Diagnostic Criteria For Depression Research Articles

Daytime sleepiness in depression—underestimated in psychiatric inpatients

Abstract Background Sleep disorders are among the most common symptoms of depression. Both the ICD-10/11 and DSM‑5 list sleep disorders of all types as diagnostic criteria for depression, but these are not defined in detail. Objective This study focused on the prevalence of daytime sleepiness and associated sleep disorders in patients diagnosed with a severe depressive episode. Materials and methods In total, 192 inpatients with a moderate/severe depressive episode from an open acute psychiatric ward were included. Sleep history immediately after admission and sleep-related questionnaires, such as the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Regensburg Insomnia Scale (RIS), were collected. Polysomnographic assessment was performed in 82 patients with suspected sleep disorders. Patient groups (e.g., with and without sleepiness or apnea) were compared. Results The prevalence of daytime sleepiness (ESS > 10) was 25.3%. Fatigue and insomnia were reported in 66.7 and 75.7% of patients, respectively. Polysomnography revealed a prevalence of sleep apnea of 18.2%, and sleep apnea was newly diagnosed in 80% of these patients. Daytime sleepiness was more common in patients with undiagnosed sleep apnea. Patients with daytime sleepiness had more fatigue but did not have more severe depression. Conclusion The present results highlight the importance of assessing sleep history in psychiatric patients, especially those with depression. The ESS may be a useful tool to specifically assess daytime sleepiness as opposed to depression-related fatigue. A systematic assessment of sleepiness and specific sleep disorders, in particular sleep apnea, might contribute to improved treatment of inpatients with depression.

Does depression increase the risk of gestational diabetes mellitus? A systematic review and meta-analysis.

Data on the relationship between depression and gestational diabetes mellitus (GDM) is scarce and conflicting. We, hereby, aimed to review evidence if prior depression increases the risk of GDM. PubMed, Embase, CENTRAL, and Google Scholar databases were searched from inception to 11th September 2021 for English language studies reporting the relationship between depression and subsequent risk of GDM. Ten studies were included. Meta-analysis of data from nine studies including 127,195 patients indicated that prior depression was associated with a significantly increased risk of GDM (OR: 1.29 95% CI: 1.10, 1.52). There was no change in the significance of the results on sensitivity analysis. On subgroup analysis based on study location, we noted that the association between depression and GDM was seen only in USA-based studies with the pooled analysis of non-USA studies indicating no such relationship. Similar conflicting results were noted on subgroup analysis based on diagnostic criteria for GDM and depression. Our study indicates that prior depression can lead to a 29% increased risk of GDM in pregnant females. Current evidence is derived from a limited number of studies with significant heterogeneity in the timing and diagnostic criteria for depression.

Depression and Quality of Life in Patients with Gliomas: A Narrative Review

In patients with gliomas, depression is a common complication that may cause severe psychological barriers and deteriorate the patient’s quality of life (QoL). Currently, the Hospital Anxiety and Depression Scale (HADS) is the most commonly used tool to diagnose depression in patients with gliomas. Female sex, unmarried status, low education level, high tumor grade, and a history of mental illness may increase the risks of depression and depressive symptoms in patients with gliomas. The QoL of patients with gliomas can be directly reduced by depression. Therefore, the evaluation and intervention of mood disorders could improve the overall QoL of patients with gliomas. Antidepressant use has become a treatment strategy for patients with gliomas and comorbid depression. This narrative review summarizes the current issues related to depression in patients with gliomas, including the prevalence, risk factors, and diagnostic criteria of depression as well as changes in QoL caused by comorbid depression and antidepressant use. The purpose of this review is to guide clinicians to assess the psychological status of patients with gliomas and to provide clinicians and oncologists with a new treatment strategy to improve the prognosis of such patients.

