Scribd Logo
Upload

Welcome to Scribd!

  • 5 Mood Problems - Capítulo Carr

    Uploaded by

    mariana.messias007
    8 views27 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    8 views27 pages

    5 Mood Problems - Capítulo Carr

    Uploaded by

    mariana.messias007

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 27
    16 Mood problems Depression in childhood or adoletconce may be particulary distressing experlence for both ‘the young parson and other family membes, particularly parents. This is ilustated by tho aso prosostod in Hox 16.1, Unfortunately tho oulcomo for depression in childhood and Adolescence sno! favourable. Available evidence suggest that while he majority af youngsters recover from a depressive episode within a year, they da nat grow aut of thelr mood dieorder (Harrington, 1995; Kovacs, 1097; Reynolds and Johnsoa, 1994). Major dopresson is @ recurrent condition, and depressed youngsters aro moro likoly than their nondoprossed ‘counterparts ta develop episod of depression as adults although they are no moro likely to develop other types of psyehologleal problem. Double depression—that Is, an ongoing persistent mood disorder (4ysthymia) and an episodic majar depressive condition: severe ‘dopresivo symptoms; matornal depression; and tho absenco of co-morbid conduct probloms have all been shown in longitudinal studies to be prodictive of worse outcomes. While dlepresed youngsters with conduct difficulties have been found ta be less at ak for recurrent ‘plsodas of dapresion, they are at greater sk forthe development of eltionship problemi in adulthood. In this chapter, aller considering the classification, epidemiology and clinica features of rood disorders, a variety of theoretical explanations concerning the aetiology of those types ‘of problom will bo considored slong with relevant empirical evidence. An approach to tho ‘assessment of childhood depression and its ueatment will then be given. This will be {ollowod by a discussion of tho management of suicide risk, Tho chapter will concludo with & ‘consideration af prevention of depression in ais populations Diagnosis and classification Diagnostic criteria for episdes of mj depression fram the DSM IV and ICD-10 classfcstion systams are presented in Table 16.1 along with tems fom the anxious depressed syndrome scale of Achonbach’s Child Behaviour Checklist system, There are muarkod similarities between these three diagnostic systems. Al) three include depressed mond, depressive ‘cognition, and suicidal ideation as central to a depressive epiaade. However, the DSM and ID systems include vegetative or somatic features, which ate cbsent from Achenbech’s syste It is noteworthy that Achonbach’s empirically derivod syndromo, in addition to excluding ‘vgotalive ftures fom its doprossive syndeome, includes anxiety. The co-occurrence of anvoty and depression is dealt with inthe DSM and ICD systems by giving two dlagaots. Box 161 [ACASE OF ADOLESCENT DEPRESSION The O Conners phoned and requ on the pono as ght eto oot History of te presenting probleme In tha ate Interiw he flowing history ofthe preening problom emarged Sara, while clang Ma's room, bad found sane bles of pesure ie ber drawer und conroted ber Mains schol phoned to ask her whereabouts, and fom ths er parents concluded sho wes trotting. Whed conironted by he lather she edt to rating wi a gi Juli, who wa Spparenty wel behaved forthe newt woo, but wes found by her eat on the way home fom, resco xsokng with flo anda pan of four youths who wraiths Ite tons or cay ventes When grounded flowing ths incident, be locked hora a er room fr 28 hours wale oreried pecially aad made Cats of sel-bar, Developmental history Mae wes bora and tod bn Sligo, but moved to Dublin withthe amily 12 months before the steal. Maim's bith wat witnut complications bat bir moor suleed pot part 1. urgent appointment tthe Clana nett ar deprasion for shout six mothe following hor inh. Daring thie poriod Maia wae cared fr by ie aunt Af in Sig, Aoife was one of Sean's four mare sbings Ma's prscho acvelopaect vas unramanable, bl she did ove oubleealing its nto ochol ead wed to is very clingy when her the thar school nthe meng Some abe ete ogo nto enous voles er ly bd eighiaces uring st onthe shoal anor hockey fn. Sh had wo clase finds and mony cguaintances, The Wanton to moconary shoot ss relatively uneven dsr xproaed some une Lo hor mole about managing se rw school. Te at tha hor bo clos lends srt to recondary school with bar ade oh poceae fay ear for he, Howes se found that she wan pystllyaturog nore pil fis he te enc od lt stra bon hs. ‘During hr fst to years socondary school she formed a close