Clinical features of depressive disorders in childhood and adolescence

Clinical features of depressive disorders in childhood and adolescence

 

Authors

 

O.V. Shushpanova

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

N.I. Golubeva

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

E.E. Balakireva

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

S.G. Nikitina

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

T.E. Blinova

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

N.S. Shalina

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

 

https://doi.org/10.26617/1810-3111-2024-4(125)-47-55

 

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2024; 4 (125):  47-55.

 

Abstract

Introduction. Depressive disorders in children are highly prevalent, but are difficult to diagnose and remain unrecognized for a long time due to the atypical clinical picture and masking of depressive symptoms by other psychosomatic disorders. The structure of depression in children may include circadian rhythm and vital symptoms characteristic of endogenous depression. At preschool age, attention deficit syndrome, anxiety-phobic disorders, sleep and appetite disorders, and behavioral disorders within the family circle are the most common ones. The differences in the clinical picture of the course of depressive disorders and concomitant mental and somatovegetative disorders in childhood require more detailed study. Objective: to study the clinical and dynamic characteristics of depression depending on the age period. To assess the variability of typical depressive symptoms, the nature and severity of comorbid symptoms that occur at the height of affective disorders. Patients and Methods. The sample included two age groups of patients with affective disorders who were treated in the Children's Clinical Unit of Mental Health Research Center (Moscow, Russia) between 2019 and 2023. From the total sample (n=33), two groups were formed depending on age: Group 1 ‒ 12 boys and 6 girls aged 8-11 years (children, mean age 9±2.1 years), Group 2 ‒ 7 boys and 8 girls aged 12-16 years (adolescents, mean age 13±2.2 years). To assess the severity of depression, the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were used. Statistical analysis was performed using the Microsoft Statistic 18 package. Data frequencies were compared using the Pearson test. Differences were considered statistically significant at p<0.05. Results. The onset of depressive disorder in both groups of patients occurred at the age of 7-9 years. The average values for the psychodiagnostic scales were as follows: BDI ‒ 22.7 points, HDRS ‒ 20.7 points in the 1st group, and BDI ‒ 28.13 points, HDRS-21 ‒ 24.68 points in the 2nd group. A mild depressive episode according to the Hamilton scale corresponded to a more severe condition according to the subjective BDI questionnaire. The Pearson correlation coefficient between the HDRS and BDI scales was: 0.34 for the 1st group, 0.95 for the 2nd group. In patients of the 2nd group, anhedonia with loss of pleasure and refusal of previously favorite activities was documented ‒ 100% of cases, suicidal thoughts (n=9; 60%), suicide attempts (n=3; 20%), concealment of suicidal thoughts from parents (n=2; 13.3%), manifestations of self-injurybehavior and compulsive actions (n=11; 73.3%), circadian rhythm with worsening of the condition in the morning, after awakening (n=6; 40%). In patients of the general clinical sample, leading symptoms were apathy and fast exhaustion (n=11; 35%), learning difficulties due to decreased processing of cognitive information (n=30; 90.9%), the most frequent complaints of discomfort in the gastrointestinal tract (100%), eating disorders due to the loss of vital sensations of hunger, thirst, satiety (n=7; 21.2%), nocturnal sleep disorders with peristaltic shift of sleep time to daytime hours with persistent insomnia at night (n=12; 36.4%), cerebrasthenic and apathetic symptoms, cephalgia without a specific localization, dizziness, lack of energy in the morning, which created the impression of a severe somatoneurological disease (n=14; 42.4%). Conclusion. In most cases, depression in childhood and adolescence is masked, which is associated with greater severity of behavioral disorders and somatovegetative symptoms, cerebrasthenic and hypochondriacal manifestations in the presence of vague clinical manifestations of affective disorders. In 22% of cases, depression acquired a protracted course and had a long asthenic exit to remission with fast fatigue and exhaustion, cognitive impairment, which reduced the cognitive and educational abilities of children and adolescents.

 

Keywords: affective disorders, depression, childhood and adolescence, mental and behavioral disorders, somatovegetative symptoms, self-injury.

 

Article (pdf)

 

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Materials  

For citation: Shushpanova O.V., Golubeva N.I., Balakireva E.E., Nikitina S.G., Blinova T.E., Shalina N.S. Clinical features of depressive disorders in childhood and adolescence. Siberian Herald of Psychiatry and Addiction Psychiatry.2024; 4 (125): 47-55. https://doi.org/10.26617/1810-3111-2024-4(125)-47-55

 

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