Depressive disorders are characterized by sadness or irritability, which are serious enough or long enough to stop to cause difficulties in coping with everyday life and to put considerable concern. The diagnosis can be set from history and examination findings. Treatment includes antidepressants, supportive and cognitive behavioral therapy, or both.

Depressive disorders are characterized by sadness or irritability, which are serious enough or long enough to stop to cause difficulties in coping with everyday life and to put considerable concern. The diagnosis can be set from history and examination findings. Treatment includes antidepressants, supportive and cognitive behavioral therapy, or both.

(Depressive disorders). Depressive disorders are characterized by sadness, or irritability, which are serious enough, or enough to stop long time to cause difficulties in coping with everyday life and to prepare considerable concern. The diagnosis can be set from history and examination findings. Treatment includes antidepressants, supportive and cognitive behavioral therapy, or both. Depression in Children and Adolescents comprise Disruptive Stimmungsdysregulationsstörung major depression Persistent depressive disorder (dysthymia) The term depression is often used colloquially to a depressed or low mood after disappointment (z. B. severe disease) or losses (z. B. Death a related person) to describe. Such depressed moods occur as opposed to depression in waves associated with thoughts or memories of the triggering event sound from when the circumstances or events improve, may alternate with periods of positive emotion or a good mood and will not be of lasting feelings of worthlessness and self-hatred accompanied. The depressed mood lasts usually only days and not weeks or months, and suicidal thoughts and longer-term functional deficits are much less likely. Such depressed moods are appropriately called demoralization or sadness. However, events and stressors that demoralization and grief can also cause an episode of major depression initiate. The etiology of depression in children and adolescents is not known, but is similar to that in adults (Depressive disorders: etiology); it is believed that it is the result of an interaction between genetic and environmental factors (especially deprivation and loss in early childhood). Symptoms and complaints The main characters are similar to those in adults, but are typical childhood issues such as school work and play-related. The children may be unable to explain their inner feelings and states of mind. Depression should be considered when children with previously good performance at school are bad at once retire or become delinquent. In some children with a depressive disorder the predominant mood irritability rather than sadness is (an important distinction between children and adults). Irritability associated with childhood depression may manifest as hyperactivity and aggressive, antisocial behavior. In children with intellectual disabilities to depression or other mood disorders in somatic symptoms and behavioral problems may be noticeable. Disruptive Stimmungsdysregulationsstörung The disruptive Stimmungsdysregulationsstörung includes persistent irritability and frequent episodes of behavior very gets out of hand, with onset between the ages of 6 to 10 years. Many children also have other disorders, especially oppositional defiant disorder (Oppositional behavior disorder), attention deficit / hyperactivity disorder (ADHD) or an anxiety disorder. The diagnosis is not applied after the age of 18 years. As adults, patients can unipolar (rather than a bipolar) depression or develop an anxiety disorder. The manifestations include the presence of the following features for ? 12 months (without a period of ? 3 months without any): Severe recurrent temper (eg verbal anger and / or physical aggression towards people or objects.), Which are highly disproportionate for the situation and the average ? 3 times / week occur temper outbursts that do not match the level of development An irritable, angry mood, which is given every day for most of the day and is observed by others (eg. as parents, teachers, peers) the outbreaks and angry mood must occur under two circumstances of 3 (depressive at home or at school, with peers depressive) disorder .Major major disorder is a discrete depressive episode lasts the ? 2 weeks. Major depressive disorder occurs in 2% of children and 5% of young people. Major depressive disorder can strike at any age but is more common after puberty. Left untreated, major depression subside after 6-12 months. The risk of recurrence is higher in patients who have severe episodes are younger or had multiple episodes. The persistence even easier depressive symptoms during remission is a strong predictor of relapse. Feeling sad or by others as sad (for example, close to tears.) Are felt irritated loss of interest or, for the diagnosis must be ? 1 of the following features for most of the day, his almost daily present during the same period last 2 weeks pleasure in nearly all activities (often expressed as a profound boredom) addition have ? 4 of the following conditions exist: weight loss (in children, failure, the expected weight gain to make), or decrease or increase in appetite insomnia or hypersomnia Psychomotor agitation or retardation, which is observed by others (not self-reported) fatigue or loss of energy Decreased thinking, concentration and ability to make decisions Recurrent thoughts of death (not just fear of dying) and / or suicidal thoughts feelings of worthlessness or plans (d. H. rejected and unloved feel) or excessive or inappropriate guilt Severe depression in an adolescent presents a big risk for school failure, substance abuse and suicidal behavior is (Suicidal behavior in children and adolescents). If they are depressed, children and young people tend to fall in their school performance and peer relationships to verlieren.Persistierende depressive disorder (dysthymia) dysthymia is a persistent depressed or irritable mood, which for most of the day on most days for ? 1 year continues and ? 