Difficulties for Depression Recognition in Primary Care

To fight the health disorder, it should be properly recognized first. The patient comes to the primary care with his problems, which might be seemingly unrelated to the clear case of the clinical depression, and unfortunately, the recognition of depression success rate in primary care is statistically less than we would like it to be. For example, 50% of people with major depression, identified by independent screening in Great Britain, were not recognized as depressed by the primary physician. The recognition of depression is particularly difficult in certain patient groups such as the physically ill, or in certain cultures, when depression is not socially accepted diagnosis. Yes, in some cultures it is just "normal" to be sad, but clinical depression is much more than cultural specifics, or normal mood swings.


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Depression is Often Unrecognized and Undertreated


Numerous studies indicate that 30-70% of cases of major depression are undiagnosed or undertreated in primary care. While some observers note that physicians are more likely to identify severe depression and to miss only milder forms of the illness, recent studies clearly demonstrated that nearly half of the undetected patients with depression in primary care developed suicidal ideation and 53% continued to meet criteria for major depression one year after the index evaluation.
                               
Physician, patient, and system variables probably account for these disturbing findings. Several theories have been offered, including health services issues, sociocultural barriers, poor consumer education, and insufficient physician knowledge level. Patient denial, cognitive impairment, lacking awareness of depressive symptoms, and inability to articulate symptoms compound the difficulties of detecting depression in primary care. Patient nonadherence, resistance to diagnosis, cultural factors, social forces, subtherapeutic dosages of antidepressants, and low insurance reimbursement rates lead to the inadequate treatment of depression. Many employment, health, disability, and life insurance practices discriminate against individuals with mental illness, thereby reinforcing stigma and adversely affecting their socioeconomic status.


Problems for Depression Recognition


There may be a number of possible reasons for a lack of recognition of depression within primary care, both related to the physicians and the patients. Generally these can be summarized as follows:


Patient factors


  • Patients ignore depression in themselves;

  • When depressed, older adults may complain less of depressed mood and present somatic symptoms which may not be identified by the clinician;

  •  Physical co-morbidity may also make the interpretation of depressive symptoms difficult. Depressed patients may appear demented, and patients with early dementia may present with depression;

  • Fear of the stigma of mental illness;

  • Worry about side effects of medication;

  • Blaming depression on circumstances, regarding it as ‘understandable’;

  •  Older adults may misattribute symptoms of major depression for ‘old age’, ill health or grief;

  • Although depression is more frequent in women, differential reporting of symptoms may lead to depression being under diagnosed in men;

  • In some cultures, depression is not considered as socially acceptable disorder, causing patients to cover up the symptoms for the proper diagnostics.

Practitioner factors


  • Primary care practitioners may lack the necessary skills or confidence to correctly diagnose late-life depression;

  • Primary care physicians have been shown to view depression as a normal response to difficult circumstances, illnesses or life events and depression may be under diagnosed because of dissatisfaction with the types of treatment that can be offered, especially a lack of availability of psychological interventions;

  •  Physicians typically have little time per patient.

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Recommendations for Patients


Unfortunately those patients who go unrecognized and untreated after the primary care visit lose the advantage of starting the instant treatment and getting on track to the recovery.


Please, remember that it is your health and your well-being is on stack, and you should do everything possible to help your primary physician in its diagnosis.  Get ready for the conversation, perform several self-checks for depression, if you just suspect that you may have it. Remember, that it is a disorder as any others, and you may significantly improve the quality of your life by accepting it and starting the professional treatment.


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Sources and Additional Information:
The Atlas of Depression by David S. Baldwin




Agitated Depressive Disorder

Agitated Depression a state of clinical depression in which the person exhibits irritability and restlessness. This term is applied to depressive disorders in which agitation is prominent. Agitation occurs in many severe depressive disorders but in agitated depression, it is particularly severe. Agitated depression is seen more commonly among the middle aged and elderly than among younger patients. However, there is no reason to suppose that agitated depression differs in other impotent ways from the other depressive disorders.






Definition of Agitated Depression


A major depression with agitation that may be driven by hypomania.
Although many people experience symptoms such as feeling slowed down and lethargic when they are depressed, others may experience just the opposite. They may feel anger, agitation and irritability. This is what "agitated depression" refers to.


Agitated depression was once called melancholia agitata. It is now also known as mixed mania.


