. Physical changes from aging impact the presentation and treatment of mental illnesses. Stigma is a barrier to care. With appropriate treatment and management of issues, recovery and well-being are possible for older women with mental health conditions.
D, a 10-year-old boy, presented with deteriorating vision but no medical cause was found. During the consultation, it was revealed he lived with a stepfather he did not like and had family relationship issues. After discussing his difficult family situation, D reported that his vision had returned to normal. This suggests he may have been experiencing a somatoform disorder where psychological or emotional factors were affecting his physical symptoms.
This document provides an overview of conversion disorder, including:
- Definitions, related illnesses, risk factors and symptoms of conversion disorder
- Neurobiological frameworks for conversion disorder involving altered attention, awareness and affect dysregulation
- The importance of comprehensive assessment including objective neurological exams, diagnostic imaging, and screening tools
- A case review of 34 patients with conversion motor paralysis who underwent rehabilitation treatment, with most showing improvement.
Suicidal tendencies in late life depressionRavi Soni
This document discusses suicidal tendencies and prevention in the elderly. It provides statistics on elderly suicide rates globally and in India. Key points include that nearly 10% of Indian suicides are among those aged 65+, though the rate is lower than other countries due to family support of elders. Common risk factors for elderly suicide are depression, physical illness, social isolation and loss of spouse. Treatment of depression and pain are important for prevention, though SSRIs may increase short-term risk which decreases after the initial period. Goals for prevention include raising awareness of suicide and depression.
The document describes the presentation, assessment, and treatment of late life depression through an interprofessional approach, outlining the epidemiology and risk factors for depression in older adults, methods for diagnostic assessment and differential diagnosis of mood disorders like major depression and bipolar disorder, and the role of both pharmacological and non-pharmacological therapies in treatment.
This document discusses psychiatric emergencies and their management. It defines a psychiatric emergency as an unforeseen situation requiring immediate action to protect the individual and others. Common emergencies include suicidal threats, violence, panic attacks, catatonic states, and drug toxicity. The goals of emergency intervention are to safeguard life, reduce anxiety, and enhance emotional security. Treatment depends on the specific condition but generally involves sedation, reassurance, searching for underlying causes, and ensuring safety. Proper handling of emergencies is important to prevent anxiety in others and allow for normal facility operations.
1. Psychosomatic disorders occur when mental stress or emotional factors negatively impact physical health. According to Unani medicine, disturbances in psychic faculties like the brain can lead to stress-related issues like depression.
2. Unani recognizes lifestyle factors like diet, exercise, sleep, and social support as essential to well-being. Imbalances in these "six essentials" as well as the temperament can contribute to psychosomatic disorders.
3. Treatment focuses on eliminating causes, correcting temperament imbalances, and strengthening the heart-mind connection. Approaches include dietary therapy, exercise, relaxation, and medications aimed at reducing stress symptoms.
The document discusses the history and evolution of somatic symptom and related disorders. It describes how concepts like hysteria, hypochondriasis, and psychosomatic disorders developed before being categorized under somatic symptom disorder, illness anxiety disorder, conversion disorder, and other diagnoses in DSM-5. It provides details on the characteristic symptoms, thresholds, and specifiers for each DSM-5 disorder category. Theories on the causes of related conditions like pseudocyesis are also summarized.
This document provides information on late life depression, including its epidemiology, presentation, risk factors, screening and diagnostic tools, and treatment options. Specifically, it discusses a study that found escitalopram effective in preventing relapse of major depressive disorder in elderly patients. The study had two periods: an initial 12-week open-label acute treatment with escitalopram, followed by a 24-week double-blind continuation treatment with escitalopram or placebo. Results showed escitalopram significantly reduced relapse rates and was well tolerated as a continuation treatment for late life depression.
Nurses and nursing assistants play a crucial role in recognizing and treating depression in elderly patients. [1] Studies show that nurses and assistants recognize around 50% of depressive episodes in elderly patients. [2] Recognition can be improved through staff training and the use of screening tools. [3] Non-pharmacological interventions led by nurses, such as behavior therapy, exercise, music therapy and emotion-oriented care, can effectively treat depression. [4] Proper communication between nurses, patients, families and doctors is key to optimizing depression care for elderly individuals.
The document discusses geriatric depression, also known as depression in older adults. It defines depression as an illness that affects mood, body, and thoughts and impacts eating, sleeping, self-esteem, and thinking. Depression prevalence increases with age, affecting 1 in 5 older people living independently and 2 in 5 living in care homes. Risk factors include genes, personal history of depression, brain chemistry changes, stressful life events like loss of a loved one, and physical illness. Treatments discussed include therapy, medication, lifestyle changes like exercise and social activity, and Ayurvedic treatments like massage, herbal oil application, and stimulating pressure points.
This document discusses recent updates on the treatment of schizophrenia. It summarizes that cognitive behavioral therapy has the strongest evidence for reducing symptoms in outpatients. It also discusses other therapies like compliance therapy and supportive therapy. Future research may explore using psychotherapy to support patients emotionally, enhance recovery of functioning, or alter the underlying illness process. The document also summarizes recent findings that schizophrenia may be linked to increased risk of autoimmune diseases, and that sodium benzoate shows promise as an adjunct treatment for improving symptoms and cognition in schizophrenia.
The document discusses oxytocin and its effects on behavior and the brain. It summarizes research showing that oxytocin is involved in social behaviors and stress response. While oxytocin has potential applications for several psychiatric disorders by improving social functioning, long term effects need further study and there are still questions about oxytocin's mechanisms of action in the brain.
The term “psychosomatic disorder” is mainly used to mean “a physical disease that is thought to be caused, or made worse, by mental factors.” ... For example, chest pain may be caused by stress and no physical disease can be found.
This document discusses elderly depression, suicide risk, and treatment options. It notes that depression is a leading cause of disability worldwide. Late life depression prevalence is estimated at 1-3% of those aged 65 and older. Risk factors for late life depression include chronic illness, cognitive impairment, and lack of social support. Screening tools like the PHQ-9 and GDS can help assess depression severity. Treatment may include psychotherapy, pharmacotherapy, partial hospitalization, or inpatient care depending on symptom severity and suicide risk. Managing elderly depression requires considering medical comorbidities and choosing appropriate treatment.
Depression commonly occurs in medical settings and can be caused by medical illnesses or their treatments. It is important to thoroughly evaluate depression in medically ill patients, as their symptoms may overlap with medical conditions or be side effects of medications. Treatment of depression in this population requires considering any interactions between antidepressants and other drugs, and utilizing biological, psychological, and educational approaches. Managing both the medical and psychiatric conditions is needed to improve outcomes.
This document discusses depression in the elderly population. It finds that around 5% of community-dwelling elderly have major depression, while that number rises to 12-30% in institutional settings. Late-life depression is defined as major depressive disorder in adults aged 60 or older. Depression in the elderly often presents atypically with somatic complaints rather than mood changes. The document outlines risk factors, screening tools, differential diagnoses, treatment considerations, and types of depression seen in elderly patients.
