User:Ongmianli/Portfolios/Adolescent depression

=Adolescent Depression (description, assessment and diagnosis)=

Demographic Information
This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled, and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of adolescent depression that they are likely to see in their clinical practice.

Base Rates of Adolescent Depression in Different Clinical Settings
p:Parent interviewed as component of diagnostic assessment; y:youth interviewed as part of diagnostic assessment.

Note: BDI = Beck Depression Inventory, PHQ = Patient Health Questionnaire, KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia, PL = Present and Lifetime version, NCS-A = National Comorbidity Survey- Adolescent, CAPA = Child and Adolescent Psychiatric Assessment

Diagnosis
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.
 * 1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
 * 2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
 * 3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
 * 4) Insomnia or hypersomnia nearly every day.
 * 5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
 * 6) Fatigue or loss of energy nearly every day.
 * 7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

Diagnostic Changes
DSM-5 contains several new depressive disorders, including
 * disruptive mood dysregulation disorder
 * premenstrual dysphoric disorder

DSM-5 conceptualizes chronic forms of depression in a somewhat modified way. What was referred to as dysthymia in DSM-IV now falls under the category of persistent depressive disorder.

Major Depressive Disorder
Neither the core criterion symptoms applied to the diagnosis of major depressive episode nor the requisite duration of at least 2 weeks has changed from DSM-IV. Criterion A for a major depressive episode in DSM-5 is identical to that of DSM-IV, as is the requirement for clinically significant distress or impairment in social, occupational, or other important areas of life, although this is now listed as Criterion B rather than Criterion C. The coexistence within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed features.” The presence of mixed features in an episode of major depressive disorder increases the likelihood that the illness exists in a bipolar spectrum; however, if the individual concerned has never met criteria for a manic or hypomanic episode, the diagnosis of major depressive disorder is retained.

In DSM-IV, there was an exclusion criterion for a major depressive episode that was applied to depressive symptoms lasting less than 2 months following the death of a loved one (i.e., the bereavement exclusion).

Specifiers for Depressive Disorders
Suicidality represents a critical concern in psychiatry. Thus, the clinician is given guidance on assessment of suicidal thinking, plans, and the presence of other risk factors in order to make a determination of the prominence of suicide prevention in treatment planning for a given individual. A new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders, allowing for the possibility of manic features in individuals with a diagnosis of unipolar depression. A substantial body of research conducted over the last two decades points to the importance of anxiety as relevant to prognosis and treatment decision making. The “with anxious distress” specifier gives the clinician an opportunity to rate the severity of anxious distress in all individuals with bipolar or depressive disorders.

Recommended Diagnostic Interviews

 * Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS PL)- Hardcopy in assessment file cabinet at Finley.
 * Diagnostic Interview for Children and Adolescents
 * Child and Adolescent Psychiatric Assessment (CAPA)
 * Child Behavior Checklist (CBCL)- Hardcopy in assessment file cabinet at Finley.
 * Teacher’s Report Form (TRF)- Hardcopy in assessment file cabinet at Finley.
 * Youth Self Report (YSR)- Hardcopy in assessment file cabinet at Finley.

Areas Under the Curve (AUC) and Likelihood Ratios (LR) for Potential Screening Measures
Note: CBCL = Child Behavior Checklist, YSR = Youth Self Report, HSCL-6 = Hopkins Symptom Checklist-6, HSCL-10= Hopkins Symptom Checklist-10, SCL-90= Symptom Checklist-90, CDI = Children’s Depression Inventory, CDI:S = Children’s Depression Inventory Short Version, KADS = Kutcher Adolescent Depression Scale

Empirically Supported Treatments

 * 1) CBT Treatment
 * 2) Group plus parent component, individual, and individual plus parent/family component
 * 3) Additional psychotropic medication (David-Ferdon & Kaslow, 2008)
 * 4) Interpersonal Psychotherapy (Mufson et al., 2012)
 * 5) Brief 12-16 session therapy
 * Please refer to the page on Adolescent Depression for more information on available treatment for Adolescent Depression, or go to Effective Child Therapy for a curated resource on effective treatments for Adolescent Depression.

Local Resources
Mitch Prinstein, Ph.D. & Jennifer Kogos Youngstrom, Ph.D.-- especially for diagnostic evaluation, consultation, and psychosocial interventions; The Durham County Guidance Clinic (CGC); The Duke Program in Child Anxiety and Affective Disorders