Agitation occurs in many severe depressive disorders, but in agitated depression it is particularly severe. There is no reason to suppose that agitated depression differs in other important respects from other depressive disorders.


Diagnostic Criteria for Agitated Depression


  • Major Depressive Episode

  • At least two of the following symptoms:

    • Motor agitation

    • Psychic agitation or intense inner tension

    • Racing or crowded thoughts

Agitated depression meets the criteria for major depressive episode but not those of a mixed bipolar disorder according to the DSM-III-R.






Agitated Major Depressive Disorder Symptoms


It is not tough to identify the symptoms of agitated depression. People that suffer from this type of depression are not able to sit still and keep on restlessly moving here and there all the time. It is due to the outburst of emotional energy caused because of agitated depression. Those that suffer from this type of depression tend to complain a lot and develop the feelings of being misunderstood by others. At least 2 of the following manifestations of psychomotor retardation (not more subjective anxiety) are required for several days during the current episode:
  • Tearing of cloths

  • Motor agitation

  • Intense inner tension

  • Racing thoughts

  • Never ending baseless thoughts

  • Continuous talking

  • Hand wringing

  • Pacing

  • Pulling or rubbing on hair, skin, or clothing

  • Outbursts of complaining or shouting

  • Difficulty in explaining problem



Agitated depression in bipolar I disorder


The occurrence of agitated depression in bipolar I disorder is not rare and has significant prognostic and therapeutic implications. Whether the co-occurrence of a major depressive syndrome with one or two of these symptomatic clusters makes up a "mixed state" remains unclear.


Clinical Forms of Agitated Depression


  1. Psychotic agitated depression

    Proposed name: Melancholia

  2. Non-psychotic agitated depression

    Meets the RDC criteria

  3. Excites anxious depression

    Provisional name: Psychic agitation and racing or crowded thoughts.





Complications for Agitated depression


The complications that have been mentioned in various sources for Agitated depression includes getting involved in risky activities, dysfunction in family and work, and even suicide or homicide.


Treatment


Agitated depression can be difficult to treat because the behavior patterns associated with this form of depression lend to the inability to consistently take medication. It is important to get properly diagnosed by a mental health care professional who can supervise your treatment closely. Psychotherapy is also useful in treating agitated depression. It is usually necessary to have long term treatment as a combination drug and psychotherapy. The drug therapy has to be fine tuned to your specific needs. This can take up to a month to see results and a cessation of side effects in most people but it is highly effective.


The common treatment approaches are:
  1. Medicines - Antidepressants and anticonvulsant like divalproex, aripiprazole, clozapine or olanzapine is largely used in treatment of agitated depression.

  2. Psychotherapy - In most of the cases psychotherapy is preferred to treat agitated depression.

  3. Combination of medicines and psychotherapy - When drug therapy and psychotherapy is used in combination then effect is much better for curing agitated depression.

  4. Electroconvulsive therapy - Electricity is passed to the brain through electrodes to overcome from agitated depression.





Sources and Additional Information:

Reichian Therapy against Depression

Reichian Theory


When we are open, we experience pleasure, liveliness, and vitality. Many of us, however, find that our lives and relationships feel painfully constricted. We develop coping strategies early in life to ward off difficult, uncomfortable feelings. These defenses become habitual and can inhibit us from experiencing joyful, expansive feelings as well as pain. We become frozen and trapped in our defenses, and can become physically ill. These symptoms are cries for help from our wounded past, a past that may keep us from being fully available to the present. Our contracted self reveals itself in our character structure and body armor. To find our free, authentic self we must become conscious of our armoring - our self-distortions that turn us into unnatural adults that attack, cling, avoid, deny or pretend. Reichian therapy is an intensive, confrontational, personally demanding process for those who wish to profoundly change themselves and their life.


As we shed unnecessary layers of armor and facade we begin to discover our true, naturally sexual and spiritual natures.


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What is Reichian / Orgonomic Therapy?


Reichian Therapy, developed by Wilhelm Reich, is a method for character transformation that recognizes the essential identity of the mind and body. Also known as Orgone Therapy, Orgonomic Therapy, and Bio-psychotherapy, Reichian Therapy recognizes how "armoring" against the free flow of life energy blocks full emotional expression. The Orgonomic therapist works with the principles of psychodynamic psychotherapy to reveal to the patient\client their character attitudes and their character armoring.