This document discusses depression in older adults, including barriers to treatment, treatment goals and modalities, and considerations for providers and patients. It describes common psychotherapies and pharmacotherapies used to treat depression at different phases. The goals are to resolve current episodes, prevent relapse and recurrence, and improve quality of life and functioning. Barriers include inadequate treatment, lack of accessible care, and limited specialty mental health use.
The correct answer is C. Apnea is not a symptom of depression. It denotes pause or absence of breathing during sleep and is not included in the DSM criteria for depression.
This document discusses mental health issues affecting older women. It covers demographics showing increasing life expectancy. Having a early-onset mental illness brings additional challenges with aging like interacting medications. Late-life mental illnesses discussed are dementia, delirium, and depression which are underrecognized. Physical changes from aging impact the presentation and treatment of mental illnesses. Stigma is a barrier to care. With appropriate treatment and management of issues, recovery and well-being are possible for older women with mental health conditions.
D, a 10-year-old boy, presented with deteriorating vision but no medical cause was found. During the consultation, it was revealed he lived with a stepfather he did not like and had family relationship issues. After discussing his difficult family situation, D reported that his vision had returned to normal. This suggests he may have been experiencing a somatoform disorder where psychological or emotional factors were affecting his physical symptoms.
This document provides an overview of conversion disorder, including:
- Definitions, related illnesses, risk factors and symptoms of conversion disorder
- Neurobiological frameworks for conversion disorder involving altered attention, awareness and affect dysregulation
- The importance of comprehensive assessment including objective neurological exams, diagnostic imaging, and screening tools
- A case review of 34 patients with conversion motor paralysis who underwent rehabilitation treatment, with most showing improvement.
Suicidal tendencies in late life depressionRavi Soni
This document discusses suicidal tendencies and prevention in the elderly. It provides statistics on elderly suicide rates globally and in India. Key points include that nearly 10% of Indian suicides are among those aged 65+, though the rate is lower than other countries due to family support of elders. Common risk factors for elderly suicide are depression, physical illness, social isolation and loss of spouse. Treatment of depression and pain are important for prevention, though SSRIs may increase short-term risk which decreases after the initial period. Goals for prevention include raising awareness of suicide and depression.
The document describes the presentation, assessment, and treatment of late life depression through an interprofessional approach, outlining the epidemiology and risk factors for depression in older adults, methods for diagnostic assessment and differential diagnosis of mood disorders like major depression and bipolar disorder, and the role of both pharmacological and non-pharmacological therapies in treatment.
This document discusses psychiatric emergencies and their management. It defines a psychiatric emergency as an unforeseen situation requiring immediate action to protect the individual and others. Common emergencies include suicidal threats, violence, panic attacks, catatonic states, and drug toxicity. The goals of emergency intervention are to safeguard life, reduce anxiety, and enhance emotional security. Treatment depends on the specific condition but generally involves sedation, reassurance, searching for underlying causes, and ensuring safety. Proper handling of emergencies is important to prevent anxiety in others and allow for normal facility operations.
1. Psychosomatic disorders occur when mental stress or emotional factors negatively impact physical health. According to Unani medicine, disturbances in psychic faculties like the brain can lead to stress-related issues like depression.
2. Unani recognizes lifestyle factors like diet, exercise, sleep, and social support as essential to well-being. Imbalances in these "six essentials" as well as the temperament can contribute to psychosomatic disorders.
3. Treatment focuses on eliminating causes, correcting temperament imbalances, and strengthening the heart-mind connection. Approaches include dietary therapy, exercise, relaxation, and medications aimed at reducing stress symptoms.
The document discusses the history and evolution of somatic symptom and related disorders. It describes how concepts like hysteria, hypochondriasis, and psychosomatic disorders developed before being categorized under somatic symptom disorder, illness anxiety disorder, conversion disorder, and other diagnoses in DSM-5. It provides details on the characteristic symptoms, thresholds, and specifiers for each DSM-5 disorder category. Theories on the causes of related conditions like pseudocyesis are also summarized.
This document provides information on late life depression, including its epidemiology, presentation, risk factors, screening and diagnostic tools, and treatment options. Specifically, it discusses a study that found escitalopram effective in preventing relapse of major depressive disorder in elderly patients. The study had two periods: an initial 12-week open-label acute treatment with escitalopram, followed by a 24-week double-blind continuation treatment with escitalopram or placebo. Results showed escitalopram significantly reduced relapse rates and was well tolerated as a continuation treatment for late life depression.
Nurses and nursing assistants play a crucial role in recognizing and treating depression in elderly patients. [1] Studies show that nurses and assistants recognize around 50% of depressive episodes in elderly patients. [2] Recognition can be improved through staff training and the use of screening tools. [3] Non-pharmacological interventions led by nurses, such as behavior therapy, exercise, music therapy and emotion-oriented care, can effectively treat depression. [4] Proper communication between nurses, patients, families and doctors is key to optimizing depression care for elderly individuals.
The document discusses geriatric depression, also known as depression in older adults. It defines depression as an illness that affects mood, body, and thoughts and impacts eating, sleeping, self-esteem, and thinking. Depression prevalence increases with age, affecting 1 in 5 older people living independently and 2 in 5 living in care homes. Risk factors include genes, personal history of depression, brain chemistry changes, stressful life events like loss of a loved one, and physical illness. Treatments discussed include therapy, medication, lifestyle changes like exercise and social activity, and Ayurvedic treatments like massage, herbal oil application, and stimulating pressure points.
This document discusses recent updates on the treatment of schizophrenia. It summarizes that cognitive behavioral therapy has the strongest evidence for reducing symptoms in outpatients. It also discusses other therapies like compliance therapy and supportive therapy. Future research may explore using psychotherapy to support patients emotionally, enhance recovery of functioning, or alter the underlying illness process. The document also summarizes recent findings that schizophrenia may be linked to increased risk of autoimmune diseases, and that sodium benzoate shows promise as an adjunct treatment for improving symptoms and cognition in schizophrenia.
The document discusses oxytocin and its effects on behavior and the brain. It summarizes research showing that oxytocin is involved in social behaviors and stress response. While oxytocin has potential applications for several psychiatric disorders by improving social functioning, long term effects need further study and there are still questions about oxytocin's mechanisms of action in the brain.
Hani hamed dessoki, telomeres and depressionHani Hamed
A study of over 2,400 people found that those with a history of depression had significantly shorter telomeres, representing about 4 to 6 years of accelerated aging at the cellular level. Telomeres are structures at the end of chromosomes that protect DNA from damage. Shorter telomeres have been linked to aging and age-related diseases. While the study does not prove causation, depression is known to disrupt many physical systems in the body and this cellular evidence suggests psychological distress from depression may accelerate biological aging. Further research is still needed to understand the implications and potential for intervention.
This document discusses the potential for using genetic biomarkers to improve treatment for psychiatric disorders. It notes that while the causes of psychiatric disorders are still unclear, identifying genetic markers that predict treatment response could help tailor medication selection. The document outlines several studies that have identified candidate genes associated with response to antidepressants and other psychotropic drugs. It acknowledges limitations but argues that further research in pharmacogenetics, using larger, more standardized studies, could help incorporate genetic testing into clinical practice to select safer, more effective treatments for individual patients.
