Childhood Depression and Developmental Implications

Developmental Implications

• Childhood depression:
  • Symptoms vary by age:
    • < age 3: feeding problems, tantrums, lack of playfulness, emotional expressiveness, failure to thrive, delays in speech and gross motor
    • Ages 3-5: accident proneness, phobias, excessive self-reproach
    • Ages 6-8: physical complaints, aggressive behavior, clinging behavior, lack of social skills
    • Ages 9-12: morbid thoughts and excessive worrying, lack of interest to play with friends
  • Other symptoms: hyperactivity, delinquency, school problems, sleeping and eating disturbances, social isolation, suicidal thoughts
  • Focus of therapy: alleviate symptoms, strengthen coping and adaptive skills, and prevent future psychological problems

Adolescence

• Symptoms: anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out, substance abuse, restlessness, apathy
• Clue to differentiate depression from normal adolescent behavior: TBD
• Treatment:
  • Supportive psychosocial intervention
  • Antidepressant medication (carry FDA black-box warning for increased risk of suicidality)

Senescence

• Bereavement overload
• High percentage of suicides among the elderly
• Symptoms of depression often confused with symptoms of neurocognitive disorder
• Treatment:
  • Antidepressant
  • Electroconvulsive therapy
  • Psychosocial therapies

Postpartum Depression

• Lasts weeks to months
• Associated with hormonal changes, tryptophan metabolism, or cell alterations
• Symptoms:
  • Fatigue, irritability
  • Loss of appetite
  • Sleep disturbances
  • Loss of libido
  • Concern about inability to care for infant
• Treatment:
  • Antidepressants
  • Psychosocial therapies

Nursing Process/Assessment

• Severe depression marked by distress that interferes with social, occupational, cognitive, and emotional functioning
• Four spheres of human functioning:
  • Affective
  • Behavioral
  • Cognitive
  • Physiological

Levels of Depression

• Transient depression:
  • Symptoms not necessarily dysfunctional
  • Affective: "the blues"
  • Behavioral: some crying
  • Cognitive: some difficulty getting mind off of one's disappointment
  • Physiological: feeling tired and listless
• Mild depression:
  • Symptoms associated with normal grieving
  • Affective: anger, anxiety
  • Behavioral: tearful, regression
  • Cognitive: preoccupied with loss
  • Physiological: anorexia, insomnia
• Moderate depression:
  • Symptoms associated with dysthymic disorder
  • Affective: helpless, powerless
  • Behavioral: slowed physical movements, slumped posture, limited verbalization
  • Cognitive: retarded thinking process, difficulty with concentration
  • Physiological: anorexia or overheating, sleep disturbance, headaches
• Severe depression:
  • Includes symptoms of major depressive disorder and bipolar depression
  • Affective: feelings of total despair, worthless, flat affect
  • Behavioral: psychomotor retardation, curled-up position, absence of communication
  • Cognitive: prevalent delusional thinking, with delusions of persecution and somatic delusions, confusions, suicidal thoughts
  • Physiological: a general slow-down of the entire body

Diagnosis/Outcome

• The client:
  • Has experienced no physical harm to self
  • Discusses feelings with staff and family
  • Expresses hopefulness
  • Sets realistic goals for self
  • Is willingly able to interact with others
  • Eats a well-balanced diet

Planning/Implementation

• Risk for suicide: vulnerable to self-inflicted, life-threatening injury
• Short-term goals:
  • Client will seek out...