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Fenomenologia dos sintomas depressivos uptodate Phenomenology — To clarify the phenomenology of depression in adolescents, each criterion for a major depressive episode is reviewed below with a focus on typical adolescent manifestations. Depressed or irritable mood — Many adolescents directly report a depressed mood, such as feeling down, sad, or blue much of the time. However, depression in adolescents commonly expresses itself primarily as an irritable mood. The DSM-IV provides the "irritability" criterion only for children and adolescents because many adolescents and most children lack the emotional and cognitive sophistication to correctly identify and organize their emotional experiences [35]. Irritability, as an example, often manifests in the adolescent's being "annoyed" or "bothered" by everything and everyone. Rather than expressing sadness, the depressed adolescent may be moody, negative, and argumentative, picking fights as a means to convey his or her emotional distress. He or she often is unable to tolerate frustration and responds to minor provocations with angry outbursts. Caregivers of adolescents must listen closely to adolescents to identify a depressed mood, particularly the adolescents' descriptions of how they think about themselves, their world, and their futures [50]. Depressed mood in adolescents may manifest as: finding others antagonistic or uncaring, brooding about real or potentially unpleasant circumstances, a gloomy or hopeless outlook, belief that everything is "unfair", or feelings that they disappoint parents or teachers. Mood reactivity, the capacity to be cheered up when presented with positive events, is common in adolescents and a characteristic feature of depression with atypical features. (See 'Features' below.)

Fenomenologia Dos Sintomas Depressivos Uptodate

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Page 1: Fenomenologia Dos Sintomas Depressivos Uptodate

Fenomenologia dos sintomas depressivos uptodate

Phenomenology — To clarify the phenomenology of depression in adolescents, each criterion for a major depressive episode is reviewed below with a focus on typical adolescent manifestations.

Depressed or irritable mood — Many adolescents directly report a depressed mood, such as feeling down, sad, or blue much of the time. However, depression in adolescents commonly expresses itself primarily as an irritable mood. The DSM-IV provides the "irritability" criterion only for children and adolescents because many adolescents and most children lack the emotional and cognitive sophistication to correctly identify and organize their emotional experiences [35]. Irritability, as an example, often manifests in the adolescent's being "annoyed" or "bothered" by everything and everyone. Rather than expressing sadness, the depressed adolescent may be moody, negative, and argumentative, picking fights as a means to convey his or her emotional distress. He or she often is unable to tolerate frustration and responds to minor provocations with angry outbursts.

Caregivers of adolescents must listen closely to adolescents to identify a depressed mood, particularly the adolescents' descriptions of how they think about themselves, their world, and their futures [50]. Depressed mood in adolescents may manifest as: finding others antagonistic or uncaring, brooding about real or potentially unpleasant circumstances, a gloomy or hopeless outlook, belief that everything is "unfair", or feelings that they disappoint parents or teachers.

Mood reactivity, the capacity to be cheered up when presented with positive events, is common in adolescents and a characteristic feature of depression with atypical features. (See 'Features' below.)

Mood reactivity can cause adolescents to seek activities and experiences to temporarily lift their moods. Examples of these activities include affiliation with peers, thrill-seeking, promiscuity [51], and drug use. The use of peer affiliation to alleviate depression is differentiated from the normal adolescent need for peer affiliation by its urgency and drive. For the teens who use sexual activity in the same way, a decrease in sexual interest can be a healthful sign of increased emotional stability and appropriate boundaries.

Diminished interest or pleasure — Anhedonia is the psychiatric term referring to the inability to experience pleasure in formerly enjoyable activities. Adolescents with anhedonia experience events, hobbies, interests, and people as less interesting or fun than they used to be. Adolescents express anhedonia by describing experiences as "boring," "stupid," or

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"uninteresting." They may withdraw from or lose interest in friends. If they are sexually active, they may have decreased libido or interest in sex.

Change in appetite or weight — Change in appetite and corresponding weight loss or gain is characteristic of depression. However, appetite change may not be manifest as often in depressed youngsters as in depressed adults [52].

The failure to make expected weight gains satisfies this criterion for adolescents. Anorexia is more prevalent in adolescent girls than boys. Preoccupation with weight and body image are signs of anorexia nervosa [13,53]. (See "Eating disorders: Overview of epidemiology, diagnosis, and course of illness".) Alternatively, some adolescents with depressive disorders crave and eat more specific foods (eg, junk food and carbohydrates) and accordingly gain more weight than expected during their adolescent growth spurt.