rlendship with an olar gi to was paticalaly wild Tae gi, Tec, Hved in asaghepurect lanl und pect «lt tse uneuperied, ines har mths worked Hh work and war oan st ork 3 leping while "lla and ie were i the house. Mate cecastnaly became involved In coats with bet other beans f er alaisahp with rsa uad bemute of he fa! hat she ten aye ot Tater than pormied at Tics and had bon smoking ‘When tbe O'Coaaaes moved to Dubie, Sarah wis hopolel dat the sft hat bad opened etronn bers and her dap eld els, and int ti began Yo bappn ring thoy oaths in Dublin. Mise would confide tha she had few cove nds at tcoo! acd fa ‘eluded by her elt ter She would cy. conta otra flag of lela and ty a for wholn dapat he wvokond but have diel slnping st might However, then she mt Jule wa he gap between sll ade mother wideaed Moire Sesame ibe around the ous She bat fantrume and would not keep hose ruler This wa he land othe presenting problems dverbed above. amily history Sata end Seamus had bovn mario fr 16 years, Thoy mot on holiday in England. Seamus was erking har as dive lt Une and Saas was in tect work Aller ehout «yar anager ns computing manufacturing fi ed Surah ound a scrttial poston inte sue ‘Sarah es happy todo this boss he ad no family te inthe UK: She bad ben bro up in an cchanage ed a ere of fats homes, She we pleted to rove iso a dita her Scams omy of erin ve Sean's mater andi fn avid sling cote bes na formed good rendaips with her ‘Sums and Sarah ad thro eiler, Maire in thir hid year of marrage, Bid four yore Intra Sean to oars afer that. Ar ach etl, Sarah expanse post pant dopesion, Tha fst episod flowing Mae's beh was th wora and laste sin roma All Seas Emily wer very supportive ding ese epaodos and Aco (Samir wie lng Ise [aatatce wok cae ofthe newborn child while Sarah recovered ‘Sum oak a braun ak during hecho’ ary one bat want back to wok fl ime two goat bec the famiy moved to Dublin. The move to Dain was prompted by 8 rat jb olla or Sonmus. The jo, wih «foreign computing manufacturing curpany, wat high | Srossfil an involv lng hours unpredictable ntesptons af oma ile uring se ening nd weekends, and an agressive work athe lft Seams raaivelyunevaabe for fan ie ed when eviahe he was abe and exbaasted in Dublin Sarah found her lta trough he abeans of Seem’ fily of origin and sata com sbeance fot ily fe bcaoe of hs long working hours. This iasation ed Sarah found nl hevng t2 manage the exiss with Maize ohout input ome Soa usr of he work commitment Sho oss Yeeeah crite anc eds Male ‘helt smoking, lesen apd deiace ad's highly empelse, concerned eb Inert sane owaeds Matt's loneliness and snso of daspa. Seamus etitcised or fr sdopting uch on smbiguou positon Maire prveaation Ma's scores on both the intrmlising and extmmalising sles ofthe Child Behaviour secs Teacter Report oom an You Sli Roport For wore inte inca range: Oa te [Caitdhood Depression Inventory, Maire aso soared above the sini! eatff. in Indi Interviews Mae reported suicidal ieaion without intel She described betel at lonely anh oi tha tie a hated ving sn Din, She mined er tend bom he wet sad dreaded png fo school wher sho was oxtracised and humid. She had bocomo engeod In shoplifting ai gts for Ti, who nd bneended ber Lalor he sale goode und eld tors ol coy foregut fr rtf and Trin. She didnot ballavs tt she ould eer Bt int har net schol or do wel nena, dapite ber excelent provi schol eed. She thug at there ras somesing wrong with beeen thal war the razon wy the athe ge excl be. She scribd horsolf = ugy. boring and hor. She found Wat sho could nat concenvate on ber werk and tan dete sno dopresing day dears. She ook back oe le se el i belonged to romans sls, and sad the she Know tinge woul ony gt worse and noting sue could do could change this. Se nod though a ing borslf om tive to tine but hed no frm pln. She ed lly sloping troup the ight and ota sve st 3m ad coud tack oslo. She ft ted most of hone and rarely fol Hike esting mone han tn nd tose ocaatce ave shows alfotve,cogiive, behavioural and somatic fetus consistent with a dagnois ot depression, The cmon! episode has lasted abou ayer. tn adton se shows «van eons problems wie began cal adolescence an have tated sine hen Proisposing factor for her mood disorder neil a promble gente prodixpoiion snd an oul supuraon experience ding hr mlb post puts depression. “The sumerteplade wat precipitated by the move te Duin, which involved the oes of suporant endahips end «school contnt in which she wae scceped and ws perforin shave average, ier doped statis maintained by er sl-tfsting aa of thought, te ft tat se hak now rig har tolled potion nacho and the et ha sha er paent ave [fvolopad a lect ntrctng ha i otes etal