This document discusses recent updates on the treatment of schizophrenia. It summarizes that cognitive behavioral therapy has the strongest evidence for reducing symptoms in outpatients. It also discusses other therapies like compliance therapy and supportive therapy. Future research may explore different goals of psychotherapy like providing support, enhancing recovery, or altering the illness process. The document also summarizes that new data shows individuals with schizophrenia have an increased risk of autoimmune diseases, and that an immune system protein may be linked to late-onset schizophrenia.
Hani hamed dessoki, telomeres and depressionHani Hamed
A new study found that people who had experienced depression had significantly shorter telomeres, representing about 4 to 6 years of accelerated aging at the cellular level. Telomeres are structures at the end of chromosomes that protect DNA from damage. Shorter telomeres have been linked to aging. The study of over 2,400 people showed that those with a history of depression had telomeres about 83 to 84 base pairs shorter than those without depression, even after accounting for other lifestyle factors. While the study did not prove cause and effect, depression is known to disrupt many physical systems, and these findings suggest psychological distress from depression may lead to accelerated biological aging.
This document provides information on the treatment of schizophrenia including:
- Core symptoms of schizophrenia and their association with brain circuits.
- The development of antipsychotic medications from the 1930s to present, including first and second generation antipsychotics.
- Principles for individualizing treatment with antipsychotic medications to promote recovery, safety, tolerability, quality of life, and value.
- Factors to consider when choosing an antipsychotic such as treatment history, comorbidities, adherence, and demographics.
This document discusses understanding marital conflicts in Egyptian culture. It provides statistics showing that divorce rates in Egypt have increased significantly in recent decades. Marital conflicts arise from problems with communication, feelings of neglect, disrespect, anger, and loneliness. Successful marriages are characterized by affection, positive communication, mutual childcare responsibilities, and effective conflict resolution. Distressed marriages involve more punishment and criticism rather than positive exchanges. Understanding cultural factors is important for addressing marital conflicts in Egypt, such as changing social norms around responsibility in marriage and differing responses to problems compared to the past.
Hani hamed dessoki, side effects of psychotherapyHani Hamed
This document discusses psychotherapy and its potential negative effects. It begins with an introduction to psychotherapy and definitions. It then discusses the history of recognizing potential negative effects. Several perspectives on psychotherapy are provided, including that it generally helps people but may increase anxiety initially for some. The document outlines some potential negative effects like worsening of symptoms, acquiring new symptoms, or dependency. It emphasizes the importance of informed consent in psychotherapy and discusses challenges in defining and identifying negative effects. Overall, it presents a balanced view of psychotherapy's benefits but also stresses the need for therapists to be aware of potential risks.
Stress can have biological impacts through activation of the sympathetic nervous system and HPA axis, releasing hormones like cortisol. Prolonged stress can accumulate as allostatic load and damage the hippocampus over time, impacting memory. Studies link stress and shorter telomeres, a marker of biological aging, showing the lasting impacts of stress on the body. Effective stress management utilizes strategies like exercise, relaxation, and social support.
Dopamine pathways in the brain are implicated in schizophrenia. Hypoactivity in dopamine pathways is associated with negative and cognitive symptoms, while hyperactivity is linked to positive symptoms. Serotonin and catecholamine synthesis and degradation pathways are also involved. Dopamine levels in the mesolimbic pathway correlate with positive symptoms, while levels in the DLPFC and VMPFC regions correlate with negative symptoms and cognitive dysfunction respectively.
This document discusses suicide prevention. It begins by providing statistics on suicide rates worldwide and in the US. It then discusses risk factors for suicide, including demographic, psychiatric, psychological, and childhood trauma factors. Protective factors are also outlined. The document emphasizes that most suicides can be prevented by learning to recognize warning signs and knowing how to respond. Key warning signs of suicide are listed. Myths and facts about suicide are also presented. In summary, the document aims to raise awareness about suicide and prevention efforts.
This document summarizes a study on psychiatric symptoms among children with congenital heart disease. The study aimed to examine depressive and anxiety symptoms as well as neurocognitive deficits in children with congenital heart disease compared to controls. It found that children with congenital heart disease performed significantly worse on tests of cognitive functioning and had higher levels of depressive and anxiety symptoms than controls. Common psychiatric diagnoses among the children with heart disease included adjustment disorder and depression. The results suggest children with congenital heart disease are at increased risk for psychological and cognitive issues.
This document discusses selective serotonin reuptake inhibitors (SSRIs) for treating depression. It provides information on:
- The mechanism of action of SSRIs in blocking serotonin reuptake and their effects on various serotonin receptor subtypes.
- Differences between SSRIs like their selectivity, potency, side effect profiles from receptor binding, and pharmacokinetic parameters.
- Treatment goals for depression like response, remission, and functional recovery; and challenges in achieving optimal outcomes through correct diagnosis, treatment selection, compliance, and monitoring.
This document provides information on the treatment of schizophrenia including:
- Core symptoms of schizophrenia and their association with brain circuits.
- The development of antipsychotic medications from first-generation to second-generation drugs.
- Principles of selecting and prescribing antipsychotics including individualizing treatment, safety, tolerability, and cost considerations.
- Factors to consider when choosing an antipsychotic such as a patient's medical history, adherence, and life stage. Relevant receptor profiles and side effects of different antipsychotics are discussed.
Higher levels of the protein brain-derived neurotrophic factor (BDNF) may protect against Alzheimer's disease and dementia. BDNF targets cortical brain cells, preventing their death and improving learning and memory. Studies have also found that higher serum BDNF levels can protect against future occurrence of dementia and Alzheimer's. Future research may examine using BDNF levels to predict Alzheimer's risk or giving BDNF supplements to older adults to prevent or reduce symptoms.
Hani hamed dessoki, act and schizophreniaHani Hamed
Acceptance and commitment therapy (ACT) is a form of psychotherapy based on relational frame theory and behavioral analysis. It teaches clients to accept unwanted private events like thoughts and feelings rather than trying to control them. The core principles of ACT include cognitive defusion, acceptance, contact with the present moment, observing the self, discovering values, and committed action. A study assessed using ACT over 8 sessions for delusions in addition to treatment as usual. It aimed to build acceptance, willingness, values, and defusion and hypothesized it would decrease distress, delusional conviction, and anxiety levels from baselines.
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This is the slide set to the lectures I provided to the medical staff of Child and Adolescent Behavioral Health in Canton, OH during the Fall-Winter of 2018
The correct answer is D. All of the above. Twin studies have shown a strong genetic influence for schizophrenia, autism spectrum disorder, and attention deficit hyperactivity disorder. For each of these conditions, if one identical twin has the condition, there is a significantly higher chance that the other identical twin will also have the condition compared to fraternal twins or unrelated individuals. This suggests a genetic component is involved in the etiology of these mental health disorders.