Sleep disturbance — Sleep disturbance is common in depressed adolescents, many of whom describe their sleep as nonrestorative and report difficulty getting out of bed in the morning. Sleep disturbance manifests as insomnia, hypersomnia, or significant shifts of sleep pattern over the diurnal cycle [48,52].

Initial insomnia — difficulty getting to sleep

Middle insomnia — waking in the middle of the night

Terminal insomnia — waking too early in the morning

Hypersomnia — extended nighttime sleep or daytime napping

Circadian reversal — daytime sleeping and nighttime arousal.

Psychomotor agitation or retardation — Psychomotor retardation is common in depressed youth [48]. Adolescents with psychomotor retardation talk or move more slowly than is typical for them. They produce less speech and present with longer response latencies. This criterion is met only if the adolescent actually appears to be moving in slow motion; the subjective experience of feeling slowed down does not qualify.

Alternatively, some depressed adolescents present with agitation: trouble sitting still, pacing, hand wringing, pulling at or rubbing clothes, tantrums, yelling, shouting, and non-stop talking. Adolescents can have alternating periods of retardation and agitation within a single episode of depression.

Fatigue or loss of energy — This criterion is met if the adolescent reports feeling chronically tired, exhausted, listless, and without energy or motivation. They may feel the need to rest during the day, experience heaviness in their limbs, or feel like it is hard to get going much of the time. Parent-adolescent conflict can result if the parents misinterpret the depressed adolescent's lack of energy and motivation as laziness, an oppositional attitude, or avoidance

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of responsibilities. Alternatively, parents may be concerned that the adolescent is medically ill and seek a medical explanation for the chronic fatigue.

Feelings of worthlessness or guilt — The self-perceptions of depressed adolescents usually are marked by feelings of inadequacy, inferiority, failure, and worthlessness. Evaluation of this criterion is challenging because many teens do not directly acknowledge such negative self-perceptions. Guilt about struggling with depression and its associated functional impairment is not considered sufficient to meet this criterion unless it is of delusional proportions. These thoughts may manifest as:

Reluctance to try to do things (fear of failure)

Excessively self-critical assessment of accomplishments

Difficulty identifying positive self-attributes

Desire to change several aspects of themselves

An "I don't care" stance to avoid acknowledgment of insecurity

Compulsive lying about success or skills to bolster self-esteem

Envy or preoccupation with the success of others

Marked self reproach or guilt for events that are not their fault

Belief that they deserve to be punished for things that are not their fault

Impaired concentration, indecisiveness — Depressed adolescents usually have problems with attention and concentration that were not present to the same degree before the episode of depression. Their thinking and processing of information may be slowed. In addition, they are indecisive, which manifests as procrastination, helplessness, or paralysis in taking action. They take longer to complete homework and class work than before the depressive episode; school performance may decline. Information from the school is necessary to evaluate this criterion because school performance typically is affected by the cognitive disturbance.

Recurring thoughts of death or suicide — This criterion is met if the adolescent experiences recurrent thoughts of death (not just fear of death) or suicide, or attempts suicide. Morbid thoughts are common in depressed teens and manifest as: thoughts that life is not worth living, thoughts that others would be better off if the adolescent were dead, or preoccupation with music and literature that has morbid themes.

In a subset of depressed teens, morbid thoughts devolve to thoughts of suicide, suicide plans, suicide pacts, and suicide attempts. Thoughts that contribute to suicidality include pervasive hopelessness (eg, negative expectations for the future) and a view of suicide as an option to escape emotional pain. (See "Suicidal behavior in children and adolescents: Epidemiology and risk factors".) Adolescents with depression that includes psychotic features sometimes experience command hallucinations telling them to commit suicide.

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The estimated point prevalence of major depressive disorder in adolescents is 4 to 8 percent, and of dysthymic disorder is 2 to 8 percent. The estimated cumulative incidence of major depressive disorder during adolescence is 15 to 20 percent, and the female-to-male ratio approaches 2:1. The typical duration of a major depressive episode is seven to nine months; 90 percent of episodes remit within two years. However, the cumulative probability of recurrence within two years is 40 percent and by five years is 70 percent.