Pharmacotherapy for late-life depression

Background: Late-life depression (LLD) is one of the most common psychiatric disorders. However, LLD is often undetected or inadequately treated by clinicians. This review summarizes the recent research on pharmacotherapy for LLD, updates information on monotherapy using recommended antidepressants, and discusses the clinical features and diagnostic criteria for LLD.Current Concepts: The diagnostic criteria for depression in both elderly and young adults are identical. Clinical features of the elderly with depression more likely include more comorbid medical conditions and cognitive impairment than those of young adults. Depression in the elderly tends to have a more chronic course with frequent recurrences or relapses.Discussion and Conclusion: The current pharmacological treatment guidelines for LLD recommend the use of selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor, bupropion, mirtazapine, and vortioxetine as first-line medications. SSRIs, among them, are recommended first because they present fewer serious adverse effects and more clinical evidence than those of other antidepressants. Before starting antidepressant treatment for LLD, clinicians should consider patients’ comorbid medical conditions, drug interactions, possible adverse effects of antidepressants, and polypharmacy. The starting dose of antidepressants for elderly patients should be half of that prescribed for young adults to minimize the adverse effects; however, most elderly patients need the same antidepressant doses as that prescribed for young patients. After remission, a 1-year maintenance treatment is required to prevent recurrence or relapse of LLD.

Hopelessness and depressive symptoms in children and adolescents: An integrative data analysis.

Although hopelessness has been linked to depression for centuries, the diagnostic criteria for depression are inconsistent with regard to the status of hopelessness. Most research on hopelessness and depression has focused on adults. The current study examined this relation in children and adolescents. Integrative data analyses with a pooled sample (N = 2466) showed that clinical levels of hopelessness multiplied the odds of having a clinical diagnosis of depression 10-fold. Conversely, not having clinical levels of hopelessness multiplied the odds of endorsing no clinical level of depressive symptoms 28-fold. Moreover, results differed by levels of depression: (a) among youths with clinical levels of depression, hopelessness was associated with six depressive symptoms; (b) among youths without clinical levels of depression, hopelessness was associated with nine depressive symptoms. We found that hopelessness helps to explain the heterogeneity of depressive presentations. Our finding supports the consideration of hopelessness in the diagnosis (if not treatment and prevention) of depression in children and adolescents. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Clinical Significance of Serum IL-33 and sST2 Alterations in the Post-Stroke Depression

IntroductionThis study was to test whether the serum levels of IL-33 and sST2 are correlated with the development of depression after acute ischemic stroke.MethodsPatients diagnosed with acute ischemic stroke were selected. This study took the 24-item Hamilton Depression Rating Scale (HAMD) (score ≥20) as the diagnostic criteria for depression. On the 21st day after admission, patients who met the depression diagnostic criteria were included in the depression group, and patients who failed to meet the diagnostic criteria were included in the non-depression group. The serum levels of IL-33, sST2 and hsCRP were measured by enzyme-linked immunosorbent assay (ELISA).ResultsOn 1st day after stroke, compared with the non-depression group, there was no significant difference in the serum IL-33, sST2 and hsCRP levels in the depression group; on 21st day after stroke, compared with the non-depression group, the serum IL-33 and hsCRP levels were significantly increased, while the sST2 level was significantly decreased in the depression group. Correlation analysis showed that IL-33 was positively correlated with the depression quantitative score and hsCRP, while sST2 was negatively correlated with the depression quantitative score and hsCRP. Regression analysis showed that IL-33 and sST2 were independent risk factors for the depression after acute ischemic stroke.DiscussionThe abnormal alterations of serum IL-33 and sST2 levels in the stroke patients may serve as one of the risk factors for the occurrence and exacerbation of the depression, and its mechanism may be related to the promotion of inflammatory factor production in vivo.

Displayed Depression Symptoms on Facebook at Two Time Points: Content Analysis.