overnweved These immocinemaitalning faci cur with «wider social context wher both of ber parents ind themaclves vitally samspportad and adr Sigh lovee of ea. Por Soa no ain strses are work rlste, and for Sash ioation ts the nn stron of ras and Low support hove bogua were the goed wosking el “he conduct problem appear to be sacondary tothe daprsion, They ewe an atampl to ope with elation by aang with deviant po "Thom aya mr of imspertant protective factor in hice wich suggest hatte may ba = positive vuteamo, Those incade Mains high overall lav of weadee ably and prblun ftving se Maire’ ality in the past so make and rantnin ondahie: Sear and Sarah domoastatod caput to matalna good wal reltionbip over may your a tthe fas vee mer epsodse of doprecion’ aed te press ane Mac's commitment rvaving te protien. by her pens, lesen withthe schoo which sed to inctewe Mave involvement Sucre sain such es sports an dram; apd inva copeive Userapy work whi The ways various conditions which involve depressed mood have been classified in DSM IV and ICD-10 aro set out in Figuros 16.1 and 26.2. Both eystome make a distinction between Primary mood disorders and other conditions where effective symptoms are @ secondary featore Within the primary mood disorders, both systems make distinctions between tnipolar ‘nd bipolar mood dacrders and between aevere episode disorders and the milder but more persistent conditions of dysthymia and eyclothymia, which in euler classifiction systems Imay ave boen termed depressive neuroses, Both systems provide a category for schizaifective disorder for cases that show fextizes of schizophrenia and depression, ‘hough only 1CD-10 provides a specific catagory for post-paycholic depression, Roth systems also provide a category for adjustment disorder with depressed mood. ICD-10 js unique in recognising doprssive conduct disorder as a distinct syndrome, Children who show features of msjor depression end conduct disorders would rcsive a dual disgnosis within the DSM IV ‘The distinctions between primary and secondary mood problems; between unipolar and bipolar conditions; and between securrent and persistant disorders have replaced distintions ‘used in oar clasications systems, Theso include: + neurotic and psychotic 1 overt and masked Reviews ofthe classifeaion of mood disorders identify the following reasons for sandoning thoso eatior distinctions (Kendell, 1976; Farmer and McGuffin, 1080; Hazrington, 1095, ]Williams, 1092). Tho nourotic and psychotic distinction, based originally on infrrod peychodynanic woticlogial factors and dillrences in observable symptoms, hs boca Alscarded because infor paychodynamie aetiological diferences have not been supported by ompirical evidence. Tae endogenous-teactivo distinction has boon ebandoned because evidence ffom strostul-lifewrent reerarch shows that slmost all episodes of depression, regardless of qually oc voverliy, are preceded by stressfal Life evwols and in thal pense aro reactive, The recognition that youngeers with depression may show comorbid conduct disorders has rendered the concopt of masked depression unnccassary. since the arm was often used in child and adolescent psychology to clasify depressed youngsters who masked ‘thor ow mood with angry outbursts of aggressive or detricive behaviour osu oe rere cette mie apmin Sprcin pe Spumatncana oa Tmornowsiim agpalmmim Whey, nd treed Cesar grec ne Sacks NTE Spee Satie” ic Smtemamted gtaatmcedionat Shteraytagee Rewegeomen Soothe prevous funcooning At leading to increased Fears ienpues Sader” Seyi Feat Ned saicgcra” Seagate apc renee et SS, ae coe Sioce cgi’ Seema we pclae caren Sepce Tago gona” nS we SE LSet Recs rte + marty amewhes’ + Wa etgueand TMA bow ste Tevepanen "Groat STEEL, eee mete rinee Spkacegece” ‘lomeesune, ‘oe SETS Te Ante wma Taren “iomcsae* Sen Crete seeps’ «Sater Fehr coumeme i Sckiee i irom Se en ip wee ie a + gue oe of rey 1 ing of mare «Fi canton td + cre has of Smo do nx mee Sie wind pte ‘Suna epetson Srp cate scaly sete drs ‘pamee oe ‘epson econ ‘Sh fom yea ‘ey on ‘en charac ieee the way Tepes a ag pa siance to een waaee omer na ‘Poaowe wach Salt comaty ‘ionbie eof coord vaca ‘ray pane. erin wane See See | SE Sessa <=" See =e" Em ieegene Shee RERETAT Bee cece coset” Terre seein” Se Tiegmmomace me sare sored reenplene feat e sons ‘yp pects a6 Source: Adapid from DSM NY (American Peychiate Asoc ‘gunna 080 Yo) sod Acbenberh (998) 1990), 1D VG Wor Heath Epldetlology For childzon and adolesconts tho rlibility of diegnoses of depression in opidamiological studies ranges from 0.36 to 0.9 (s Table 3.2 in Chapter 3). Thus, it appears from the bata ‘condicted studios that even with standardised