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28 terms

Depression and anxiety in children

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