BackgroundDepression is a prevalent and problematic mental disorder that often has an onset in adolescence. Previous studies have illustrated that depression disclosures on social media are common and may be linked to an individual’s experiences of depression. However, most studies have examined depression displays on social media at a single time point.ObjectiveThis study aims to investigate displayed depression symptoms on Facebook at 2 developmental time points based on symptom type and gender.MethodsParticipants were recruited from an ongoing longitudinal cohort study. The content analysis of text-based Facebook data over 1 year was conducted at 2 time points: time 1 (adolescence; age 17-18 years) and time 2 (young adulthood; ages 20-22 years). Diagnostic criteria for depression were applied to each post to identify the displayed depression symptoms. Data were extracted verbatim. The analysis included nonparametric tests for comparisons.ResultsA total of 78 participants’ Facebook profiles were examined, of which 40 (51%) were male. At time 1, 62% (48/78) of the adolescents had a Facebook profile, and 54% (26/78) displayed depression symptom references with an average of 9.4 (SD 3.1) references and 3.3 (SD 2.3) symptom types. Of the 78 participants, 15 (19%) females and 12 (15%) males displayed depression symptom references; these prevalence estimates were not significantly different by gender (P=.59). At time 2, 35 young adults displayed symptoms of depression with an average of 4.6 (SD 2.3) references and 2.4 (SD 1.3) symptom types. There were no differences in the prevalence of symptoms of depression displayed between males (n=19) and females (n=16; P=.63).ConclusionsThis content analysis study within an ongoing cohort study illustrates the differences in depression displays on Facebook by developmental stage and symptom. This study contributes to a growing body of literature by showing that using social media to observe and understand depression during the emerging adult developmental period may be a valuable approach.

Frailty and aging-associated syndromes in lung transplant candidates and recipients.

Many lung transplant candidates and recipients are older and frailer compared to previous eras. Older patients are at increased risk for pre- and posttransplant mortality, but this risk is not explained by numerical age alone. This manuscript represents the product of the American Society of Transplantation (AST) conference on frailty. Experts in the field reviewed the latest published research on assessment of elderly and frail lung transplant candidates. Physical frailty, often defined as slowness, weakness, low physical activity, shrinking, and exhaustion, and frailty evaluation is an important tool for evaluation of age-associated dysfunction. Another approach is assessment by cumulative deficits, and both types of frailty are common in lung transplant candidates. Frailty is associated with death or delisting before transplant, and may be associated with posttransplant mortality. Sarcopenia, cognitive dysfunction, depression, and nutrition are other important components for patient evaluation. Aging-associated inflammation, telomere dysfunction, and adaptive immune system senescence may also contribute to frailty. Developing tools for frailty assessment and interventions holds promise for improving patient outcomes before and after lung transplantation.

The poet’s melancholy

This article considers the relationship between depressed affect, a long-term refugee situation, and poetry among Afghan refugees in the Islamic Republic of Iran. Based on ethnographic fieldwork on the changing subjectivities of Afghan refugee poets, it explores the relationship between a perception of collective suffering, individual mental distress, and creativity in this community. Rather than establishing diagnostic criteria for depression among Afghans, the article is mostly concerned with the social and cultural ripples of psychological distress resulting from decades of war, displacement, and marginalization in the host country. It seeks to complicate biomedical understandings of depression by drawing on anthropological studies of dysphoria in Iran and on the collective experience of social suffering and structural violence. Through a discussion of four poets and their work, it explores the productive aspects of depression and the therapeutic, political, and transcendental potential of writing poetry.

