Good Kid? Bad Kid?


The Influences of Mood Disorders on Adolescent Behavior

Jack Kluck, MD

DEPRESSION

1. Introduction

A. Definitions
  1. Good kid = depressed, cooperative, in control, clean(no drugs or alcohol), likable.
  2. Bad kid= hostile, aggressive, oppositional, substance abuser, anti-social and hateful.
  3. Depression = major depression and dysthymia (DSM-III-R) sustained, aggression toward self. Doesn’t respond well to psychosocial intervention.
  4. Unhappiness = similar, but doesn’t meet criteria. Self-esteem relatively better. Responds to psychosocial intervention.
B. General information
  1. Most significant depressions have a biological etiology.
  2. Prevalence:
    1. female: 9-26%
    2. male: 5-12%
    3. f/m 2:1
    4. Many members of the same family may be affected.
  3. Depression may not be predominant symptom.
    1. Anxiety
    2. Irritability (temper)
    3. Insomnia
    4. Physical complaints
    5. Conduct / behavioral dysfunction
    6. Fatigue (feeling tired)
    7. Boredom
  4. Continuum nature.
  5. Relationship of stress, depression and substance abuse.
    1. Stress begets:
      1. Depression
      2. Substance abuse
    2. Depression begets:
      1. Substance abuse (self-medication)
      2. Stress (through regression
    3. Substance abuse begets:
      1. Depression (through regression)
      2. Stress
  6. Relationship between affective disorders and character disorders.
II. Diagnosis
A. Diagnostic Criteria for Major Depressive Episodes
  1. Five of the following:
    1. Depressed mood (or irritable)
    2. Markedly diminished interest in pleasure
    3. Appetite disturbance with change in weight
    4. Sleep disturbances
    5. Psychomotor agitation or retardation
    6. Fatigue/low energy
    7. Feelings of worthlessness and/or excessive guilt
    8. Decreased concentration
    9. Recurrent thoughts of death and/or suicide
  2. Exclusion criteria
    1. Not organic – include substance abuse during recent 2to3 weeks
    2. No delusions or hallucinations when not depressed
    3. Not superimposed on other diagnosis, i.e., schizophrenia
  3. Key points
    1. Pay attention to descriptive format
    2. Patient must be alcohol/chemical free
    3. Do not make characterological disorder diagnosis yet
    4. Family history is very helpful
III Treatment
  1. Treat substance abuse
  2. Treat affective disorder
    1. Like he/she is a “good kid”
    2. “You gotta believe”
  3. Treat close family members
    1. Affective disorders
    2. Substance abuse
  4. Psychological treatment
    1. Strong focus on psycheducation
      1. Substance abuse
      2. Depression
    2. Promote healthy (adaptic) defenses
    3. Support self-esteem
    4. Work on self-identity issues
    5. Delay uncovering or working-through techniques
    6. Involve support systems and significant others

Questions!

CONTENTS!