With a functionally deep understanding of the mind/body relationship, the Orgonomic Therapist simultaneously analyzes the patient's character ("Character Analysis") as it presents itself through the ways in which they walk, talk, hold themselves, etc., and the chronic muscular tensions that anchor and support this behavior. This is done through relationship-building verbal dialog, description, analysis, and the release of muscular tension through deep massage. Developed out of Wilhelm Reich's character-analytic technique, which views the mind and body as one functional unit, Reichian Therapy is the classical foundation of Somatic Psychology.


Therapy works on many levels: past, present and future; conscious and unconscious; physical, emotional, spiritual. Nonetheless, the primary goal at the physical level is to restore full natural respiration and the capacity to experience pleasurable sensations and the joy of life. Psychologically, the goal is to be able to love fully.


The ability to work at all these levels, and especially to go deeper, makes Reichian work unique and is a result of Wilhelm Reich’s comprehensive understanding of the human psyche and body.


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Orgonomic therapeutic process facilitates:
  • Self-awareness and deep insight

  • Emotional and physical release, followed by an increased energy flow

  • Changes in habitual, unhealthy defensive patterns

  • Effective, lasting change

Bio-Psychotherapy includes:
  • Skilled, therapeutic dialog

  • Authentic, supportive, actively engaged relationship with the therapist

  • Character analysis: examine and change unproductive defense mechanisms

  • Body work: massage and deep tissue muscular intervention

  • Facilitation of deep feeling expression

  • Breathing enhancement

  • Dream analysis

Benefits of Orgnomic Therapy:
  • Alleviate symptoms of depression

  • Ease anxiety and panic

  • Decrease stress-related symptoms

  • Assistance with eating, sleep, and other disorders

  • Reduce physical symptoms (headaches, nervous disorders, digestive problems, sexual dysfunction, autoimmune issues, etc.)

Reichian Therapy


The Reichian Therapist locates painful constrictions and facilitates expansion. What makes Reichian Therapy uniquely powerful is that it includes body work to address the physical, somatic component - the physical expression of the mind's defenses. Dreams deepen the exploration because they provide direct access to the unconscious.


The Price of Constriction


http://www.orgonomictherapy.com/img/spacer.gifThe growing relationship with the therapist illuminates the protective stance we have in relation to others and ourselves. As we grow and survive adversity, we develop repetitive coping strategies to fend off difficult feelings. These strategies can alienate others, keep us from our true feelings, needs, and desires, and inhibit our ability to actualize who we really are. Our creativity and success in the world becomes minimized. Constricted respiration can be an additional sign of dysfunctional coping. Very few patients, indeed few people, breathe to full energetic capacity. One of the best ways to suppress painful emotions is to hold your breath. Infants and children spontaneously hold their breath in frightening situations. This happens to them many times each day in a dangerous environment. By adulthood, the chest is frozen in chronic breathlessness. Problems of depression, anxiety, phobias, insomnia, emptiness, loneliness, eating disorders, and addiction are defined and understood as reaction patterns to both present and past issues. These patterns have their roots in chronic character styles developed throughout a lifetime. As these behavior patterns are confronted, the character defenses are dislodged giving way to deeper issues and feelings.


Pleasure and Pulsing


Whether the global problem is one of love, of work, or of both, the common factor is lack of fulfillment and enjoyment in life. The rock song of the 70s wailed it well: "I can't get no satisfaction," (and the performers' lives seemed to make this a self-fulfilling prophecy). Reich saw the global problem as a disorder of pleasure.


What is pleasure? It's not so-called "cheap thrills," for they're not pleasurable after the fact. It's not just what "feels good," for such can ruin one's health and body (hepatitis, AIDS, cirrhosis, lung cancer, VD) as well as one's home and family (the casual affair, credit card binges, gambling).


For our purposes, pleasure can be defined as the natural, unfettered build-up and release of energy; full pleasure is pleasure experienced when making deep ("soul-to-soul") contact with another person; and mature pleasure is full pleasure governed by genitality and autonomy. Energy is not defined as a force alien to our natural selves or foreign to science, but is instead posited as an intervening variable to explain and communicate the sensations and feelings, sometimes very intense and "streaming," that occur in our bodies. It is in no sense connected to the mystical or the occult.