0520 Treating Sleep Maintenance Insomnia Means Treating Depression?

Abstract Introduction Rumination whilst awakening nightly might be a common symptom in fragmented sleep and depression as well. The problem is that the test results on BECK or MMPI DEPRESSION SCALE often do not reach the diagnostic criteria of depression on DSM-V, only the symptoms of worry, rumination and sleep maintenance problems appear as mild depressive signs. The aim of our study was to investigate the assumption to which treating everyday worries through CBT methods would affect the amount and severity of nightly rumination and the severity of depressive mood as well. Methods 33 adult patients (M=39,55 SD=10,66) diagnosed with insomnia with the criteria of only sleep maintenance proble. Each participants filled the PSQI, the Epworth Sleepiness Scale, the Beck Depression Inventory and the Trait-Anxiety Inventory before the beginning of the CBT therapy session and 10 sessions later. Results Our results show a significant effect of the CBT therapy to sleep maintenance symptoms through treating everyday ruminations opposite to treating only nightly ruminations on sleeping quality (F(1, 31)= 55,358 p<0,01 η2 = 0,641). The significant improvement in sleep quality only were shown in the subgroup of everyday rumination CBT group (N=17, M=7,88 SD=2,57), but not in the subgroup of nightly ruminations CBT group (N=16, M=9,87, SD=1,92). Conclusion Based on our preliminary findings, treating everyday worries with CBT therapy affect sleep maintenance insomnia, while treating only nightly ruminations and worries of sleeping difficulties would not improve sleeping problems and depressive mood. Support No

Depression in Burn Patients at Al-Diwaniya Teaching Hospital

Background
 Burn injuries affact on physical and mental status of the victum.
 The researchers show different outcome in their articles when they study depression in burned patients.
 Aim of the study
 The study aims are : 1. identify the prevalence rate of depression in burn patients. 2.measure severity of depression .3. study the socio-demographic variables of those patients.
 Methods
 A case –control study was condefed on One hunderd patients at the burn unit of AL- Diwaniya Teaching Hospital from a period of April 2nd 2014 to January 2nd 2015.
 the presence of depression was diagnosed by using a semi –structured interview schedule based on ICD-10, diagnostic criteria for depression ,and its severity was rated by Beck depression inventory. 
 Results
 The result revealed the depression was found in 40% of burned patients compared with 15% among their matched control group and this result was statistically significant .the rate of depression was higher for females than males,according to the Beck Depression Inventory (BDI), the majority of depression patients (60%) were of moderate severity. 
 Conclusion
 The prevelence of depression was 40(40%) patients . There is a close association between burn related variables and depression
 The study show the importance of evaluation and management of depression in burn injured patients

Depression InType2 Diabetic Patients In Al-Diwaniyah Teaching Hospital

Objectives: Depression is commonly found as a comorbid condition in chronic medical illnesses in general, and diabetes mellitus (DM) in particular. Patients with diabetes are twice as likely to suffer from depression as compared to the general population. The aims of the study were to estimate: the prevalence of depression in type 2diabetic patients and its severity, the rate of depression in type 2 diabetes in relation to socio-demographic variables, and to find out the correlation of depression with some diabetes variablesMethods:100 Iraqi patients with type 2 DM compared with 100 persons from general population as control group participated in across sectional study. Participants were interviewed using: a semi-structured interview schedule based on ICD-10, diagnostic criteria for depression ,Beck depression inventory II for severity of depression and socio demographic questionnaire.Results: The prevalence rate of depression in type 2 diabetes was 44%. The rate of depression was higher for females, married, housewife ,those of secondary level education, in age group(50-59),those of poor glycemic control, with long duration of diabetes, in patients on insulin and those with cardiovascular complication.Conclusions: Depression is more common in type2 diabetic patients than in normal individuals. This will necessitate the need for more attention and screening for such conditions, which plays a role in the patients state physically and mentally.Keywords: Depression, Type 2 diabetes mellitus.

Depression Among Internally Displaced People After February 22,2006 In Al-Diwaniya Governorate