interview schedules and clear diagnostic teria, sts often dificult to diagnose depression reliably. Depression fs not a rare cont ‘and is’ moro provalont among adoloconts than among children (Harrington, 1993). In ‘community samples, provalanco rats of doprossion in pre-adolasconce range from 05 to 2.5 par cont and in adolescants from 2 to & por cont. Doprossion is vory common among clinic refers n elie studio abost 25 per canta referrals have a major depression Figure 161 Clssication of divers where aod i sor ete in SMV Depression quite commonly occurs in conjunction with other disndns, particularly in children rofored for treatment. In community studies of childhood depression, co-morbidity rales of 20-17 por cont have boon found for conduct disorder, anxiety disorders, and ttontion ote disorlee (500 Table 3.2 in Chapter 3) In community studies of the anxious depresied syndrome ofthe Child Rebevioue Checklist, co-morbidity rates of 15-28 per cant were found for tho eggressive behaviour, attention problems and somatic symptoms syndromes of tho Child Hehovionr Checklist 60 'Tble 3.¢ in Chapter 3) Im elinie sides of refered eases with the Child Behaviour Checklist anxious deprested syndrome, ca-monbdity rates of 20-4 per cont were found for the aggressive behaviour, attention problems and somatic symptoms syndromes ofthe Child Behaviour Checklist (see Table 5.4 in Chapter 3) thas boon mentioned tht in 12D-10 childzen who show both serious conduct problems and depression are given a diagnosis of depressive conduct disorder. This is because these children have w distinct profile. Children with depressive conduct disorder ar who meet DSM lognostic extra for both conduct disordar and dopression have gzeatar mood variability. Ihave worse sponse to imipramine, show higher rates of substance abuso in adulthood, and Ihave lower rates af dopzession i adulthood (Harrington, 1993), ‘Sex differences inthe dsttution of dapression have consistently been found, Depression {is equally common in proadolescont boys and girls but more common in adalescon girls then Figure 16.Chssfcation of disorders whats mood is malo tein I-20 in boys (e00 Table 88 in Chaptr 9). This groster preponderance of depression among toonage isle an among boys is similar tothe sex distebution of depression amang adults. The Tolative contsibution of biological factors and paychosocial factors to this sex diference in provelonco is curently unclear. Hypothesos about differential impact of hormonal changos in puberty on boys and girls and diffring rolo demands on male and fomaleadolesconts doservo ‘exploration (Clinical features ‘The main features of dopression are presented in Table 16.2 Hazengton, 1993: Kovues, 1997 ‘Reynolds and Johnson, 1904). These features may be linked by assuming thatthe depressed child has usually sailor s loss of some sort may be a loss ofan miportant relationship, 8 loss of some valied attribute such ae athletic ability or health, or alos of ttus Table 16.2 Clinical otros of depression Pace ‘ercapl ta ovarde agus rt owdcongoe faces” onion Neve ow ofl, word a fre Ectene pet Mond cogune dln Sapir ero uc Depressed moot tng perp rst rd aphanson anor jchomaorreareion or econ Degree nano Seen at Fem Birney ‘ada pt {ef mpene or overening ‘Gung noche Sec an nod (oem orig Irarpernladurinnt ——_Detarlrton nay retort ‘ihe om per rope Poor scos eters "The ostars coca in weve epaodes of eprenon ‘With rspect to perception, having slfered a loss, depressed children tend ta perceive the ‘world at if farther loses were probable. Depressed children selectively attend to nogative features ofthe environment, and this in turn leads them to engage in depresive cognitions and unzewarding behsviour paters, which further entrench their depressed mood, In seve casos of adolescont doprossion, youngsters may report mood-congruoat euditory hallucinations. We may assume that this sovere perceptual abnormality is present wher ‘youngsters report hearing voices eiiciang tham or teling them dapresive things. Auditory hhlluciations also occur in schizophronia, which is discussod in Chapter 18. Howaver, tho Jallucinations which occur in schizophronia ar not nocessuily mood congruent ‘With respoct fo cognition, eoprossed childron describ themselves, tho word and the future In negetive terms. They evaluate themselves as worthless and are critical oftheir seademic, thetic, musical and social accomplishments. Often this nogative sl-ovalation is expres fas guilt for not living up to certain standards or liting others doven, They see their world including femily, friends and school, as sarewading, critical and hostile or apathetic. They

    You might also like