The build-up and release of energy seems to be the basis of the spontaneous, naturally-occurring movement that occurs in, and perhaps is a necessary condition of, all life. It is pulsation. Pulsation consists of an energy cycle in which mechanical tension leads to a bioelectric charge, a bioelectric discharge, and then mechanical relaxation, after which the cycle repeats.


This tension-charge-discharge-relaxation [TCDR] cycle can be demonstrated in unicellular organisms, as in the movements of amoebas, and in more complex organisms at all levels: the exchange of materials at the cellular level, the firings of nerve cells, the pulses in arteries, the peristaltic movements in the digestive system, the inspiration-expiration of breathing, the process of orgasm, daily (circadian) cycles, monthly cycles (menstruation), reproductive cycles (conception to birth), and perhaps even the cycle of life, itself.


Of course, no one fits any of these patterns exactly, and people have wide varieties and combinations of these and other patterns for differing times, circumstances, and stressors. Physiological conditions add their overlay to these patterns, as well. Being physically sick, having blood-sugar fluctuations, or experiencing pre-menstrual pressures (or lesser-known vague hormonal cycles in men) all distort the TCDR cycles.


The Concept of Armor


After years of living, we have diminished our capacity to feel to such an extent that we experience anxiety whenever the intensity of our feelings (our energy) starts to rise to a biologically normal level. In defending against this anxiety, we adjust our lives to feel only as much as we can tolerate, which often is just a mere fraction of the potential.


We defend against this anxiety by setting up resistances to the energy flow, and we do this by automatically tightening our muscles in specific patterns. This blocks or reduces the strong feelings to manageable proportions, and is known as muscular armor.


The prototype of this is the startle reaction, where we suck in our breath, hunch our shoulders, and become hyperalert as a reflex against a sudden noise or movement. A more recognizable block would be the "lump in the throat" one feels during a sad movie. Here, the throat muscles (pharyngeal constrictors) go into spasm as if to "choke down" the sadness that wants to come out. When the person cries fully, the tightness disappears.


Reich elaborated seven areas of armoring: the eyes, including the back of the neck; the jaw; the neck and throat; the chest; the diaphragm; the abdomen; and the pelvis. No two people have muscular armor in the exact same places for the same reasons, but there are patterns of armoring that seem to appear with certain traumas and conditions.


For example, people with ocular armoring ("eye blocks") often have headaches behind their eyes or in the back of their necks, and habitually block off visual contact with others. People with chronic jaw tension may grind their teeth (bruxism), and they have sweet smiles masking jaw muscles over-developed from "biting back" anger. The housewife at the beginning of this article had a strong throat block, as did also a man with a history of childhood oral-genital sexual abuse. A muscleman afraid of crying might develop a puffed-up chest, et cetera.


Character armor is an attitude or set of attitudes toward life that usually arises out of the muscular armor. The muscleman described just above might well have a puffed-up, inflated attitude about himself and thus relate to people through this defense, afraid to let his softness and vulnerability show. Contrariwise, a person with neck and chest armor in chronic contracted position may approach the world in a beaten-down, milquetoast way, protecting himself from experiencing his own rage.


Obvious cases like these, of course, are easy to identify. Usually, however, the muscular and character armoring patterns are subtle, and they can, and do, shift around during the course of therapy.


When we originally armor ourselves, we do so in idiosyncratic patterns that relate to our past histories. But the common factor is that everyone's TCDR cycle is distorted, and the result is usually a feeling of intense internal pressure, and perhaps even pain, accompanied by many of the standard psychological symptoms. Some people don't experience specific symptoms, but instead have a global feeling of being dissatisfied, or of having angst. And others have tightened up so much they cannot even feel; they have deadened themselves to their own distress.


The Process of Expansion


The Reichian Therapist usually starts body work by focusing on the eyes and respiration. The eyes (as an extension of the brain) help us to sustain contact with the world and ourselves. Almost everyone has some blocking in the eyes, and it is important that the eyes be reasonably unarmored for therapy to proceed. It is also important to dissolve blocks in respiration as breathing is essential in building and sustaining an energy level that will "push" emotions to the surface.


Reichian Therapy or Orgone Therapy, works from the head down toward the pelvis, leaving the latter for last. At the same time character analytic work is proceeding, peeling back layers of character attitudes that hide emotion, the layers of body armor are dissolved as well. The combined work results in spontaneous emotional release and provides the therapist with a deeper understanding of the character of the patient, yielding insight on "where to go" to deepen the therapy.