Background Internally displaced persons (IDPs) are those who have been forced from their home but, unlike refugees, remain within the borders of their own countries. Mental health is recognized as a key public health issue for conflict-affected populations. Studies revealed high levels of depression among IDPsAims of the studyThis study aims to identify the prevalence rate of depression among IDPs who left their homes after the bombing of the Al-Askari Shrine in Samara and now are resettled in AL-Diwaniyah governorate.Also to study the prevalence rate of depression in relation with some socio- demographic variables (such as age, sex, marital status, occupation, and education).Also measuring the severity of depression among those people.MethodsOne hundred ten IDPs have been randomly selected in one area of Al-Diwaniya governorate (Insaf village) from a period of august 2nd, 2012 to January 2nd,2013. The presence of depression was diagnosed by using a semi –structured interview schedule based on ICD-10, diagnostic criteria for depression ,and its severity was rated by Beck depression inventory. The patients group was matched for age and sex with control group to achieve comparability.ResultsThe result showed that the prevalence rate of depression in IDPs was 34.5% compared with 16.4% among their matched control group and this result was statistically significant. The rate of depression was higher for females than males ,with some differences in depression rate among socio-demographic variable. And According to the Beck Depression Inventory (BDI) , the majority of our depressive patients(60%) were of moderate severity of depressionConclusionsDepression is common in IDPs .

Prevalence and severity of depression among Iraqi patients with systemic lupus erythematosus: A descriptive study.

BACKGROUND:Systemic lupus erythematosus (SLE) patients have high risk for depression which is a potentially life-threatening disorder.OBJECTIVES:To evaluate the prevalence and severity of depression in a sample of Iraqi patients with SLE if present.PATIENTS AND METHODS:This cross-sectional study involved 60 patients with SLE diagnosed according to revised American College of Rheumatology (ACR) classification criteria. Demographics and clinical data were collected. All patients were screened for depression by using the diagnostic and statistical manual of mental disorders-5 (DSM5) diagnostic criteria of depression. Severity of their depression was determined by using the Beck Depression Inventory criteria.RESULTS:The prevalence of depression was 31.7%. A severe form of depression was observed in 13.3% of SLE cases, moderate depression in 10%, and a mild degree of depression was 8.3% of the cases. Patients with high SLE disease activity index (SLEDAI score >12) had an obviously higher rate of depression (40%) compared to 20% among those with mild or moderate disease. There was no important or statistically significant difference in median SLEDAI score between depression severity categories (p > 0.05).CONCLUSIONS:Prevalence of depression in SLE patients was relatively high. SLE disease activity increase depression rate.

Confirmatory Factor Analysis of the Gotland Male Depression Scale in an Australian Community Sample

Abstract. The Gotland Male Depression Scale (GMDS) was developed to improve the assessment and identification of depression in men by assessing symptoms that fall outside DSM-V/ICD-10 diagnostic criteria for depression. However, research findings from the GMDS have been markedly discrepant. Attempts to validate the latent GMDS factor structure using exploratory factor analysis (EFA) have yielded inconsistent results, bringing the validity and public health utility of the scale into question. The current study used confirmatory factor analysis to test the construct validity of five competing latent factor models identified from prior research. Data were obtained and analyzed separately from an Australian community sample of adult males (n = 318) and females (n = 345). Fit indices demonstrated the original GMDS two-factor model (distress, depression) to be a poor fit to the data. An alternative mixed three-factor model demonstrated improved model fit, although indices remained marginal. Results question the factor structure validity of the GMDS in the present sample and highlight the need for further psychometric development of the scale.

Problem behaviours and symptom dimensions of psychiatric disorders in adults with intellectual disabilities: An exploratory and confirmatory factor analysis