Mental health refers to maintaining successful mental functioning including daily activities and relationships. Mental illness occurs when the brain is not working properly, disrupting thinking, emotions, behavior, or physical functioning. Major causes of mental illness include genetics, environment, and brain disorders. While mental illness can significantly impact individuals and families, many people with mental illness live productive lives with treatment. Prevention strategies include creating supportive environments, community education, early detection, and ongoing care for those diagnosed.
Mental Health struggles among Teens.pdfAntony125853
This document discusses mental health issues among teens. It begins by defining mental health and noting that around 1 in 5 teens have a diagnosable mental disorder such as depression or anxiety. Some common disorders discussed include anxiety disorders, depression, eating disorders, substance use disorder, schizophrenia, and ADHD. The document outlines symptoms of these disorders and notes that they are often caused by excessive technology use, social media, academic pressure, and an immature brain. It emphasizes the importance of seeking professional help for mental health issues in teens.
Children are at high risk of emotional disorders. These have become the most common reasons for their visits to the psychiatrist.
They include mood disorders, anxiety disorders, and trauma and stress-related disorders.
This slide explains each of these in details.
Enjoy
This document provides information on bipolar disorder, including its subtypes, diagnostic criteria, epidemiology, clinical presentation, etiology and risk factors, comorbidity, and treatment. It discusses bipolar disorder types I and II, as well as cyclothymic disorder. It outlines the DSM-5 diagnostic criteria for mania, hypomania, and depression. It notes the prevalence of bipolar disorder in adults and youth, gender and age of onset differences, burden of illness, and course of the disorder. It covers etiology, risk factors, and high rates of comorbidity with other psychiatric disorders. It also discusses clinical presentations, differential diagnosis, assessment, and treatment approaches including pharmacotherapy, sleep hygiene, psychosocial
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This document provides an overview of a course on depressive disorders in children and adolescents. The four sessions will cover epidemiology and clinical presentation, evaluation and diagnosis, pharmacotherapy and medical treatments, and non-pharmacologic treatments. Key points include variations in depressive symptoms by developmental stage, diagnostic criteria for major depressive disorder, importance of differential diagnosis and high rates of comorbidity. Rating scales are commonly used but have limitations. Factors like family history, medical conditions, and environment contribute to risk.
Bipolar disorder can present in children and adolescents with manic, hypomanic, or depressive episodes. It is a chronic and disabling condition associated with impaired functioning. Treatment involves medication, psychoeducation, and psychotherapy to stabilize mood symptoms, improve coping skills, and prevent recurrences. Lithium, anticonvulsants, and second-generation antipsychotics are commonly used but require careful monitoring due to side effect risks.
The document discusses depression and suicide in teenagers. It defines depression as a mood disorder causing persistent sadness and loss of interest. There are four main types of depression that affect teens: adjustment disorder, dysthymia, bipolar disorder, and major depression. Risk factors include family history, abuse, bullying and medical issues. Left untreated, depression can lead to problems in school, family life, substance abuse, self-harm and suicide. Warning signs of suicidal thoughts are discussed. Treatment involves therapy, medication, and hospitalization if needed. Parents are advised to provide love, support, and healthy habits to help prevent and treat depression and suicide in teens.
A 42-year-old man is experiencing a recurrent major depressive episode. He had previously responded well to treatment with imipramine but did not tolerate the anticholinergic side effects. Given his history of responding well to antidepressants and preference to avoid side effects, an SSRI with fewer anticholinergic effects would be a suitable first-line treatment option for this episode. Close monitoring would also be important given his risk of recurrence.
PsychologicalDisorders to create lcelh local lanONLYDOWNLOAD1
Psychological disorders are defined by the APA as significant disturbances in thoughts, feelings, and behaviors that lead to distress or disability. The DSM-5 classifies and diagnoses disorders based on symptoms. Perspectives include biological factors like genetics or brain abnormalities and psychosocial factors like learning or environment. The diathesis-stress model suggests some people are predisposed to disorders when faced with stressors. Common disorders are anxiety disorders, depression, PTSD, schizophrenia, and personality disorders.
Suicide is a serious problem among youths and is the third leading cause of death for those aged 10-24. Risk factors include depression and other mental illnesses. While suicide attempts are more common among girls, boys are more likely to die by suicide. Effective prevention and treatment includes evaluating suicidal thoughts and intentions, providing support, and treating any underlying conditions through psychotherapy, medication, or both. Cognitive behavioral therapy and dialectical behavioral therapy can help reduce suicidal ideation and behaviors.
Definition of mental health
Describe the problem statement
List the characteristics of a mentally healthy person
List the warning Signals of Poor Mental Health
Classify mental illness
Enumerate the causes of mental ill-health
Discuss the consequences of poor mental health
Explain about the Mental Health Services
Epidemiology of Alcoholism and Drug Dependence
Describe the Symptoms of drug addiction
Prevention, treatment, and rehabilitation for drug dependence
When is World Mental Health Day
This document discusses mental health issues among college students, specifically depression and bipolar disorder. Some key points:
- Nearly 15% of college students have been diagnosed with depression and about 1/3 report that stress impacts their academic performance.
- The symptoms of depression include feelings of sadness, hopelessness, changes in appetite and sleep, difficulty concentrating, and sometimes suicidal thoughts.
- Bipolar disorder causes shifts between manic and depressive episodes and also mixed states with symptoms of both. It is treated with medication, counseling, or a combination of both.
- Both genetics and stress contribute to depression and bipolar disorder. Seeking treatment is important, as over 80% of individuals see improvement with counseling, medication,
This document discusses depression, anxiety, and epilepsy in children and adolescents. It finds that depression and anxiety are very common psychiatric issues for those with epilepsy. Rates of depression are over 20% for those with epilepsy, compared to 3.7-6.7% in the general population. Anxiety affects up to 40% of youth with epilepsy. The document examines risk factors, screening tools, and treatments like cognitive behavioral therapy and antidepressant medications to address the high prevalence of these important mental health issues in pediatric epilepsy.
This document discusses several factors that can contribute to mental health issues such as school pressures, childhood trauma, social isolation, discrimination, poverty, bereavement, stress, and physical health conditions. It provides statistics showing that 10-20% of children and adolescents experience mental health problems each year, with rates of depression and anxiety increasing significantly. Common illnesses include depression, anxiety disorders, schizophrenia, and bipolar disorder. World Mental Health Day aims to increase awareness and support for those struggling with mental illness.
This document provides information about mood disorders and suicide risk. It discusses the signs and symptoms of mood disorders like major depression and bipolar disorder. It notes that mood disorders are common in children and adolescents and often involve comorbid conditions. Left untreated, mood disorders can negatively impact school performance and social functioning and increase risks of self-harm and suicide. The document outlines strategies for recognizing mood disorders in students and assisting students who are recovering. It also provides guidance on assessing suicide risk and intervening to help ensure student safety and access to appropriate treatment and support.
Depression is a mood disorder involving persistent sadness and loss of interest. It involves episodes of symptoms lasting at least two weeks. Symptoms include changes in appetite, sleep, and energy levels as well as feelings of worthlessness. Depression can be triggered by major life events but also has genetic and biological causes. Treatment options include antidepressant medication and psychotherapy. While there is no cure, many people experience remission of symptoms with proper long-term treatment.