Reichian Therapy supports individuals, couples, and groups to experiment with their character and body structure in bold and profound ways that insist on change. Couples struggle as their character stances collide. Productive communication can become paralyzed. Reichian Therapy alters this stasis and teaches effective communication strategies so that the couple can maintain harmony and support the autonomy of the individuals. Group therapy is a process where participants can reveal their habitual, dysfunctional relationship patterns and learn different ways of being/behaving through the confrontation and support of other group members. Group is a very effective, fast, catalytic tool for change.


About Wilhelm Reich


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Wilhelm Reich was born at the end of the 19th century in what was then the Austro-Hungarian Empire. His early life on a farm was filled with sexual openness and experimentation that would influence much of his later work. Reich fought in World War I, and then went to school in Vienna, studying Freud, and becoming a part of the Vienna Psychoanalytic Association by the time he was 23. At 25 he set up his own private practice, and by his mid-30s he had developed a great deal of theories which would later underpin Reichian therapy.


Sources and Additional Information:






Link between ADHD Drug Ritalin and Depression



What ADHD is?


Attention Deficit Hyperactivity Disorder (ADHD) has become America’s number one childhood psychiatric disorder. It has been estimated that more than 5 million children are presently affected by this disorder in the U.S., which represents as many as 7 to 12 percent of preadolescent children. These percentages mean that almost every classroom can have children with ADHD. This disorder usually begins in infancy and continues into adulthood.  Usually there is a gender skew with this disorder, where boys are usually affected more often than girls, at a ratio of 4 to 1 for boys and 9 to 1 for girls.


It seems that the problem with ADHD has increased in later years, however, rather than having now a greater number of children affected by it, the reason for the increased number may well be that more children are diagnosed today than they were in the past.  Children are usually diagnosed with the disorder when they start school, thus many are only diagnosed during the first three grades and not before.


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What Ritalin is?


Methylphenidate (or MPH) is an amphetamine-like central nervous system (CNS) stimulant commonly used in treating Attention Deficit Hyperactivity Disorder (ADHD) in children and adults. It is also one of the primary drugs used to treat symptoms chronic fatigue syndrome (CFS), symptoms of traumatic brain injury, and drowsiness brought on my narcolepsy. Common brand names of drugs containing methylphenidate include Ritalin, Concerta and Methylin, among others. Ritalin is manufactured by Novartis AG. It was granted FDA approval in 1980, ushering in the so-called generation of “Ritalin kids” as the drug became hugely popular in the 1980s for children diagnosed with ADD or ADHD.


Ritalin Controversy


From the date of its approval, Ritalin has been the focus of much controversy. This controversy includes harmful Ritalin effects, Ritalin abuse (including snorting Ritalin), Ritalin addiction and other Ritalin side effects. Since 1980, prescriptions for Ritalin have skyrocketed, and now there are more than 5 million young patients who take this medicine on a daily basis.


While it is true that children can show improvement in ADHD symptoms while on Ritalin, the Ritalin effects last only several hours. Ritalin effects ADHD symptoms but the Ritalin effects wear off when the drug wears off.


In most cases the Ritalin side effects are mild but some, though rare, are life-threatening. Nervousness and insomnia are the most common adverse Ritalin side effects. Parents need to be clear about the benefits as well as the potential Ritalin effects – including the potential for Ritalin abuse and addiction - before administering Ritalin to their children.


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Kiddie Cocaine


Ritalin is often referred to as "Kiddie Cocaine" for good reason. Long-term Ritalin effects have been linked to brain development abnormalities similar to those found with cocaine use. The Journal of the American Medical Association, one of American's leading medical journals, published an article in August entitled "Ritalin Acts Much like Cocaine." An Archives of General Psychiatry report states; "Cocaine has pharmacological actions that are very similar to those of methylphenidate (Ritalin), which is now the most commonly prescribed psychotropic medicine for children in the U.S."


DEA data on methylphenidate and amphetamine for the treatment of ADD symptoms shows:
  • That methylphenidate (Ritalin, Concerta) and amphetamine (Adderall, Dexedrine) produce effects similar to cocaine in laboratory animals and in humans.

  • In clinical studies, methylphenidate and amphetamine produce behavioral and psychological effects similar to cocaine.

  • In simple terms, this data means that the human body cannot tell the difference between cocaine, amphetamine, or Ritalin.

