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The Depressed Child and Adolescent
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Book description

In this thoroughly revised and updated edition an international, interdisciplinary team of mental health experts draw together more recent research in the psychopathology of depression in young people. Combining theory and practice, the psychological, neurochemical and genetic causes are discussed and an account of the clinical characteristics and frequency of the condition is given. The key questions are fully addressed: the importance of life events and difficulties in the onset and continuation of depression; the efficacy of current psychological therapies and the role of medication; how depressed young people progress into adult life, and how depression arises and the effects it may exert on brain and behaviour during this crucial developmental period. This book will appeal to child psychiatrists and psychologists, developmental psychologists, neuroscientists and mental health professionals in clinical services.

Reviews

‘Ian Goodyer has assembled an internationally recognized group of researchers as authors … In the resulting tour de force, we are taken from an exposition of the development of emotional behavior and understanding, through the contributions of temperament, attachment and personality development, to depressive vulnerability. … Each chapter contains a depth of information not found in usual textbooks and a subtlety of understanding that only experts of international standing who are reviewing the areas of their own research can provide ... this book documents, with references, the great strides child and adolescent psychiatry and psychology have made in the past 30 years.’

Source: The New England Journal of Medicine

‘Rather than being just another text book on depression, this volume has adopted a broad perspective ... [and] ends in an excellent overview of the findings on the continuity between childhood and adult depression and the key issues which need to be addressed by further longitudinal research. This book has benefited from the contributions of most of the experts in the field … I strongly recommend that professional institutions dealing with young children make this book accessible to a wide range of professionals.’

Eric Fombonne Source: Journal of Child Psychology and Psychiatry

‘The most outstanding aspect of this book is its attempt to integrate rather complex developmental theory with the description and phenomenologic literature on depression in children. It does an excellent job of discussing how development affects the presentation of depression and, conversely, how depression affects subsequent development, and would thus be of considerable interest to the more psychodynamically oriented clinician or clinician who treats very young children.’

Source: Doody’s Journal

‘The book would be worth buying alone for the chapter on the development of emotional regulation and emotional response … I can fully recommend this book to all child psychiatrists and all those interested in child and adolescent depression.’

Michael Fitzgerald Source: Psychological Medicine

‘… excellent coverage of diverse aspects of depression in childhood and adolescence … moves beyond the descriptive level of analysis to delineate the processes by which children and adolescents come to be at risk for, or are protected from, depression. This focus is particularly salient given the pressure faced by clinicians and researchers alike to identify which interventions are most effective for which populations under a variety of service delivery conditions.’

Janet Shapiro Source: Social Work in Health Care

‘… succinct review of the pertinent literature presented in the chapters on development, epidemiology, and etiologic factors. Clinicians who wish to read about this particular disorder (and others in future volumes) will be rewarded with, as Dr Goodyer states ‘a coherent account of current knowledge’.’

Michelle Kim-Leff Source: American Journal of Psychiatry

‘… 25 internationally distinguished researchers present the latest understanding of depression’.

Source: Bulletin of the Menninger Clinic

‘… this extensive multi-authored text is a ‘state-of-the art’ exploration of child and adolescent depression, and as such, is required reading for clinicians and researchers in the area.’

Florence Levy Source: Psychological Medicine

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Contents

  • 1 - Historical aspects of mood and its disorders in young people
    pp 1-23
  • View abstract

    Summary

    The rapid growth of clinical and research interest in mood disorders in juveniles over the last 20 years was preceded by a long period in which these conditions were discussed only cursorily, or not at all, in textbooks of psychiatry, child psychiatry or paediatrics. This chapter provides evidence about the wider historical background and sets some current clinical and research issues in perspective. It discusses the growth of interest in juvenile mental disorder, changing theories of child mental development, and changing conceptions of childhood. With the subsequent return to near-Kraepelinian concern for descriptive diagnosis and the search for organic causes, fostered by new knowledge and pharmacological treatments, clinical and scientific interest in mood disorders and their pathophysiology began to surface. The historical study of mood disorders in children and adolescents draws attention to many of the issues and questions that continue to call for clinical and research attention.
  • 2 - The development of emotional intelligence
    pp 24-45
  • View abstract

    Summary

    There is a large set of cognitive abilities involved in the understanding and regulation of emotions, known collectively as emotional intelligence. This chapter aims to address some of the major developments in this domain. It commences with a discussion on early concept formation, including children's understanding of the link between situation and emotion. Then, the chapter discusses the development of emotional knowledge within the more general context of the development of a theory of mind. It shows how children's increasing abilities to analyse cognitively emotional situations result in the understanding of more complex emotions such as guilt, shame and pride. After a note on emotion regulation, the chapter addresses the reciprocal relation between cognition and emotion, discussing examples of a so-called emotional bias. It suggests that problematic development may be countered by early interventions along the lines of cognitive behaviour therapy.
  • 3 - Developmental precursors of depression: the child and the social environment
    pp 46-78
  • View abstract

