Depression in Young People: Initial Presentation and Clinical Course

McCauley, Elizabeth; Myers, Kathleen; Mitchell, J. R.; Calderon, Rosemary; Schloredt, Kelly; Treder, Robert

doi:10.1097/00004583-199307000-00003

Cited by 234 publications

(113 citation statements)

References 21 publications

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“…Also, the alleviation of persistent posttraumatic stress symptoms may have curbed the escalation of secondary depression (5). Involvement of parents and teachers in the therapeutic program may have improved the home and school milieu, thereby facilitating recovery from depression (22,23).…”

Section: Discussionmentioning

confidence: 99%

Outcome of psychotherapy among early adolescents after trauma

1997

AJP

307

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O n December 7, 1988, an earthquake with a magnitude of 6.9 on the Richter scale struck Armenia (population 3.5 million). It caused the destruction of four cities and 350 villages and killed at least 25,000 people in a region populated by approximately 550,000 people. The second largest city of Armenia, Gumri, was 20 miles from the epicenter. At least 18,000 people (7% of the city's total population) were killed in this city. Approximately 50% of the buildings in Gumri were destroyed. The earthquake occurred late in the morning when children and adolescents were in school. Nearly all of the children experienced extreme direct threats to their life and were exposed to horrifying sights and sounds during the earthquake and for several days thereafter.The literature indicates that there can be serious and long-lasting psychiatric consequences among children and adolescents after natural and man-made disasters (1-3). Our previous studies in Armenia have documented severe posttraumatic reactions and high rates of comorbid depression 1 1 ⁄2 years after the earthquake among children and adolescents in cities that were close to the epicenter (4, 5). The severity of their symptoms was attributable to extreme disaster-related experiences during, and in the aftermath of, the earthquake. Such findings indicate the need for provision of mental health services.To date, there is a paucity of controlled treatment outcome studies in children or adolescents after disasters (6, 7). After the 1980 earthquake in Italy, Galante and Foa used monthly structured classroom interventions over 1 academic year and reported a reduction in earthquake-related fears (8). This study did not specifically measure posttraumatic stress or depressive reactions. Yule (2) reported results of cognitive-behavioral treatment among girls after the sinking of the cruise ship Jupiter. After 5-9 months, the group who received treatment had lower scores on the Impact of Event Scale and on a fear survey. These findings would have been more definitive had the baseline scores for subjects not given treatment been included in a treatment-by-time interaction analysis.The Psychiatric Outreach Program of the Armenian

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Section: Discussionmentioning

confidence: 99%

Outcome of psychotherapy among early adolescents after trauma

1997

AJP

307

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“…For example, the average duration of an episode of major depression is 6 months. 18,19 It is possible that eating disorders, particularly BED, may simply show a shorter course. Perhaps individuals will only tolerate these eating disorders for a certain duration before the subjective distress motivates them to seek treatment or discontinue these behaviors on their own.…”

Section: Long-term Stability Of Eating Disorder Diagnoses (Fichter Andmentioning

confidence: 99%

Stability of eating disorder diagnoses: A commentary

Stice

Spoor

2007

Int. J. Eat. Disord.

