Mood disorders in children and adolescents: an NIMH perspective

Executive functioning and self-reported depressive symptoms within an adolescent inpatient population

Although the relationship between executive dysfunction and depressive disorders has been well established in the adult population, research within the adolescent population has produced mixed results. The present study examined executive-functioning subdomains in varying levels of self-reported depression within an adolescent inpatient sample diagnosed with primary mood disorders. Via retrospective chart review, the sample consisted of those adolescents (ages 13-18 years) who completed a combined psychological/neuropsychological assessment during hospitalization (N = 105). When the sample was divided into adolescents with mood disorders with self-reported depressive symptoms and adolescents with mood disorders without self-reported depressive symptoms, no differences in various executive functions were identified. There were also no correlations between overall self-reported depressive symptoms and overall executive functioning. However, there were negative correlations between select executive subdomains (e.g., problem solving and response inhibition) and certain depressive symptom subdomains (e.g., negative mood and interpersonal problems). Based on these findings, there was no difference in executive functions between mood disorders with depressive symptoms and mood disorders without depressive symptoms, although there may be select executive subdomains that are particularly involved in certain depressive symptoms, providing important information for the treatment of adolescent depression.

Physical aggression, diagnostic presentation, and executive functioning in inpatient adolescents diagnosed with mood disorders

While a relationship has been identified between physical aggression and executive functioning within the adult population, this relationship has not yet been consistently examined in the adolescent population. This study examined the association between physical aggression towards others, self-reported depressive symptoms, and executive functioning within an adolescent inpatient sample diagnosed with a mood disorder. This study consisted of a retrospective chart review of 105 adolescent inpatients (ages 13-19) that received a diagnosis of a mood disorder (excluding Bipolar Disorder). Participants were grouped based on history of aggression towards others, resulting in a mood disorder with physically aggressive symptoms group (n = 49) and a mood disorder without physically aggressive symptoms group (n = 56). Ten scores on various measures of executive functioning were grouped into five executive functioning subdomains: Problem Solving/Planning, Cognitive Flexibility/Set Shifting, Response Inhibition/Interference Control, Fluency, and Working Memory/Simple Attention. Results from analyses of covariance indicated that there were no significant differences (p < .01) between aggression groups on any executive functioning subdomains. Correlation analyses (p < .01) indicated a negative correlation between disruptive behavior disorders and response inhibition/interference control, while anxiety disorders were negatively correlated with problem solving/planning. These findings provide important information regarding the presence of executive dysfunction in adolescent psychiatric conditions, and the specific executive subdomains that are implicated.

Association between Cognitive Distortion, Type D Personality, Family Environment, and Depression in Chinese Adolescents

Purpose. Depression prevalence and risk increase among adolescents are related to biological, psychosocial, and cultural factors. Little is known about the association between cognitive distortion, type D personality, family environment, and depression. The aim of this paper was to examine the relationships of cognitive distortion, type D personality, family environment, and depression in a sample of Chinese adolescents. Methods. A sample of Chinese adolescents with depression and the controls were investigated cross-sectionally with life orientation test-revised (LOT-R), type D personality Scale-14 (DS14), family environment scale (FES), and Zung self-depression scale (SDS); respectively, all scales were administered in Chinese. Results. Chinese-depressed adolescents showed more cognitive distortion, type D personality, and adverse family environment than control groups. Furthermore, lower level of Optimism, negative affectivity, and poor family cohesion may increase the risk of depression in Chinese adolescents. Conclusions. Our study indicates that lower level of Optimism, Negative Affectivity, and poor Family Cohesion factors were implicated to contribute to depression in Chinese adolescents. Lower level of optimism and negative affectivity may be crucial associated factors of depression among these samples. our findings pointed to the importance of broad screening and intervention of vulnerable population.