BackgroundThe limited evidence on the relationship between problem behaviours and symptoms of psychiatric disorders experienced by adults with intellectual disabilities leads to conflict about diagnostic criteria and confused treatment. This study examined the relationship between problem behaviours and other psychopathology, and compared the predictive validity of dimensional and categorical models experienced by adults with intellectual disabilities. MethodsExploratory and confirmatory factor analyses appropriate for non-continuous data were used to derive, and validate, symptom dimensions using two clinical datasets (n=457; n=274). Categorical diagnoses were derived using DC-LD. Severity and 5-year longitudinal outcome was measured using a battery of instruments. ResultsFive factors/dimensions were identified and confirmed. Problem behaviours were included in an emotion dysregulation-problem behaviour dimension that was distinct from the depressive, anxiety, organic and psychosis dimensions. The dimensional model had better predictive validity than categorical diagnosis. ConclusionsInternational classification systems should not include problem behaviours as behavioural equivalents in diagnostic criteria for depression or other psychiatric disorders. Investigating the relevance of emotional regulation to psychopathology may provide an important pathway for development of improved interventions. What this paper addsThere is uncertainty whether new onset problem behaviours or a change in longstanding problem behaviours should be considered as symptoms of depression or other types of psychiatric disorders in adults with intellectual disabilities. The validity of previous studies was limited by the use of pre-defined, categorical diagnoses or unreliable statistical methods. This study used robust statistical modelling to examine problem behaviours within a dimensional model of symptoms. We found that problem behaviours were included in an emotional dysregulation dimension and not in the dimension that included symptoms that are typical of depression. The dimensional model of symptoms had greater predictive validity than categorical diagnoses of psychiatric disorders. Our findings suggest that problem behaviours are a final common pathway for emotional distress in adults with intellectual disabilities so clinicians should not use a change in problem behaviours as a diagnostic criterion for depression, or other psychiatric disorders.

Identifying Maternal Depression in Pediatric Primary Care: Changes Over a Decade.

Maternal depression affects 10% to 40% of mothers with young children and has negative consequences for children's health and development. The American Academy of Pediatrics (AAP) recommends that pediatricians identify women with maternal depression. The authors examined trends in inquiring about (asking informal questions) or screening for (using a standardized instrument) maternal depression by pediatricians in 2004 and 2013 and identified correlates of usually inquiring/screening to identify maternal depression. Data were ascertained from 778 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2004 (n = 457) and 2013 (n = 321) AAP Periodic Surveys. Pediatricians answered questions about physician and practice characteristics, training, attitudes, and inquiring/screening to identify maternal depression. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted. The prevalence of usually inquiring/screening to identify maternal depression increased from 33% to 44% (p < .01). In both years, pediatricians who usually inquired about child/adolescent depression had increased odds of usually inquiring/screening to identify maternal depression. Patient race/ethnicity and training in adult Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for depression were associated with inquiring/screening in 2004, and believing that family screening is within the scope of the pediatrician was associated with inquiring/screening in 2013. Although inquiring/screening about maternal depression has increased since 2004, less than half of pediatricians usually screen or inquire about maternal depression, representing a missed opportunity to identify depression and manage or refer women for treatment. Further training on the importance of mental and family health to children's health may increase identification of maternal depression in pediatric primary care.

Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success.

Patients with psychiatric disorder were reported to have a poor outcome in bariatric surgery. Few studies have examined the outcome of laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) in patients with psychiatric history. We aimed to compare excess weight loss (%EWL) in patients with and without psychiatric comorbidities who underwent LSG or LAGB. Patients undergoing LSG or LAGB were identified from our prospective database. A multidisciplinary team evaluated all patients preoperatively, including a psychological evaluation. Patients with the diagnosis of depression, anxiety, bipolar disorder, and schizophrenia were included in the psychiatric comorbidity group (PSY). Others were included in group NON-PSY. All patients were first screened to be psychologically stable to undergo surgery. Initial BMI and %EWL at 3, 6, and 12 months postoperatively were compared. A total of 590 patients (81.4 % women), with a median BMI of 43.8 kg/m(2) (range 30-99) who underwent LSG (n = 222) or LAGB (n = 368) from January 2006 to June 2013, were identified. Psychiatric comorbidities that were well controlled at the time of surgery were found in 188 patients (31.9%). Diagnostic criteria for depression were met in 154 patients (26.1%), 75 patients suffered from anxiety (12.7%), 9 from bipolar disorder, and 4 from schizophrenia (0.7%). Initial BMI was not different between the two groups. No significant difference in %EWL between the groups was found during follow-up (44.13 vs. 43.37%EWL, respectively, at 1 year; p = 0.76). When LSG and LAGB patients were analyzed as subsets, again no difference in %EWL at 1 year was found for PSY vs. NON-PSY (LSG: 51.56 vs. 54.86%EWL; LAGB: 38.48 vs. 38.45%EWL, all p = ns). In multivariate analysis, the differences from unadjusted analysis persisted. These findings demonstrate that a similar %EWL can be achieved in patients undergoing LSG or LAGB despite the presence of well-controlled psychiatric comorbidity.