1) Mental disorders vary according to age and gender. Schizophrenia typically occurs in young adulthood while anxiety disorders are more common in young adults. Alcoholism peaks in early midlife.
2) Women have higher rates of schizophrenia, depression, neurosis, and late-life depression while men have higher rates of alcoholism and drug addiction.
3) Environmental stress, powerlessness, and learned helplessness contribute to mental disorders which are more common in lower socioeconomic classes and women.
The document discusses guidelines and best practices for psychiatrists working with media. It emphasizes the importance of ethics, competence, informed consent, and maintaining confidentiality. Psychiatrists should carefully consider their level of expertise on topics, have control over the final published product, and avoid potential harms when engaging with media. The well-being of patients should be the top priority.
The document discusses guidelines and best practices for psychiatrists working with media. It emphasizes the importance of ethics and maintaining professional standards when sharing expertise publicly. Psychiatrists should carefully consider their competence on topics, respect clients' confidentiality, and clarify whether they are offering personal opinions or speaking in an official capacity. When interacting with media, priorities include preparing thoroughly, understanding the purpose and format, and retaining appropriate control over how professional views are presented.
Transcranial ultrasound (TCS) is a non-invasive neuroimaging technique that uses ultrasound waves to visualize deep brain structures through the intact skull. TCS has emerged as a useful tool in psychiatry, with several studies finding characteristic alterations in brain structures in various psychiatric disorders. In depression, TCS often finds reduced echogenicity or interruptions in the brainstem raphe. Studies of bipolar disorder have found both increased third ventricle width and hypoechogenicity of the brainstem raphe. TCS research in other areas such as OCD, panic disorders, and schizophrenia has also identified potential biomarkers related to changes in structures like the caudate nucleus and substantia nigra.
Transcranial ultrasound (TCS) is a non-invasive neuroimaging technique that uses ultrasound waves to visualize deep brain structures through the intact skull. TCS has emerged as a useful tool in psychiatry, with several studies finding characteristic alterations in brain structures in various psychiatric disorders. In depression, TCS often finds reduced echogenicity or interruptions in the brainstem raphe. Studies of bipolar disorder have found both increased third ventricle width and hypoechogenicity of the brainstem raphe. TCS research in other areas such as OCD, panic disorders, and schizophrenia has also identified potential biomarkers related to changes in structures like the caudate nucleus and substantia nigra.
The document discusses coping with anxiety related to the COVID-19 pandemic. It describes common psychological issues that can arise during and after outbreaks, including acute stress, grief, depression, substance abuse, and exacerbation of pre-existing mental health conditions. It outlines vulnerable populations and stressors such as death tolls, job losses, misinformation, and social distancing. Common psychological disturbances like sadness, worry, sleep problems, and substance use are explained. The document provides coping strategies such as limiting news exposure, spending time with family, practicing hobbies, meditation, volunteering, and maintaining a positive outlook.
This document discusses the neurobiology of major depressive disorder (MDD) by examining the key brain regions, neurotransmitter systems, and circuits involved. It begins by outlining the major dopamine, norepinephrine, and serotonin projections in the brain. It then discusses how depressed mood and apathy may relate to inefficient information processing in specific brain regions regulated by these neurotransmitters. The document goes on to summarize the areas of the brain implicated in MDD, including the prefrontal cortex, amygdala, hippocampus, and others. It also outlines cortico-cortical circuits and basal ganglia neurocircuitry that may play a role in the pathology of psychiatric disorders like MDD. Finally, it discusses recent directions in understanding M
This document discusses the relationship between pain and depression. It notes that around 30% of community members suffer from a mental health issue, but only a small portion receive treatment. Major depressive disorder is associated with functional and structural brain changes. Depression and pain commonly occur together and negatively impact health and quality of life. The neurobiology of depression and pain involve neurotransmitters like serotonin, norepinephrine, and dopamine. Depression and chronic pain have overlapping symptoms and biological underpinnings related to these neurotransmitter systems and brain regions like the hippocampus. The document examines theories on how depression and pain may influence each other.
This document discusses the relationship between depression and chronic medical illness. It finds that depression is highly prevalent in many medical conditions, can worsen symptoms and functional impairment, decreases adherence to treatment regimens, and is associated with increased health care costs, morbidity, and mortality. Treating depression can improve health outcomes for individuals with chronic medical conditions.
This document provides an update on antipsychotic medications from Prof. Hani Hamed Dessoki. It discusses oral and long-acting injectable second-generation antipsychotics (SGAs) including two new products, Vraylar and Nuplazid. It also mentions guidelines for antipsychotic use in dementia and a new boxed warning for olanzapine regarding DRESS syndrome. Product and guideline updates are provided at the end.
Aripiprazole is a novel antipsychotic that acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors. This combination of actions helps stabilize dopamine neurotransmission and provides benefits over previous antipsychotics. Studies show aripiprazole has efficacy against positive and negative symptoms with minimal risk of extrapyramidal side effects, prolactin elevation, weight gain, and long-term health consequences compared to other antipsychotics.
Serotonin plays an important role in regulating mitochondrial function and biogenesis in neurons through the 5-HT2A receptor. Stimulation of the 5-HT2A receptor activates the SIRT1-PGC-1α pathway, which are master regulators of mitochondrial biogenesis. This suggests serotonin signaling helps neurons adapt energetically and survive environmental challenges by increasing mitochondrial capacity.
This document discusses how psychotherapy changes the brain and genes. It explains that cognitive behavioral therapy (CBT) has been shown through brain imaging to produce similar changes in the brain as medications for conditions like depression and obsessive-compulsive disorder. Studies have also found that genes influence how responsive children are to psychotherapy for anxiety disorders. Researchers are exploring using biomarkers and genetics to enhance psychotherapy by combining it with drugs or other neurobiological tools.
Antipsychotics are increasingly being used as antidepressants due to their ability to improve outcomes for patients with treatment-resistant depression. While antipsychotics can provide benefits when augmenting antidepressants, they also carry risks like weight gain, akathisia, and metabolic side effects. Future research should aim to better identify patient subgroups most likely to benefit from specific antipsychotic medications and combinations with antidepressants, as well as optimal dosages and durations of treatment to maximize effectiveness and minimize adverse reactions.
Hanipsych, aripiprazole as antidepressantHani Hamed
This document discusses the use of aripiprazole as an adjunctive treatment for major depressive disorder.
1) A study found that adjunctive aripiprazole resulted in significantly greater improvement in depressive symptoms compared to placebo, as measured by the MADRS scale. Remission rates were also higher with aripiprazole.
2) Adjunctive aripiprazole was well tolerated with completion rates similar to placebo and lower discontinuation due to adverse events.
