Depression in Youth

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I guess what I miss most is being drunk.
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SUD Assessment

• Parental values
• Genetics
• Culture
• Individual characteristics
• Peer group

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Suicide

• Epidemiology

• Impulse control risk factors

• Biopsychosocial etiology

• Gender differences

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Tic Disorders

• Sudden, rapid, recurrent non-rhythmic,
  stereotyped, motor movement or vocalization
• Tourettes Disorder
• motor before vocal
• autosomal dominant

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Eating Disorders

• Anorexia Nervosa
• Bulimia Nervosa
• Pica

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Symptoms of Depression in Young People

• Irritability

• Denial of depression

• Low self-esteem

• Somatic Complaints

• Depressed appearance

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Diagnosis of Dysthymia

• Depressed or irritable mood lasting a year or
  longer
• Never symptom free for longer than 2 months

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Diagnosis of Dysthymia(Contd.)

• Symptoms
• pessimism
• social withdrawal
• decreased energy
• low self-esteem

• poor concentration
• hopelessness
• sleep and appetite changes

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Risk Factors for MDD and Dysthymia

• Stressful life events

• Parental dysfunction and loss

• Boys - neonatal health problems

• Girls - perceived unpopularity,
• anxiety

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Early Onset Bipolar Disorder

• Changes in mood, sleep pattern and energy
• Hyperactivity and irritability
• Distractibility
• Pressured speech

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Early Onset Bipolar Disorder (Contd.)

• Affective symptomatology
• Visual hallucinations
• Unreasonable irritability and anger

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Epidemiology of Depression

• Incidence increasing

• 4.7 MDD among adolescents

• Mean age of onset 11 years

• 0.7 bipolar among adolescents

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Son, its important to remember that its O.K. to
be depressed.
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Depression Biologic Etiology

• Genetic influences
• Structural and functional changes
• Serotonin and norepinepherine
• Cortisol and growth hormone
• Attachment experience

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Depression Psychosocial Etiology

• Developmental dynamics
• Life stress
• Family dysfunction
• Cultural support

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Depression DDX and Co-mobidity

• Bipolar Disorder

• ADHD

• Anxiety and PTSD

• Medical causes

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Separation Anxiety Disorder

• Excessive anxiety about separation from the home
  or from significant others

• Differential Diagnosis
• Phobia LD
• Conduct Disorder Depression

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Selective Mutism

• Failure to speak in specific social situations
  despite speaking in other situations.

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Reactive Attachment Disorder of Infancy or Early
Childhood

• Developmentally inappropriate social relatedness
  beginning before age 5 associated with
  pathological care.
• Inhibited and Disinhibited Type

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Generalized Anxiety Disorder

• Excessive anxiety and worry for at least 6 months

• Worry about performance at school and sports

• DSM IV criteria less stringent

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Phobias

• Most common disorder in childhood
• Fears and anxieties decrease with age. About 2 -
  3 of adolescents have significant fears.

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Phobias (Contd.)

• Fear of loud noises, the dark, animals, or
  imaginary creatures are common in younger
  children. In older children, fears are more
  focused on health, social and school problems.

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Obsessive-Compulsive Disorder

• High incidence in Tourettes
• Age of onset younger in males
• Basal ganglia disorders (PANDAS)

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PTSD

• Fear of separation, withdrawal, reenactment,
  sleep disturbance, regression, impulsivity
• Anxiety, psychosis
• Physical symptoms, nightmares

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Response to Traumatic Events

• The effect of trauma depends on the mediating
  processes
• developmental level
• biology of the trauma experience
• social context
• coping skills, protective factors, resilience

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Childhood Trauma

• Type I
• full detailed memories
• omens and misperceptions

• Type II
• denial and numbing
• self-hypnosis, dissociation, rage

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Dissociativeexperiences bothduring the
traumaand afterward is relatedto the later
developmentof PTSD
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Biologic Response to Stress

• Genetics
• Fight or flight
• Norepinepherine linked to immediate and prolonged
  response
• Serotonin linked to anxiety and panic in PTSD

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Biologic Response to Stress(Contd.)

• Brain regions involved include locus coeruleus,
  ventral tegmental region, and amygdala
• Increase glucocorticoid release results in loss
  of neurons and decreased dendritic branching in
  hippocampus and cognitive dysfunction.

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The Child Interview (Pynoos)

• Stage I
• focus and traumatic reference

• Stage 2
• relive experience
• coping themes
• closure, recapitulation, courage/strengths

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Associated Problems

• Co-morbid psychiatric disorders
• Substance abuse
• Sexual/intimacy problems