Ritalin effects children the same way related stimulants like cocaine effect adults. Just as predictably, children are subject to Ritalin side effects, as adults are subject to the side effects of cocaine and other stimulant drugs.


Aside from the Ritalin side effects and potential for Ritalin abuse and addiction, another disturbing aspect of Ritalin is the long-term Ritalin side effects.


Until recently physicians believed that Ritalin side effects remained as short-term. Scientists at the University at Buffalo found otherwise. Research with gene expression in animals suggests that Ritalin has the potential for causing long-lasting changes in brain cell structure and function. Methylphenidate (Ritalin) appears to initiate changes in brain function that remain long after the therapeutic Ritalin effects dissipate.


In particular, the study results, made on preteen rats, from a research team led by William A. Carlezon Jr., PhD, director of the behavioral genetics laboratory at McLean Hospital and associate professor at Harvard Medical School, strongly suggest that Ritalin use in childhood may present a serious risk factor for depression development in adult years. "Rats exposed to Ritalin as juveniles showed large increases in learned-helplessness behavior during adulthood, suggesting a tendency toward depression," Carlezon says in a news release. "These rats also showed abnormally high levels of activity in familiar environments. [This] might reflect basic alterations in the way rats pay attention to their surroundings."


While research now indicates adverse long-term Ritalin side effects physically, other studies show that Ritalin use does not make an impact on behavior in the long run. A comprehensive follow-up study at Montreal Children's Hospital revealed that the behavior of hyperactive children did not differ significantly from the behavior of non-hyperactive children after taking ADHD medication for five years.


"Although it appeared that hyperactive kids treated with Ritalin were initially more manageable, the degree of improvement and emotional adjustment was essentially identical at the end of five years to that seen in a group of kids who had received no medication at all," the report stated.


Given the lack of long-term benefits, the potential for long-term Ritalin side effects and Ritalin abuse and addiction, many parents uncomfortable with Ritalin side effects choose alternative treatments for Attention Deficit Disorder.


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Other Side Effects


While the purpose of this post establishing link between Ritalin and Depression, we cannot skip other side effects, caused by this drug:


  • Appetite Disturbance

  • Stomach Aches

  • Headaches

  • Stunted Growth

  • Rebound

  • Difficulty Sleeping

  • Irritability

  • Anxiety

  • Jittery Feelings

  • Blood Glucose Changes

  • Blood Pressure Changes

  • Paranoia/Psychosis

  • Seizures

  • Death

Though rare, Ritalin has been known to cause sudden death in a few individuals. While many times there are additional factors that lead to this fatal ending, it is a dangerous effect to be aware of.


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Summary


As a parent, you should be really careful to admit your kid is positively diagnosed with ADHD clinical diagnosis. Note that ADHD symptoms may confuse you, as parents are often given ADHD checklists or questionnaires, which list symptoms such as:
  • fails to give close attention to details

  • makes careless mistakes

  • doesn't listen

  • doesn't follow instructions

  • loses things

  • talks too much

  • moves around too much or is always on the go

  • can't wait his turn

  • interrupts others

Can these be ADHD symptoms? Sure, but they can also be symptoms of a normal preschooler or an immature five year old, so it is important to consider the symptoms in the context of the child you are thinking about, especially his age and developmental level.


Most importantly, remember that for a child to have ADHD, the symptoms should be causing impairment for your child. That means that the ADHD symptoms should be causing him to have some trouble learning, making and keeping friends, participating in after-school activities (including sports) or even functioning at home.


Sometimes, teachers and associated medical professionals are eager to stamp overly normal, but active, child with AD/HD diagnosis, as that makes their life easier. Do not accept this verdict as granted, seek for second opinion, and admit the disorder only when evidence is overwhelming. If and when diagnosis is confirmed, and Ritalin is admitted, closely monitor your child for the side effects appearance, and ring a bell, when they go out of control immediately.




Sources and Additional Information:




Childhood Abuse and Clinical Depression in Adults

Overview


Childhood abuse and neglect is an insidious problem with far-reaching consequences. According to the U.S. Department of Health and Human Services Administration for Children and Families, in 2007 close to 800,000 children were determined to be victims of neglect or abuse. These statistics likely underestimate the actual incidence of abuse because an unknown but significant amount of abuse is never reported or investigated. Abuse has devastating, enduring effects on children. Adults who were abused as children continue to suffer from their childhood trauma. One of the many effects of childhood abuse is treatment-resistant depression.