3) Aripiprazole's mechanism of action as a partial agonist at dopamine and serotonin receptors provides a unique pharmacological profile that may improve outcomes for patients with treatment resistant depression when used as an adjunct
The document discusses how examining the eyes can provide insights into mental health conditions. It describes how optical coherence tomography (OCT) can be used to image the retina and optic nerve, revealing changes associated with disorders such as multiple sclerosis, schizophrenia, Parkinson's disease, and Alzheimer's disease. Electroretinography is also discussed as a potential tool for identifying individuals at risk of developing schizophrenia by measuring the retina's response to light. Overall, the document outlines how the eye can act as a "window to the brain" and how its examination has potential for improving diagnosis and monitoring of neurological and neuropsychiatric disorders.
Major depressive disorder affects around 300 million individuals worldwide and is a significant public health concern. While SSRIs are usually first-line treatment, many patients do not respond or have intolerable side effects. Novel antidepressants target multiple neurotransmitter systems and have improved efficacy and tolerability profiles. Vilazodone, vortioxetine, and levomilnacipran are newer antidepressants approved for treatment of MDD. Ketamine, psilocybin, and transcranial magnetic stimulation show promise but require more research before being widely adopted.
Oxytocin is a hormone produced in the hypothalamus that is involved in social behaviors. It modulates areas of the brain related to social cognition and stress response. Alterations in the oxytocin system have been implicated in several psychiatric disorders characterized by impaired social functioning, such as autism, schizophrenia, and borderline personality disorder. Early studies suggest oxytocin may help treat social deficits in autism, but its potential as a treatment for other disorders requires more research. Overall, oxytocin appears to play a role in social behaviors and stress response, and understanding its actions in the brain could provide insights into related psychiatric conditions.
Hanipsych, antipsychotics and antidepressants actionHani Hamed
Antipsychotics have long been used as an adjunct treatment for depressive disorders. Only 60-70% of patients respond to antidepressants alone. Adding an antipsychotic can target multiple receptor systems and may improve outcomes. Second-generation antipsychotics are now preferred due to their safer side effect profiles. Several atypical antipsychotics have been approved to treat depressive disorders based on evidence they provide antidepressant effects. Their mechanisms of action are not fully understood but may involve influencing serotonin and dopamine pathways in areas involved in mood regulation.
Hanipsych,, biology of borderline personality disorderHani Hamed
The document discusses the biology of borderline personality disorder (BPD). It covers the history of BPD and notes that early life stress and trauma are risk factors. Genetics and changes in brain structure/functioning also contribute to BPD risk. People with BPD may have reduced activity in prefrontal regions involved in emotional regulation and increased reactivity in limbic regions like the amygdala. Oxytocin levels are also involved, and treatment focuses on regulating these biological systems through medications and therapies. In conclusion, BPD arises from an interaction of environmental, anatomical, functional, genetic, and epigenetic factors.
The document discusses bipolar disorder and provides an agenda for the topics that will be covered, which include the epidemiology, costs, and hidden forms of bipolar disorder. It is presented by several professors of psychiatry and addresses objectives like understanding subtle and special population presentations of bipolar disorder as well as treatment guidelines. Bipolar disorder is a chronic and disabling condition that is often misdiagnosed or diagnosed late. Accurately diagnosing and treating it can be challenging.
2. Adolescent DepressionAdolescent Depression
Prof. Hani Hamed Dessoki, M.D.Psychiatry
Prof. Psychiatry
Chairman of Psychiatry Department
Beni Suef University
Supervisor of Psychiatry Department
El-Fayoum University
APA member
3. Agenda
• Introduction & History
• Scope of the problem
• Etiology
• Clinical Manifestation
• Suicide
• Management
6. What is Depression?
-Depression is a medical illness
-Major depressive disorder is
(reoccurring periods of depression)
-It is not just the feeling of “ups” and “downs:
It is the most common mood disorder
Major depressive disorder is classified by the feeling of sadness
and loss of interest in nearly all activities for at least 2 weeks
7. Severity of Problem ….
Untreated Depression can be taken as important cause
of suicide in adolescentssuicide in adolescents, even adults
8. A Brief History of Depression in Children andA Brief History of Depression in Children and
AdolescentsAdolescents
• Case reports on childhood depression date to theCase reports on childhood depression date to the early 17early 17thth
centurycentury
• Melancholia in children was first reported in theMelancholia in children was first reported in the mid-19mid-19thth
centurycentury
• In general, however, the existence of depression prior toIn general, however, the existence of depression prior to
1960 was seriously doubted because it was felt that1960 was seriously doubted because it was felt that
childrenchildren’s’s immature superegoimmature superego would not permit thewould not permit the
development of depressiondevelopment of depression
• Research from Europe and NIMH funded American studiesResearch from Europe and NIMH funded American studies
in the 1970in the 1970’s increased the awareness & acceptance of’s increased the awareness & acceptance of
childhood depressionchildhood depression
9. Depression: Scope of the Problem
• Children: 1 year prevalence rate of 2%
• Adolescents: 1 year prevalence rate of 4% to 8%
• National Cormorbidity Survey: 6.1%, 15-24 years
• Lifetime prevalence (up to age 18) 15%-20%
• 65% of adolescents report some depressive symptoms
• 5% to 10% of youth with subsyndromal symptoms have
considerable psychosocial impairment, high family loading
for depression, and an increased risk for suicide and
developing MDD (Fergusson et al., 2005)
10. Scope of the Problem
• Mean length of episodes: 7 to 9 months
• 6% to 10% become protracted
• Recurrence: 30 -50%
• Approximately 20% develop bipolar disorder
• Associated with significant:
• comorbidity
• functional impairment
• risk for suicide
• substance use
11. Increasing Prevalence of Depression in
Adolescence
Depressive Disorders:
• Adults: 15-20% rates; 2:1 female to male
• Age 11: Incidence low; males > females
• Age 13: Incidence rising; males = females
• Age 15, 18, 21: Incidence rising; males <
females
12. Complexities in Diagnosing MDD in Children and
Adolescents
• Overlap of mood disorder symptoms
• Symptoms overlap with comorbid disorders
• Developmental variations in symptom manifestations
• Etiological variations of mood disorders involving gene-
environment interactions
• Are disorders spectrum or categorical disorders
• Effects of medical conditions
13. Need to Recognize Developmental Variations of
MDD
CHILDREN:
• More symptoms of anxiety (i.e.
phobias, separation anxiety),
somatic complaints, auditory
hallucinations
• Express irritability with temper
tantrums & behavior problems,
have fewer delusions and
serious suicide attempts
ADOLESCENTS:
• More sleep and appetite
disturbances, delusions,
suicidal ideation & acts,
impairment of functioning
• Compared to adults, more
behavioral problems
14. Differential Diagnosis: Complexities of Diagnosing
MDD
• Overlap of symptoms with nonaffective disorders (i.e.,
anxiety, learning, disruptive, personality, eating
disorders):
• Overlapping symptoms include: poor self-esteem,
demoralization, poor concentration, irritability, dysphoria,
poor sleep, appetite problems, suicidal thoughts, being
overwhelmed
15. Seeking Help
Many people feel ashamed or afraid to seek help,
others make light of their symptoms leading
them to suffer in silence.