    Summary

    Understanding the underpinnings of clinical depression is a complex task, which must include consideration of multiple factors. This chapter explores developmental variables, including family, individual and environmental, that might contribute to, or constitute, a predisposition to onset of depression during adolescence. It discusses family studies and intergenerational transmission; family warmth, support and cohesion; intergenerational transmission; and peer relationships and social competence. It reviews developmental processes that are central to the adolescent's formation of emotion regulation skills and sense of self. The chapter considers a working model of how developmental factors could contribute to lowering the threshold for depression. It considers how key elements of the child's and adolescent's developing personality contribute to increased risk for depression. The model that is presented further elaborates on factors leading to compromised attachment, incorporates the role of emotion regulation and focuses on a more holistic view of the development of depression.
  • 4 - Physiological processes and the development of childhood and adolescent depression
    pp 79-118
  • View abstract

    Summary

    This chapter examines five issues of childhood and adolescent depression that consider the interplay between continuity and risk. The first focuses on the rate of various forms of depression in the childhood and adolescence years. The second tracks the physiological concomitants and possible predictors of depression among the physiological changes that characterize early adolescence. The third is regarding the timing and sequencing of biopsychosocial changes in the first half of adolescence. The fourth concerns family history and rearing environment. Finally the fifth looks at what is known about continuity between clinical depression and less severe forms of depressed affect, especially as the study of physiological processes might shed light on this most important aspect of continuity. Research suggests that a high degree of comorbidity occurs between depression and other mental disorders and research on psychological mechanisms considers both clinical depression and depressed affect.
  • 5 - Childhood depression: clinical phenomenology and classification
    pp 119-142
  • View abstract

    Summary

    This chapter focuses on the clinical phenomenology and descriptive classification of unipolar disorders of childhood. The advent of reliable and valid measures of present mental state in children and adolescents has greatly advanced our understanding of major (unipolar) depression. Research confirms that the clinical picture of affective disorders in children and adolescents resembles the presentation of that in adults. Comorbidity is the concurrent presence of two or more disorders greater than expectation by chance alone. The first way of defining depressive subsyndromes in childhood is the clinical approach where clinical pictures are drawn, utilizing an inductive method combined with clinical judgement. The second is a statistical approach using multivariate procedures such as exploratory factor analysis. What has not yet emerged is a clear idea of the proportions of prior disorders which shift into major depression, and the proportion of major depressive disorder (MDD) that remain 'uncontaminated' by comorbidity.
  • 6 - The epidemiology of depression in children and adolescents
    pp 143-178
  • View abstract

    Summary

    This chapter discusses the prevalence of depressive disorders in children and adolescents, unipolar depression, puberty and depression, comorbidity, and environmental risk factors for depression. Only a small minority of disturbed children are referred for psychiatric treatment. Thus estimates of the rates of depression in children and adolescents cannot be determined from clinical data. Much less attention has been paid to bipolar disorders (BPDs) in the child and adolescent epidemiological literature. Studies of adults have documented that women have 1.5-3 times more current and lifetime unipolar depression than do men. The National Institute of Mental Health study of puberty and psychopathology found negative associations between testosterone: oestradiol ratio, sex hormone binding globulin, and androstenedione concentration and negative emotional tone in boys. Recent review shows that comorbidity between depression, conduct disorder, anxiety, attention deficit hyperactivity disorder (ADHD) and substance abuse is common in the general population of children and adolescents.
  • 7 - Family–genetic aspects of juvenile affective disorders
    pp 179-203
  • View abstract

    Summary

    Disturbances of mood in young people encompass a wide range of clinical phenomena and associated risk factors. Similarities in the syndromic expression of depression in juveniles and adults are well documented, but homogeneity of phenotype does not mean there is a single common disorder across all age groups. An unusually high density of familial illness appears to be a distinguishing feature of juvenile-onset mood disorders. Parental matings involving depression and anxiety appear significantly to increase liability for both conditions in offspring, whereas parental alcoholism elevates risk to offspring of conduct problems and substance abuse. Depression is clearly among the most prominent types of psychopathology in offspring of parents with affective disorder, unipolar major depression in particular. However, psychopathology in general is widespread in these samples, thus raising questions about the mechanisms underlying parent-child resemblance for depression and the co-aggregation of affective and nonaffective conditions.
  • 8 - Life events: their nature and effects
    pp 204-232
  • View abstract

    Summary

    A life event is an environmental circumstance that has an identifiable onset and ending and may carry the potential for altering individual's present state of mental or physical well-being. Whilst there is now considerable evidence that undesirable life events do precede and increase the risk for depression in adolescents and adults, how they exert their effects remains unclear. To date, the findings indicate that an onset of major depression may occur as a consequence of a range of recent life events and difficulties from either the familial or peer group domain. The findings on both prospective community and longitudinal clinical studies that have carried out concurrent hormone measurement implicate nonpsychosocial processes in the onset and maintenance of depression. Future research clearly requires a combined approach both in terms of the design of studies and collaboration between behavioural and neuroscientists.
  • 9 - Adolescent depression: neuroendocrine aspects
    pp 233-266
  • View abstract