Depressive symptoms and deliberate self-harm in a community sample of adolescents: a prospective study

The associations between depressive symptoms and deliberate self-harm were studied by means of a 2-wave longitudinal design in a community sample of 1052 young adolescents, with longitudinal data for 83.6% of the sample. Evidence was found for a bidirectional relationship in girls, with depressive symptoms being a risk factor for increased self-harm one year later and self-harm a risk factor for increased depressive symptoms. Cluster analysis of profiles of depressive symptoms led to the identification of two clusters with clear depressive profiles (one severe, the other mild/moderate) which were both characterized by an overrepresentation of girls and elevated levels of self-harm. Clusters with more circumscribed problems were also identified; of these, significantly increased levels of self-harm were found in a cluster characterized by negative self-image and in a cluster characterized by dysphoric relations to parents. It is suggested that self-harm serves more to regulate negative self-related feelings than sadness.

Review: magnetic resonance spectroscopy studies of pediatric major depressive disorder

Introduction. This paper focuses on the application of Magnetic Resonance Spectroscopy (MRS) to the study of Major Depressive Disorder (MDD) in children and adolescents. Method. A literature search using the National Institutes of Health's PubMed database was conducted to identify indexed peer-reviewed MRS studies in pediatric patients with MDD. Results. The literature search yielded 18 articles reporting original MRS data in pediatric MDD. Neurochemical alterations in Choline, Glutamate, and N-Acetyl Aspartate are associated with pediatric MDD, suggesting pathophysiologic continuity with adult MDD. Conclusions. The MRS literature in pediatric MDD is modest but growing. In studies that are methodologically comparable, the results have been consistent. Because it offers a noninvasive and repeatable measurement of relevant in vivo brain chemistry, MRS has the potential to provide insights into the pathophysiology of MDD as well as the mediators and moderators of treatment response.

Diurnal cortisol profiles and evening cortisol in post-pubertal adolescents scoring high on the Children's Depression Inventory

Early-onset mood disorders have become a significant public health problem in recent years. The Children's Depression Inventory (CDI) is a commonly used self-report measure. We studied the relation of CDI cut-offs to biological markers of depression such as the diurnal cortisol rhythm and evening cortisol. In 58 post-pubertal adolescents (29 boys and 29 girls, M(age)=15.1 years), the diurnal cortisol profile was derived from three saliva samples, collected at awakening, at noon and in the evening on a week-end day. Longitudinal repeated measurements regression revealed that the group with CDI>18 (high depressive symptoms) clearly had a higher and flatter diurnal rhythm with elevated evening cortisol compared to either the group with CDI between 13 and 18 (moderate depressive symptoms) or CDI<13 (low depressive symptoms). Multinomial logistic regression indicated that evening cortisol was useful in classifying the adolescents in the high depressive symptoms group, while awakening and noon cortisol were not. Our results indicate that the type of high flattened profiles sometimes seen in individuals who are clinically depressed according to diagnostic interviews can also be identified with a self-report inventory, at high levels of symptom reporting. Given the complexity of conducting diagnostic interviews, this result bears clinical relevance.

The impact of prescribed psychotropics on youth

Many psychotropics prescribed to children are unlicensed or off-label. This article uses the two most prescribed psychotropics (MPH and SSRIs) to illustrate various concerns about their impact on youth. Many mental illnesses begin in childhood or early adulthood, warranting a treatment of some kind. However, commentators have argued that prescribing is influenced by five myths: (1) children are little adults; (2) children have no reason to develop depression or anxiety; (3) psychiatric disorders are the same across adults and children; (3) children can be prescribed lower doses of the same drug; (5) drugs are preferable to alternative treatments and are more successful. Several lines of evidence suggest that these are incorrect assumptions. We update readers with recent research in relation to these myths, concluding that researchers should clarify child/adult differences for psychotropics, attend to the growth of "cosmetic" use of psychotropics in children and adolescents, and address concerns about the diagnostic validity of mental illness in the current DSM classification system.