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Types of Abuse


The forms of childhood abuse include neglect, emotional abuse, physical abuse and sexual abuse. The lion's share of abuse and neglect takes place within the home. Younger children and infants are particularly vulnerable as they lack the physical, emotional, verbal and social resources to defend themselves or to obtain help. Emotional abuse and neglect are harder to substantiate legally but have insidious effects on individuals and on society. All forms of childhood abuse cause immediate harm and have lasting effects. In many cases, victims of childhood abuse become perpetrators of abuse, continuing the cycle of abuse and victimization of children.


Effects of Abuse


Children who are abused experience symptoms of trauma, including anxiety, depression, difficulties at school or work, anger, aggression, cognitive and learning deficits, medical illness, social withdrawal, impulsivity, sexual activity at an early age and difficulty maintaining close relationships. Victims of childhood abuse are at higher risk for substance abuse, arrest, incarceration and legal problems.




Physiological effects include impairment of regions of the brain that regulate emotions and memory and sensitization of physiological stress response mechanisms. For example, according to a report in the December 2002 "American Journal of Psychiatry," women with histories of chronic childhood abuse and trauma have a smaller left hippocampus volume--a region of the brain involved in spatial memory--than non-depressed and non-childhood traumatized women. Similarly, women with childhood histories of abuse excrete greater amounts of the stress hormone cortisol in response to stress than do women who do not have childhood trauma. These varied effects of abuse often persist into adulthood.


Researchers at McLean Hospital, the largest psychiatric affiliate of Harvard Medical School, have confirmed that child abuse and neglect can "rewire" the developing brain. When brain circuitry is altered during the formative years it may eventually cause such disorders as anxiety and depression to more readily surface in adulthood.



According to Martin Teicher, MD, PhD, director of the Developmental Biopsychiatry Research Program, "science shows that childhood maltreatment may produce changes in both brain function and structure. These changes are permanent. This is not something people can just get over and get on with their lives."


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During the course of their studies, the researchers found that four abnormalities are more likely to be present in victims of child abuse and neglect:



* Changes to the Limbic System, the area of the brain that, together with the hypothalamus, controls hunger, thirst, emotional reactions and biological rhythms. In addition, it coordinates complex activities requiring a sequence of performance steps. Changes to the limbic system can result in epileptic seizures and abnormal electroencephalograms (EEG), usually affecting the left hemisphere of the brain, which is associated with more self-destructive behavior and more aggression.

* Deficient Development of the Left Side of the Brain, which can contribute to depression and impaired memory.

* Impaired Corpus Callosum, the pathway integrating the two hemispheres of the brain, which can result in dramatic shifts in mood and personality.

* Increased Blood Flow in the Cerebellar Vermis, the part of the brain involved in emotion, attention, and regulation of the limbic system, which can disrupt emotional balance.


Sexual abuse is even more harmful than physical abuse.  Adolescents and young adults who were abused or neglected during childhood are more than three times as likely to become depressed or suicidal, according to a study in the Journal of Child Psychiatry (1999). This research study also found that children who are sexually abused are more likely to become depressed or suicidal. Victims of sexual abuse were about six times more likely to attempt suicide; additionally, the risk of repeated suicide attempts was eight times higher than in children who were not sexually abused.  Further, 36 percent of those subjected to sexual abuse were diagnosed with a depressive disorder, compared to a 25 percent rate in victims of all types of child abuse or neglect.


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Sexual abuse carries the greatest risk of depression and suicide and this has always been noted in the research.  More than a third, 36 percent of sexually abused youths attempted suicide, compared to 16 percent of physically abused youths.   Six percent of children without a history of abuse reported attempting suicide.


Researchers from this study also found that the incidence of suicide attempts was higher during adolescence. ``Adolescence is the most vulnerable time for sexually abused youths, who are more prone to make repeated suicide attempts,'' the researchers said. Contextual factors such as family conflict, parental substance abuse and illegal activities should be addressed and dealt with in the treatment of depressed and suicidal adolescents who have been neglected in childhood.  Familial, parental and environmental factors are often possible contributors to depression. Familial factors include a poor marriage; parental factors include a low parental involvement; and environmental factors include welfare dependence and other socioeconomic issues.




Sources and Additional Information:






 
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