    Summary

    Neuroendocrine studies of adolescent depression are still in their early formative years. This chapter reviews the current literature on various neuroendocrine studies in adolescent depression. It summarizes relevant physiological information about various endocrine systems and succinctly reviews selected adult findings in similar areas of investigation to highlight similarities and differences to adolescent studies in findings where they occur. Growth hormone (GH) release from the pituitary is regulated by the interplay of the neurotransmitters, either by direct hypothalamic action or through their effect on intermediate compounds such as growth hormone-releasing hormone (GHRH) or somatostatin. The hypothalamic-pituitary-growth hormone (HPGH) axis provides a good model for evaluating CNS functioning. Studies of adult depressives have shown blunted ACTH responses to CRH regardless of serum cortisol levels. Neurotransmitter regulation of melatonin secretion is complicated and not fully understood. Further research into the multiple aspects of serotonergic functioning should be a priority in future development.
  • 10 - Suicidal behaviour in adolescents
    pp 267-291
  • View abstract

    Summary

    Suicidal behaviour and depression share aetiology and epidemiology, and are overlapping but also distinct, since the majority of depressed adolescents do not attempt or commit suicide, and not every suicidal adolescent is depressed. This chapter describes the concept of suicide and presents some basic rates of the various suicidal behaviours. It discusses studies that have explored why some depressed persons attempt or commit suicide and others do not. The development of suicidal behaviour is mediated or facilitated by certain thoughts or patterns of thoughts. These may reflect differences in the general normal cognitive style of dealing with social problems or difficult emotions, or they may be due to the presence of abnormal cognitive distortions. Explaining the progression from depression to suicide, the chapter discusses impulsivity, imitation, hopelessness, attitude, and comorbidity. One effective strategy of dealing with suicidal behaviour is to prevent or treat depression.
  • 11 - Psychopharmacology of depressive states in childhood and adolescence
    pp 292-324
  • View abstract

    Summary

    Depressive disorders confer a high risk for substance abuse, physical illness, early pregnancy and poor vocational, academic and psychosocial functioning. The longer an episode of major depressive disorder (MDD) in school-aged children or adolescents persists, the greater the risk for long-lasting impairment in school, social or family domain. Looking at mood states and depressive syndromes from a psycho-pharmacological point of view shows remarkable differences, but also similarities between childhood/adolescence and adulthood. This chapter discusses these, providing an overview of the present state of pharmacological treatment of depressive syndromes in young people. Antidepressant medication in childhood and adolescence is indicated in cases of severe depressive symptomatology which are unresponsive to psycho-therapeutic interventions. For patients requiring pharmacotherapy, selective serotonin reuptake inhibitors (SSRIs) are the initial antidepressants of choice. Several psychopharmacological strategies are recommended for adults: optimization, augmentation or combination, and switching to the same or a different class of medications.
  • 12 - The psychotherapeutic management of major depressive and dysthymic disorders in childhood and adolescence: issues and prospects
    pp 325-352
  • View abstract

    Summary

    This chapter begins with the discussion of clinical features of depressive disorders that have implications for the design and implementation of therapeutic interventions with youths. It summarizes peer-reviewed articles of randomized controlled trials with clinically depressed youths as well as studies with youths classified as depressed based on symptom rating scales. The chapter raises several issues that have not received sufficient consideration in treatment outcome studies of depressed youths and remain to be addressed in current treatment development efforts. Finally, it discusses current issues in the psychotherapeutic management of depressed youngsters and identifies topics that require further attention. The course and outcome of childhood-onset depressive disorders are complicated by family psychopathology and strife. In the treatment of depressed youths, the systematic involvement of the parents or primary care-takers is important. Parents should be engaged, whenever possible, as agents of change in the treatment of their own children.
  • 13 - Natural history of mood disorders in children and adolescents
    pp 353-381
  • View abstract

    Summary

    Knowledge of the natural history of an illness is critical to understanding its origins and to optimizing its management. Over the past 15 years, data have been accumulating steadily on the course and outcome of juvenile affective conditions. This chapter begins with an account on the risk of recurrence of juvenile depression. This is followed by the mechanisms involved in continuity and recurrence. Prospects for recovery and the natural history of other juvenile affective disorders are discussed with a focus on bipolar disorder. Finally, a discussion of some of the clinical implications of these research findings is presented. There has recently been interest in milder forms of bipolar disorder in adolescents, such as bipolar II disorder (episodes of major depression and hypomania) and cyclothymia (chronic mild states characterized by symptoms such as irritability, decreased need for sleep, and so on).

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