Depression and anxiety in children

28 terms by nkaefer 

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See also the flashcards for anxiety disorders and mood disorders. I have minimized overlap

Phobia

Excessive fear of an object or situation

Types of specific phobias

Animal phobias
Phobias of the natural environment
Blood-injection-injury phobias
Phobias of a variety of situations

Animal phobias

Some are universal
Usually isolated disturbances that do interfere with one's life and rarely require treatment. Some persist into adulthood

Phobias of the natural environment

May spread by psychological contagion in families
Water, heights and storms

Blood-Injection-Injury phobias

may interfere with a child's dental, physical and psychiatric care. Frequently familial and associated with fainting.

Phobias of a variety of situations

flying, heights, elevators, enclosed spaces, driving, etc

Selective mutism

Children who are mute at school but speak normally at home
Probably a form of social phobia

School phobia

The agoraphobia equivalent of childhood
Caused by fear of crowds or due to separation anxiety disorder

Separation anxiety disorder

Specific to childhood
Child develops intense anxiety to the point of panic, as a result of being separated from a parent or another loved one

Types of children who get separation anxiety disorder

children who are conscientious and well behaved and come from close-knit families

When separation anxiety disorders develop

-Acutely after a psychological stress
-After a medical conditon
-Just out of the blue

Somatic symptoms of school phobia

headaches, stomaches, dizziness and other pains and aches; fatigue
may try to sleep with parents or close to their room

Mothers of children with separation anxiety disorder

20% patients mother is also depressed
worries excessively
clings to child as much as he is to her

Traits linked with the development of anxiety disorders in childhood

Behavioural inhibition with shyness, fear and a tendency to withdraw in response to new situations

Medications to treat anxiety disorders

1. Antidepressants, most commonly SSRIs
2. BZD

Psychtherapeutic interventions

Behaviour therapy or CBT
Patient encouraged to gradually face the phobic object

Prevalence of major depression in childhood and adolescence

1% preadolescents
2-3% adolescents

Signs of depression in the young

usually withdraw from their friends, spend most of their time alone listening to music or watching TV, cling to their parents, are reluctant to go to school, drop out of sports and do poorly in their studies.

Suicidality and depression

Suicidal thoughts and suicidal attempts are less common before puberty

Depression and somnia/appetite

Adolescents with depression usually eat more and sleep more
Rarely see classical insomnia (early wakening)
Spend most of weekend in bed

Dysthymic disorder

Not uncommon in children
"has always been sad"

Children with dysthymia

show more general social impairment than those with major depression
more likely to be seen as being 'bad' children

Prognosis

For the individual episode it is good
80% will have episode recurrence

Complications of depression

disruption of social life (no friends), deterioration of academic achievement, poor school attendance, poor work record, alcoholism and drug abuse, neglect of associated medical illness, eating disorders and suicide.

Morbidity of adolescent depression

Significantly lower educational achievement and social class
More likely to miss work
72% had one or more major depressions during follow up
significantly more hospitalizations and more impairment in their work, leisure, social and family life

Mortality of adolescent depression

26.1% of patients made their first suicide attempt,
23.3% had made repeated suicidal attempts
7.7% had killed themselves

Treatment

First, any associated GMCs or SA
Outpatients with psychotherapy, antidepressants, or both
Usually use SSRIs

Anxiety and depression

Majority present with both

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