A Qualitative Study of the Prodrome to First-Episode Major Depressive Disorder in Adolescents

Background: Currently, we lack a clear picture of the evolution of major depressive disorder (MDD) in adolescents. The period of disturbance preceding MDD can be conceptualised as the prodrome. The aim of the study was to explore the prodrome of first-episode MDD retrospectively in a group of help-seeking adolescents using qualitative methodologies. Sampling and Methods: Consecutively referred adolescents (15-18 years of age) with first-episode MDD were recruited for this study from Orygen Youth Health, Melbourne, Vic., Australia. After using quantitative methodologies to confirm the index episode of MDD and measure the extent of recovery, the prodrome was investigated in depth using qualitative techniques. Results: Twenty-nine adolescents (20 females and 9 males) and 7 informants (6 mothers and 1 grandmother) participated. All 29 participants had a prodrome of varying lengths (between 6 days and 4 years). The most noticeable symptoms initially were perplexity and confusion and, thereafter, sadness and irritability. A common pattern was a reduction in their ability to fulfil their role accompanied by guilt, self-blame and reduced self-esteem. Around half of the participants had increased thoughts of suicide and increased anxiety. There were gender differences in the patterns of symptoms noticed, with males more commonly noticing a change in how they related to the world and females more commonly noticing a change in the way that they related to others. All informants noticed a prodrome of varying lengths; in 2 cases longer, in 2 cases shorter and in 3 cases around the same time period as that noticed by the participant. The changes most commonly noticed by informants were sadness, upset, irritability and reduced self-esteem. The symptoms were fewer in number and sometimes varied from those noticed by the adolescents themselves. Conclusions: Whilst we recognise that this study is vulnerable to autobiographical bias, we took all reasonable measures to minimise this. Symptoms not included in the diagnostic criteria for depression were the earliest changes noticed by the adolescents themselves and are, therefore, potentially important in informing prevention strategies, as is the finding that there are gender differences in the patterns of changes noticed. In addition, parents may provide an additional avenue to help seeking.

Misdiagnosis of ADHD in Adoption Cases: Implications for Psychiatric Epidemiology

A fourteen-year-old bi-racial girl, adopted more than a decade earlier, presents with behavioral problems, i.e. bullying, poor grades, difficulty with social interaction with peers and teachers, etc. in middle school. Physicians initially diagnosed, and treated, the child with stimulants for ADHD. We suggest a differential diagnosis (D/Dx) of depression from the unacknowledged trauma of adoption. Deeper interviewing into the psycho-dynamics of an adopted child, as well as observation, and interview of peers, is required to discern depression from ADHD. The child makes remarks, set as jokes, but which reveal psychic pain. “You don't like me because I'm black,” is a statement she has made to a close friend, on several instances, only to immediately amend the remark by saying, “I'm joking.” We believe this repeated behavior demonstrates self-loathing. The patient clearly meets the diagnostic criteria for depression – presents with “anger or irritability” as well as “reckless behavior” and “helplessness/hopelessness” and “loss of interest in daily activities” and “self-loathing.” (DSM V, 2013). ADHD presents with similar, but fewer symptoms, e.g. “inattention, hyperactivity, impulsivity.” (DSM-V, American Psychiatric Association Publishing). As the child enters high school this fall, we believe it is time to adjust the diagnosis and treatment strategy and recommend psychotherapy as well as treatment with an anti-depressant shown to be safe with adolescents as a transitional care strategy. ADHD is too much of a surface diagnosis in this case. Reasoning by analogy, the same kinds of symptoms may be seen in other adoption cases.