It’s important to remember that depression isn’t a
character defect or something that you have
brought on yourself
19. Neurobehavioral Development in
Adolescents
Early Adolescence
Puberty stimulates
changes in brain systems
regulating arousal and
appetite that influence
intensity of emotion and
motivation
Late Adolescence
With age and
experience comes
maturation of frontal
lobes which facilitates
regulatory competence
Middle Adolescence
adolescent emotional and
behavioral problems 2nd to poor
regulation skills--particularly when
gap between pubertal arousal and
consolidation of cognitive skills is
extended
20. Stress in students leading to depression
• Parental pressure to perform and to stand out among
other children
• If not come up to expectations
• Frustration
• Physical stress
• Aggression
• Undesirable complexes
21. • Extreme sensitivity to rejection or failure
• Low self-esteem and feelings of guilt
• Frequent complaints of physical illnesses such as
headaches and stomachaches
• Frequent absences from school or poor performance in
school
• Threats or attempts to run away from home
• Major changes in eating or sleeping patterns
(American Academy of Child and Adolescent Psychiatry, 8/98)
Symptoms of Major Depression:Symptoms of Major Depression:
Adolescents with depression may display some of the following signsAdolescents with depression may display some of the following signs
22. • Sad, blue, irritable and/or complains that nothing is fun
anymore
• Trouble sleeping, low energy, poor appetite and trouble
concentrating
• Socially withdrawn or performs more poorly in school
• Can be suicidal
National Institute of Mental Health, Treatment of Adolescent Depression Study (TADS)
Symptoms of Major Depression:Symptoms of Major Depression:
Adolescents with depression may display some of the following signsAdolescents with depression may display some of the following signs
23. Adolescent Anxiety
• Excessive worries
• Worries about school performance
• Difficulty making friends
• Isolative
• Perfectionistic
• Rigid thinking and behavior patterns
• Phobias
24. ConsiderConsider…..…..
It was once thought that only adults developed depression and that
children and teens could not.
Symptoms of depression in children and teens can be difficult to
recognize.
Mood swings and other emotional changes caused by depression
may be overlooked as unimportant or as a normal part of growing up.
Prolonged or severe depression can lead to problems making and
keeping friends, difficulty in school, substance abuse, suicidal
behaviour, and other problems that may carry into adulthood.
Government of British Columbia- B.C. Health Guide: Depression in Childhood and Adolescence
http://www.bchealthguide.org/kbase/topic/major/ty4640/course.htm
25. Depression thinking can become part of a child’s developing personality,
leaving long-term effects in place for the rest of the child’s life.
Future of depressed school-age children….
• School performance and learning
• Lack of trust – can lead to Substance abuse
• Disruptive behaviour
• Violence and Aggression
• Legal troubles and even suicide
26. Clinical Course: Relapse
• Relapse is an episode of MDD
during period of remission
• Predictors of relapse: Natural
course of MDD, Lack of
compliance, Negative life
events, Rapid decrease or
discontinuation of therapy
• 40%-60% youth with MDD
have relapse after successful
acute therapy
• Indicates need for continuous
treatment
27. Clinical Course: Recurrence
• Recurrence is emergence of
MDD symptoms during period
of recovery (asymptomatic
period of more than 2 months)
• Clinical & nonclinical samples
probability of recurrence 20%-
60% in 1-2 years after
remission, 70% after 5 years
Recurrence predictors:
• Earlier age at onset
• Increased number of prior
episodes
• Severity of initial episode
• Psychosis
• Psychosocial stressors
• Dysthymia & other comorbidity
• Lack of compliance with
therapy
28. Clinical Course: Risk of Bipolar Disorder
• 20%-40% MDD youth develop bipolar disorder in 5 years of onset of
MDD
• Predictors of Bipolar I Disorder Onset:
• Early onset MDD
• Psychomotor retardation
• Psychosis
• Family history of psychotic depression
• Heavy familial loading for mood disorders
• Pharmacologically induced hypomania
29. Suicidal Ideation among Adolescents
(Hoberman and Garfinkel 1988)
In a study of 229 completed youth suicides:
• 62% had made a suicidal statement
• 45% had consumed alcohol within 12 hours of killing
themselves
• 76% had shown a decline in academic performance in the
past year
30. Teen Suicide in the U.S.
• There are 25 suicide attempts for every
completion for our country as a whole
• There are between 100-200 teen attempts before
completing suicide
• Girls attempt more often (3:1)
• Boys complete suicide more often (4:1)
• Every year approximately 2,000 teens suicide
Journal of American Academy of Child and Adolescent Psychiatry, Practice Parameters,
2002
31. Although suicide is the 11th
leading cause of death for the overall
population, it is the 3rd
leading cause of death for 15-24 year olds.
32. Risk Factors for SuicideRisk Factors for Suicide
Current suicidal thoughts
Other mental health or disruptive disorders, such as conduct
disorder
Impulsive or aggressive behaviours
Feelings of hopelessness
A history of past suicide attempts
A family history of suicidal behaviour or mood disorders
A history of being exposed to family violence or abuse
Access to firearms or other potentially lethal means
Social isolation/alienation
Government of British Columbia- B.C. Health Guide: Depression in Childhood and Adolescence
http://www.bchealthguide.org/kbase/topic/major/ty4640/course.htm
33. Some common precipitants of suicidal
behavior in teenagers include:
death of a family member or close friend (particularly if by suicide)
loss of a romantic relationship or good friendship
loss of a parent through divorce or separation
loss of a pet, treasured object, job or opportunity
fear of punishment
physical, sexual or psychological abuse
unwanted pregnancy
poor grades
fight or argument with family member or loved one
belief one has harmed or brought harm to a family member or friend
embarrassment or humiliation
concerns about sexuality
suicide of a friend
34. Treatment of MDD in Children & Adolescents
• Psychotherapy for mild to moderate MDD
• Empirical effective psychotherapies: CBT, ITP
• Antidepressants can be used for: non-rapid cycling
bipolar disorder, psychotic depression, depression with
severe symptoms that prevents effective psychotherapy
or that fails to respond to adequate psychotherapy
• Due to psychosocial context, pharmacotherapy alone
may not be effective
35. Treatment of MDD in Children & Adolescents
• Few studies of acute treatment with medication for
MDD
• Few pharmacokinetic & dose-range studies
• SSRI’s may induce mania, hypomania, behavioral
activation (impulsive, agitated)
• No long-term studies of treatment of MDD; long-term
effects of SSRI’s not known
36. Treatment of MDD in Children and Adolescents
• Small number of case reports (King et al, 1991; Teicher et al., 1990)
described association between SSRI’s treatment and increased
suicidal tendencies, possibly linked to behavioral activation or
akathisia
• Abrupt discontinuation with SSRI’s with shorter half-lives may induce
withdrawal symptoms that mimic MDD
• SSRI’s inhibit metabolism of some medications metabolized by
hepatic enzymes (P450 isoenzymes)
• SSRI’s interact with other serotonergic medications (MAOI’s) to
induce serotonergic syndrome (agitation, confusion, hyperthermia)
37. How is Teenage Depression Treated?
Depression is commonly treated
with therapy or with therapy and
medication. A combination of
approaches is usually most
effective:
Cognitive-behavioral therapy focuses on the
causes of the depression and helps change negative
thought patterns.
