Childhood Mood
Childhood Depression
it’s out there and there’s a lot of it
3 of top 10 medications prescribed by all physicians are antidepressant medications - thus plays a big role
family doctors give out more antidepressants than psychiatrists - 40% of family doctor’s practice is psychiatry
society is seeing more depression in adolescents now a days
still don’t know what causes depression but we use a lot of antidepressant medications
75% of what family doctors see is addiction related (i.e. smoking, eating)
Symptoms
key indications of depression in young people - #1 sign is irritability!!
declining school performance
withdrawal from social activities
somatic complaints
sleep difficulties
conduct problems
irritability - #1 sign to look for
looking for the people who don’t have friends, sits by themselves, etc.
Epidemiology
Prevalence of major depression: 2% in pre-pubertal children; 4% in adolescents
Before puberty: boys > girls
Adolescence: girls > boys
Why is this? We don’t know
Etiology
genetics - we know depression runs in families - the chance of anyone having a depression episode is 50%!!
associated with parents who model depression, are emotionally unavailable, or have decreased capacity for caretaking
abuse/neglect issues
Differential Diagnosis
substance abuse (ETOH/drugs)
separation anxiety disorder
reactive attachment disorder - people who cannot attach to other people
ADHD - way over diagnosed, no way to test for it
medical problems (you want to rule out): thyroid, diabetes, neoplasm, epilepsy, lead poisoning
Treatment
therapy: individual (goal = better understanding of yourself or the situation); family
medications: SSRI’s (best right now, fewer side effects but does reduce sexual desire); wellbutrin; tricyclics;
not
MAOI’s
Childhood Bipolar disorder
don’t know what bipolar disease looks like in children; even the 2 top experts disagree as to what it is
Sports Psychiatry
only two people do it
disorders involved: the "thing"; anxiety
Future: ADHD is widely under-diagnosed at the professional athlete level (i.e. Pete Rose)
Examples of consults
:
The "thing"
- when a person cannot do what they need to do; i.e. a batter in a slump has the "thing"
What is it? How do you treat it? What questions do you ask?
Differential Diagnosis = depression, anxiety, substance abuse
Treatment = get them off the field!; if they’re out there too long, it may become a phobia
John Rocker
What to look for = low IQ, bipolar disorder, drug (stimulants) and alcohol