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Question 1

Depression: Diagnostic Features, Symptoms and Treatment Options

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A person is said to be depressed when he or she manifests a loss of energy, loses interest in things that he or she normally finds interesting, has feelings of guilt, finds it difficult to concentrate, has no or reduced appetite, and entertains thoughts of death or suicide (Sadock & Sadock, 2003). Depression is a feature of several mood disorders, as defined by the Diagnostic and Statistical Manual of Mental Disorders 4th ed. (American Psychiatric Association [APA], 2000), including Major Depressive Disorder, Bipolar I Disorder, and Bipolar II Disorder. For a person to be diagnosed with any of these disorders, he or she must meet the criteria for a major depressive episode.

According to the Diagnostic and Statistical Manual of Mental Disorders 4th ed. (APA, 2000), the following criteria must be satisfied to diagnose a major depressive episode:

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1)   Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood

(2)   Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3)   Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4)   Insomnia or hypersomnia nearly every day

(5)   Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6)   Fatigue or loss of energy nearly every day

(7)   Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8)   Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9)   Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a mixed episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

In treating a patient with depression, or any other mood disorders for that matter, several goals must be kept in mind. The first of these is to guarantee the patient’s safety. Next, the patient must be subjected to a complete diagnostic evaluation. Finally, the treatment plan must not only manage the patient’s current symptoms but most also provide for the patient’s future well-being (Sadock & Sadock, 2003).

There are several options for treatment, and the decision is made depending on the severity of the patients’ symptoms. For patients who are at risk for suicide or homicide, cannot take food or shelter, do not have adequate support systems (such as a caring family), or whose symptoms are rapidly progressing, hospitalization is necessary. For all patients with depression, whether they are hospitalized or not, a combination of psychosocial therapy and pharmacotherapy is believed by many clinicians and researchers to be the most effective method of treating depression. Psychosocial therapy may use or include the following approaches: psychodynamic therapy, cognitive therapy, interpersonal therapy, behavior therapy, psychoanalysis, and family therapy. Pharmacotherapy involves the use of such drugs as selective serotonin reuptake inhibitors, tricyclic antidepressants, and lithium.

Question 2

Depression in Children and Adolescents

Children and adolescents are not spared from mood disorders such as depression. The incidence of depression increases as a child’s age increases. Mood disorders are very rare in children of preschool age, whereas it is estimated that 5% of adolescents in the community have major depressive disorder (Sadock & Sadock, 2003).

Although the criteria set in the Diagnostic and Statistical Manual of Mental Disorders 4th ed. (APA, 2000) are applicable to children as well, the ways by which mood disturbances are manifested may vary in children. A depressed child may show diminished enthusiasm in sports, school activities or friends. They may have a general feeling of worthlessness. In addition, there are several symptoms seen in depressed children that appear less often as they become adults. These symptoms include somatic complaints and auditory hallucinations.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. Text rev.) Washington, DC: American Psychiatric Association

Sadock, B. J., & Sadock, V. A. (2003). Synopsis of Psychiatry: Behavioral Sciences / Clinical Psychiatry (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

 

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