Issues in the diagnosis of depression among the young

Defining the boundaries between extremes of normal behaviour and psychopathology is a dilemma that pervades all of psychiatry. It is especially problematic to establish the limits of depressive disorder in young people because of the cognitive and physical changes that take place during this time. Adolescents tend to feel things particularly deeply, and marked mood swings are common during the teens (Rutter et al., 1976). It can be difficult to distinguish these intense emotional reactions from depressive disorders. By contrast, young children do not find it easy to describe how they are feeling and often confuse emotions such as anger and sadness (Kovacs, 1986). They have particular difficulty in describing certain of the key cognitive symptoms of depression, such as hopelessness and self-denigration. Indeed, there are developmental changes in many of the cognitive abilities that may underlie these depressive cognitions. Thus, for instance, during middle childhood (age 7-9 years), the self is conceived in outward, physical terms. If asked to describe themselves, children of this age will tend to frame their descriptions in terms of external characteristics, or what they do. It is only by adolescence that young people regularly describe themselves in terms of psychological characteristics.

A further issue arises from the fact that all epidemiological studies conducted up to now have found that depressive disorder very commonly occurs in conjunction with other psychiatric problems. Indeed, one of the best discriminators in community studies between children with any form of psychiatric disorder and children with no psychiatric disorder is the symptom of depression (Rutter et al., 1970). Moreover, some of the symptoms that are part of the depressive constellation may arise as a symptom of other disorders. Thus, restlessness is seen in agitated depression, hypomania, and hyperkinetic syndrome. As a general rule, the double diagnosis should be made only when symptoms that are not simply part of another disorder clearly indicate the separate presence of a depressive disorder.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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