Early Onset Affective Disorders Symposium
Mood Disorder Section of the Iranian Psychiatric Association
The high prevalence of the mood disorders and their adverse effects on the quality of life of the sufferers made the Iranian Psychiatric Association to establish the Mood Disorder Section in May 2006 .
The Section aims to enhance the collaboration on education and research with an objective to advance the treatment of the mood disorders, resulting in improvements in outcomes/quality of life for those with mood disorders and their families .
The Section has as its missions the promotion of awareness of this condition in Iran at large, and providing the necessary information to those with mood disorders and their families.
Mood Disorder Section of The Iranian Psychiatric Association in collaboration with Iranian Academy of Child & Adolescent Psychiatry held a symposium about early onset affective disorders on Feb 5, 2009.
The abstracts of this symposium were published in this issue of Iranian Journal of Psychiatry as a way for promotion of the scientific efforts of our colleagues in this section of Iranian Psychiatric Association.
1- Early onset depressive disorders
Dr. F. Assarian
Child and Adolescent Psychiatrist, Kashan University of Medical Sciences, Isfahan, Iran
Depressive disorders are often familial recurrent illnesses associated with increased psychosocial morbidity and mortality. Early identification and effective treatment may reduce the impact of depression on the family, social, and academic functioning in youths and may reduce the risk of suicide, substance abuse, and persistence of depressive disorders into adulthood.
Epidemiology: The prevalence of Major depressive disorder (MDD) is estimated to be approximately 2% in children and 4% to 8% in adolescents, with a maleto- female ratio of 1:1 during childhood and 1:2 during adolescence. The risk of depression increases after puberty, particularly in females. Approximately 5% to 10% of children and adolescents have subsyndromal symptoms of MDD. The few epidemiological studies on dysthymic disorder have reported a prevalence of 0.6% to 1.7% in children and 1.6% to 8.0% in adolescents.
Clinical representation: Overall, the clinical picture of MDD in children and adolescents is similar to the clinical picture in adults, but there are some differences that can be attributed to the child's physical, emotional, cognitive, and social developmental stages. Children may have mood lability, irritability, low frustration tolerance, temper tantrums, somatic complaints, and/or social withdrawal instead of verbalizing feelings of depression. Also, children tend to have fewer melancholic symptoms, delusions, than depressed adults. There are different subtypes of MDD, which may have prognostic and treatment implications.
%40 to 90% of youths with depressive disorder also have other psychiatric disorders, with up to 50%having two or more co-morbid diagnoses. The most frequent co-morbid diagnoses are anxiety disorders, followed by disruptive disorders, attention-deficit/hyperactivity disorder (ADHD), and, in adolescents, substance use disorders. Because most children and adolescents presenting to treatment are experiencing their first episode of depression, it is difficult to differentiate whether their depression is part of unipolar major depression or the depressive phase of bipolar disorder. Certain indicators such as high family loading for bipolar disorder, psychosis, and history of pharmacologically induced mania or hypomania may herald the development of bipolar disorder .It is important to evaluate carefully for the presence of subtle or short duration hypomanic symptoms because these symptoms often are overlooked and these children and adolescents may be more likely to become manic when treated with antidepressant medications. It is also important to note that not all children who become activated or hypomanic while receiving antidepressants have bipolar disorder. …