2 of the following characteristics: loss of appetite or overeating insomnia or hypersomnia Low energy or fatigue Low self-confidence of concentration feelings of hopelessness A major depressive episode may occur before or during the first year (ie before the time criterion for persistent is satisfied depressive disorder). Diagnosis Clinical Evaluation The diagnosis is made due to the symptoms and findings, including those listed above criteria. A detailed analysis of the history and appropriate laboratory tests are needed to rule out other disorders such. As infectious mononucleosis and thyroid diseases. The history should include factors such as domestic violence, sexual abuse and exploitation, and medication side effects. Questions about suicidal behavior should be provided (fantasies, hints attempts). Other mental disorders that increase the risk of depressive symptoms and / or modify its course can (z. B. anxiety, bipolar disorders) must be considered. Some children who develop bipolar disorder or schizophrenia, show initially a severe depression. Once diagnosed, an illumination of family and social relations is useful to identify strains that have triggered the depression. Treatment Simultaneous measures for the family and the school for young people usually antidepressants and psychotherapy for präpubetäre child psychotherapy, followed by antidepressants, if necessary suitable measures for the family and the school must accompany the direct treatment of the child, in order to achieve that the child copes with his daily life and school does not fall. A short hospital stay may be necessary in crisis situations when suicidal intentions are expressed. In adults, a combination of psychotherapy and antidepressants is much better results than both therapies alone. In pre-adolescent children the appropriate treatment is much less clear. Most doctors opt for psychotherapy in younger children. But drugs can be used in younger children (fluoxetine can be used in children ? 8 years), especially if the depression is severe or does not respond to psychotherapy. Typically, an SSRI (see table: drugs for long-term treatment of anxiety and related disorders) the method of choice when an antidepressant is indicated. Children should be monitored carefully because of side effects such as light-headedness and behavioral problems (footnotes in drugs for long-term treatment of anxiety and related disorders). Studies in adults have shown that antidepressants are somewhat more effective with an effect on both systems (serotonergic and adrenergic / dominerg). Such drugs (eg, duloxetine, venlafaxine, mirtazapine;. Some tricyclic antidepressants, in particular clomipramine) but seem to have more side effects. These agents can be particularly useful in the treatment of resistant cases. Nichtserotonerge antidepressants such as bupropion and desipramine can also be combined with an SSRI to increase the effect. As with adults, relapse and recurrence are common. Children and adolescents should be treated after the cessation of symptoms for at least one year. Most experts agree that children should be treated with ? 2 episodes indefinitely. Risk of suicide and antidepressants suicide risk and treatment with antidepressants are a common discussion and Forschungsthema1. In 2004, the US FDA conducted a meta-analysis of 23 durch2 previously conducted studies involving nine different antidepressants. Although no patient carried out a suicide in these studies, a small but statistically significant increase in suicidal thoughts in children and adolescents has been found that taking an antidepressant (about 4% vs. about 2%), resulting in a “black box” warning on all classes of antidepressants introduced (z. B. tricyclic antidepressants, SSRIs, serotonin-norepinephrine reuptake inhibitors such as venlafaxine, tetracyclic antidepressants such as mirtazapine). In 2006, a Metaanalyse3 found (from the UK) of children and adolescents who were treated for depression that patients taking an antidepressant, were compared with those taking placebo a small increase in self-harm or suicide-related events ( 4.8% vs. 3.0% of those treated with placebo). However, if the difference was statistically significant or not, varies depending on the type of analysis (fixed effects analysis or random-effects analysis). There was a non-significant trend towards an increase in suicidal thoughts (1.2% vs. 0.8%), self-injury (3.3% vs. 2.6%) and suicide attempts (1.9% vs. 1.2% ). It seems to have been some differences in risk between the different drugs; however, no direct head-to-head studies have been carried out and it is difficult to control the severity of depression and other confounding risk factors. Observation and epidemiological studies4 have found no increase in the rate of suicide attempts or completed suicides in patients taking antidepressants. In addition, the suicide rate has increased despite a decline in prescriptions for antidepressants. Although antidepressants have limited efficacy in children and adolescents, the benefits seem to outweigh the risks in general. The best approach seems to be to combine the medication with psychotherapy and risk mitigation through a close observation of treatment. Regardless of whether drugs are used or not, suicide is always a concern in a child or adolescent with depression. The following should be done to reduce the risk: parents and psychologists should discuss the issue in detail. The child or adolescent should be supervised at an appropriate level. Psychotherapy with regular meetings should be included in the treatment plan. 1Hetrick SE, McKenzie JE, Merry SN: Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev, November 11, 2012. 2US FDA: Review and evaluation of clinical data: Relationship between psychotropic drugs and pediatric suicidality. 2004. Accessed March 24, 2014. 3Dubicka B, Hadley S, Roberts C: Suicidal behavior in youths with depression Treated with new-generation antidepressants: Meta-analysis. Br J Psychiatry November 189: 393-398, 2006. 4 Adegbite Adeniyi-C, et al: An update on antidepressant use and suicidality in pediatric depression. Expert Opin Pharmacother 13 (15): 2119-2130, 2012 found.


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