Group therapy is often very helpful for teens,
because it breaks down the feelings of isolation that
many adolescents experience (sometimes it helps
just to know that "I'm not the only one who feels this
way").
Family therapy as an adjunct to individual therapy
can address patterns of communication and ways
the family can restructure itself to support each
member, and can help the teenager feel like others
share the responsibility for what happens in the
family.
Physical exercisePhysical exercise is helpful in lifting depression, as itis helpful in lifting depression, as it
causes the brain's chemistry to create morecauses the brain's chemistry to create more
endorphins and serotonin, which change mood.endorphins and serotonin, which change mood.
Creative expressionCreative expression through drama, art or music is oftenthrough drama, art or music is often
a positive outlet for the strong emotions ofa positive outlet for the strong emotions of
adolescents.adolescents.
Volunteer workVolunteer work is sometimes helpful for adolescents.is sometimes helpful for adolescents.
Helping someone else whose problems are greaterHelping someone else whose problems are greater
than one's own offers a perspective and also anthan one's own offers a perspective and also an
opportunity to be helpful, which can increase one'sopportunity to be helpful, which can increase one's
sense of purpose and meaning.sense of purpose and meaning.
MedicationMedication for depression should be used with greatfor depression should be used with great
caution, and only under careful supervision. Recentcaution, and only under careful supervision. Recent
studies by both the UK government and the FDA havestudies by both the UK government and the FDA have
led to warnings that not all psychiatric drugs may beled to warnings that not all psychiatric drugs may be
appropriate for teenagers and children. Seek aappropriate for teenagers and children. Seek a
physician who works specifically with teenagers.physician who works specifically with teenagers.
HospitalizationHospitalization may be necessary in situations where amay be necessary in situations where a
teen needs constant observation and care to preventteen needs constant observation and care to prevent
self-destructive behavior. Hospital adolescentself-destructive behavior. Hospital adolescent
treatment programs usually include individual, grouptreatment programs usually include individual, group
and family counseling as well as medications.and family counseling as well as medications.
Helpguide.org: “Teen Depression”
http://www.helpguide.org/mental/depression_teen.htm#symptoms
38. Take SUICIDE Seriously
Even if they are only thoughts about suicide take them
seriously!
The risk of suicide increases in those with depression and it's
important to take suicidal thoughts seriously.
39. What parents can
do for their teen:
Respond with love, kindness, and support
Repeatedly let your child know that you are there, whenever she
or he needs you
Be gentle but persistent if your adolescent shuts you out
Do not criticize or pass judgment once the adolescent begins to
talk
Encourage activity and praise efforts to socialize and be active
Seek help from a doctor or mental health professional if the
adolescent's depressed feeling doesn't pass with time
Helpguide.org; “Teen Depression
http://www.helpguide.org/mental/depression_teen.htm#symptoms
40. Antidepressant SalesAntidepressant Sales
• Prescriptions for antidepressants have dropped by 20% for those 18Prescriptions for antidepressants have dropped by 20% for those 18
y/o and younger since 2004 when FDA initial warnings werey/o and younger since 2004 when FDA initial warnings were
publishedpublished
• Sales of antidepressants among adults were down 14% in 2005Sales of antidepressants among adults were down 14% in 2005
• Sales are climbing again in 2006Sales are climbing again in 2006
41. • Depression in children and adolescents is a serious
problem with potentially disastrous outcomes
• Practical and effective approaches to assessment and
treatment have now been organized
• Several well supported treatment options exist both
pharmacologically and nonpharmacologically
• Antidepressants should be respected, but not feared
Take Home Message
Editor's Notes
False: No, depression is not a choice it is an illness.
Like we mentioned earlier everybody goes through &quot;ups and downs&quot; in their lives. Sometimes we use the term &quot;depression&quot;, or &quot;depressed&quot; to describe these everyday feelings. However, the normal experiences of life shouldn&apos;t be confused with the serious medical illness known as depression. There are many different kinds of mood disorders including, bipolar, schizophrenic but clinical depression is the most common. Depression is classified by the feeling of sadness and loss of interest in nearly all activities for at least 2 weeks
Depression is a very real illnesses that can have serious and sometimes fatal results we will be discussing the most fatal result of depression which is suicide later in this presentation.
Go over each point. Add:
Teens who are depressed often have a negative view of themselves, the world and their future. As such, they may appear to be on the lookout for signs of rejection or criticism. They may appear to overreact to situations that aren’t necessarily negative.
Since they are very connected to their peer groups, depressed teens may feel responsible, or guilty about things that happen with their friends. They see themselves as having little control and their feelings to hinge on things that are happening around them.
Go over key points on slide. Emphasize:
While many people think of depression as a pervasive feeling of sadness, in teens it often shows up as increased irritability.
“Most children experience fluctuations in mood and behavior as a result of normal developmental transitions. Healthy children can exhibit on occasion, any of the symptoms of more serious behavioral and emotional disorders without needing much concern. However, when these symptoms appear over an extended period of time, it is wise to have the child checked by a doctor.” (Red Flags in Children’s Behavior)
Teens also show depression by dropping out of activities that they once found enjoyable, and by reporting that things that they are doing isn’t fun anymore. Depressed teens may continue to try to do things with friends, and may have the expectation that the activity is going to be fun, but then finds that it isn’t fun when they try to do it.
They may stop calling their friends, and may stop taking friend’s phone calls. However, some teens report their most serious symptoms either at home or at school, and may say they feel fine when they are with their friends. This generally has to do with the lower expectations that are placed on them by friends as opposed to home or school.
Younger teens may not actively threaten to kill themselves, but instead might make statements saying they wished they were dead, or had never been born.
Adolescents with anxiety disorders also show a high incidence of suicidal behavior. These may be the children who seem to be doing well in school, show no signs of depression, but who seem to “suddenly suicide”. There are several different disorders which make up the anxiety disorders spectrum. We cannot list all the signs and symptoms of all the disorders here. If you suspect a child may have an anxiety disorder, they should be referred to a mental health professional for evaluation and treatment.
According to the National Education Association, a 1997 study of 16,000 high school students found that:
Over 20% had seriously thought about attempting suicide and:
Over 15% had a specific plan of how to do that.
It is a myth that people who attempt suicide, but do not complete it were “just doing it for attention”. It appears that people who eventually complete suicide may have made multiple prior attempts. While an adult may make 25 attempts before actually killing themselves, teens may make 100-200 attempts.
It is estimated that 2 million U.S. adolescents attempt suicide each year and that almost 700,000 receive medical attention for their attempt. 2,000 teens commit suicide each year. Of those, 90% had an associated psychiatric disorder at the time of death, and more than half had had a psychiatric disorder for at least two years.
Disruptive behavior disorders increase the risk of suicidal ideation in children under 12. Suicidal teens may have depression, anxiety disorders or other mood disorders.
Journal of the American Academy of Child and Adolescent Psychiatry: Practice Parameters, 9/18/02.