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Eat ing disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are one of the most prevalent psychiatric problems for girls and young women, result in subjective distress and functional impairment, and increase risk for future onset of obesity, depression, suicide attempts, anxiety disorders, substance abuse, and health problems. 1,2 Although these eating disorders are clearly associated with functional impairment, less is known about the course of these eating disorder diagnoses over time. The purpose of this commentary is to discuss the findings of two articles on the longitudinal course of eating disorder diagnoses that appear in this special issue to discuss implications for nosology, and to offer suggestions regarding future research in this area.Long-term Stability of Eating Disorder Diagnoses (Fichter, & Norbert) This manuscript reports data on the stability of eating disorders over a 12-year period in a large treatment sample (N 5 311). Assessments were conducted at the beginning of therapy and at 2-year, 6-year, and 12-year follow-ups. The 12-year stability rate was 41.4% for AN, 34.4% for BN, 3.0% for BED, and 3.2% for other eating disorder not otherwise specified diagnoses (EDNOS). Results suggest moderate longitudinal instability of AN and BN, and pronounced longitudinal intability of BED and other EDNOS conditions. This instability was due to recovery, relapse, and diagnostic crossover. Most crossovers occurred from AN to BN and from BED to BN. Long-term outcome for BN and BED was encouraging, with both showing high recovery rates. The long-term outcome for AN was worse relative to BN and BED. Furthermore, the longitudinal course of BN and BED seemed to be nearly identical with similar percentages of remission and relapse. Relapse rates were low in this treatment sample.Before discussing the implications of these findings for nosology and future research directions, it is important to compare the findings from this study with other studies that have been previously published. Although research indicates that the overarching diagnosis of ''eating disorder'' is relatively stable, 3 several studies suggest that there is considerable longitudinal instability of the specific eating disorder diagnoses of AN, BN, and EDNOS in treatment samples, resulting from recovery, relapse, and crossover between and within the eating disorder diagnoses. 3,4-6 The recovery rates for AN and BN were moderate to high at each of the follow-up assessments in Fichter and Quadflieg study, which is similar to the rates reported by 7 who found that at 5-year follow-up, 56% of patients with AN, 74% of patients with BN, and 78% of patients with EDNOS no longer met criteria for any eating disorder diagnosis.Recovery rates of other treatment studies, however, are somewhat lower. For example, Fichter and Quadflieg reported a remission rate of 43.8% in AN and 56.8% in BN over a 2-year period; these recovery rates increased to about 60% for AN and about 70% for BN over a 6-12-year period....

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“…These impairments cause decreased quality of life, decreased productivity, and increased health-care costs (Skolnick et al, 2009). Children, adolescents, and young adults, who have significant risk of recurrence, are increasingly diagnosed with the disorder (McCauley et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

Resting Glutamate Levels and Rapid Glutamate Transients in the Prefrontal Cortex of the Flinders Sensitive Line Rat: A Genetic Rodent Model of Depression

Hascup

Stephens

et al. 2011

Neuropsychopharmacol

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Despite the numerous drugs targeting biogenic amines for major depressive disorder (depression), the search for novel therapeutics continues because of their poor response rates (B30%) and slow onset of action (2-4 weeks). To better understand role of glutamate in depression, we used an enzyme-based microelectrode array (MEA) that was selective for glutamate measures with fast temporal (2 Hz) and high spatial (15 Â 333 mm) resolution. These MEAs were chronically implanted into the prefrontal cortex of 3-to 6-month-old and 12-to 15-month-old Flinders Sensitive Line (FSL) and control Flinders Resistant Line (FRL) rats, a validated genetic rodent model of depression. Although no changes in glutamate dynamics were observed between 3 and 6 months FRL and FSL rats, a significant increase in resting glutamate levels was observed in the 12-to 15-month-old FSL rats compared with the 3-to 6-month-old FSL and age-matched FRL rats on days 3-5 post-implantation. Our MEA also recorded, for the first time, a unique phenomenon in all the four rat groups of fluctuations in resting glutamate, which we have termed glutamate transients. Although these events lasted only for seconds, they did occur throughout the testing paradigm. The average concentration of these glutamate-burst events was significantly increased in the 12-to 15-month-old FSL rats compared with 3-to 6-month-old FSL and age-matched FRL rats. These studies lay the foundation for future studies of both tonic and phasic glutamate signaling in rat models of depression to better understand the potential role of glutamate signaling in depression.

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Depression in Young People: Initial Presentation and Clinical Course

Cited by 234 publications

References 21 publications

Outcome of psychotherapy among early adolescents after trauma

Outcome of psychotherapy among early adolescents after trauma

Stability of eating disorder diagnoses: A commentary

Resting Glutamate Levels and Rapid Glutamate Transients in the Prefrontal Cortex of the Flinders Sensitive Line Rat: A Genetic Rodent Model of Depression

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