Immigrant youth at risk for disorders of mood: recognizing complex dynamics

The number of youth immigrating to the United States from Latin America and the Caribbean has consistently and dramatically been increasing. However, little research or epidemiological data that capture the mental health status of these youth from their countries of origin or once they enter the United States exist. As a result of migration and the acculturation process, these youth are at risk for exacerbation of preexisting mood disorders or development of mood or other psychiatric symptoms. Pre-migration social and environmental stressors affecting this population include poverty, exposure to violence, sexual or physical victimization, and substance abuse. Post-migration stressors include loss (of friends, family, country, and lifestyle), changes in social support, negative experiences in the United States, language difficulties, and academic challenges. This review of the existing literature will describe the contextual experiences of immigrant Latin American and Caribbean youth from their country of origin and as new immigrants in the United States, discuss their risk for mood disorders, highlight relevant assessment data that should be obtained, and identify treatment implications for advanced practice psychiatric-mental health nurses working with this population.

Methylphenidate treatment during pre- and periadolescence alters behavioral responses to emotional stimuli at adulthood

BACKGROUND

Methylphenidate (MPH) is a psychomotor stimulant medication widely used for the treatment of attention-deficit/hyperactivity disorder (ADHD). Given the extent of prescribed use of MPH, and because MPH interacts with the same brain pathways activated by drugs of abuse, most research has focused on assessing MPH's potential to alter an individual's risk for adult drug addiction. Data examining other potential long-term behavioral consequences of early MPH administration are lacking, however.

METHODS

We investigated the long-term behavioral consequences of chronic administration of MPH (2.0 mg/kg) during pre- and periadolescent development in adult rats by assessing their behavioral reactivity to a variety of emotional stimuli.

RESULTS

The MPH-treated animals were significantly less responsive to natural rewards such as sucrose, novelty-induced activity, and sex compared with vehicle-treated control animals. In contrast, MPH-treated animals were significantly more sensitive to stressful situations, showed increased anxiety-like behaviors, and had enhanced plasma levels of corticosterone.

CONCLUSIONS

Chronic exposure to MPH during development leads to decreased sensitivity to rewarding stimuli and results in enhanced responsivity to aversive situations. These results highlight the need for further research to improve understanding of the effects of stimulants on the developing nervous system and the potential enduring effects resulting from early-life drug exposure.

Pediatric mood and anxiety syndromes in primary care: who gets identified?

OBJECTIVE

To seek clues to the enhancement of primary care management by (i) Determining how often and in whom primary care clinicians in the United States, Puerto Rico, and Canada identify pediatric mood or anxiety syndromes; (ii) Determining which clinical and demographic features predict higher rates of identification; (iii) Describing assessment methods used.

METHODS

This report uses the database of the multi-site Child Behavior Study. This cross-sectional study involved 206 primary care practices in the United States, Puerto Rico, and Canada; 395 clinicians and 20,861 primary care attenders aged 4-15 years. Clinicians completed a visit questionnaire addressing presence and type of psychosocial problems and how assessed. Parents completed a questionnaire addressing family demographics, child symptoms (Pediatric Symptom Checklist) and functioning, and child service use.

RESULTS

Clinicians identified psychosocial problems on 17.9% of visits, but mood or anxiety syndromes on only 3.3%, most commonly in children judged to have co-morbid behavioral syndromes, of whom the majority (66.7%) already had contact with specialized mental health. Neither parental concerns about mood and anxiety symptoms nor clinician familiarity with the patient were major predictors of identification. When making a diagnosis of a pure internalizing syndrome (i.e., without a co-morbid behavioral syndrome) clinicians rarely used standardized tools or school reports.

CONCLUSIONS

Neither screening for nor diagnosis of mood and anxiety syndromes is a routine part of primary care of children and adolescents. Efforts to improve care must include practical, validated screening procedures to enhance assessment for mood and anxiety syndromes, particularly among children in whom primary care clinicians identify psychosocial problems.