the correlation between adolescent major depression disorder and the types of treatment
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The Correlation Between Adolescent Major Depression Disorder and The Types Of Treatment. By Dammy Kolade Mentor: Dr. Laura Mufson. Objective. - PowerPoint PPT PresentationTRANSCRIPT
The Correlation Between Adolescent Major Depression Disorder and The Types Of Treatment
By Dammy KoladeMentor: Dr. Laura Mufson
Objective
I evaluated the efficiency of four treatments for adolescents with major depressive disorder: fluxentine, cognitive-behavioral therapy, their combination, and a pill placebo.
Special Thanks
Mr. Francesco for guiding through this study and teaching me the skills to be able to complete this studyMy parents for helping and getting me the materials I needed to complete this course
Fluxentine
Definitions
SRI’s or serotonin reuptake inhibitors are medications that only block serotonin.CBT or Cognitive Behavior Therapy is the combination of two types of therapy one that identifies the problems and the other which creates solutions for the problems . Serotonin’s chemical
make up
Materials and Methods
In this study there will be adolescents (from ages12-17) with a primary DSM-IV diagnosis of current major depressive disorder.The one group patients will be administered 20 or 40mg fluxentine ( based on weight and age of the patient ) a specific SRI. (serotonin reuptake inhibitors ) .
Materials and Methods The a second group of patients will administered cognitive-behavioral therapy.Another group of patients will be administered a combination of the last two treatments (Fluxentine and CBT).And the last group of patients were administered acutely, pill placebo.
Materials and Methods
This study was a double blind placebo study . Which means that when the medicine was
given out that neither I nor the patient knew is what type of medication they received .
Materials and Methods
The experiment has three stages of the treatment of the patients
Stage 1 is a 12-week acute treatment period comparing four randomly assigned treatment groups: fluxentine (FLX), cognitive-behavioral therapy (CBT), their combination, and a pill placebo
Materials and Methods
In stage II (6 weeks), employed a treatment extension design to ask whether higher intensity treatment in partial responders to stage I treatment was helpful.Stage III, which lasts 8 weeks, focused on long-term maintenance of treatment gains.
Materials and Methods
The 120 patients were from Columbia’s Child and Adolescent Psychiatric Department.
All the patients in the study were outpatients that went to Columbia’s Presbyterian Child and Adolescent Psychiatric Department for treatment.
Materials and Methods
For responders to CBT, biweekly follow-up sessions lasted 30-50 minutes and emphasized generalization training and relapse prevention. For partial responders to CBT, weekly visits, which lasted 50 to 60 minutes (higher dose), were tailored to the patient's needs utilizing problem-specific individual or family modules
Materials and Methods
Stage II pharmacotherapy visits included biweekly or every-third-week visits, depending on response status, with responders continuing on their stage I dosing regimen.Partial responders advanced to 60 mg FLX as tolerated beginning at the week 12 office visit.
Materials and Methods
The screening process included a brief telephone interviewFollowed by a visit to the clinic in which consent and assent were obtained before an evaluation of study eligibility.
The patients that were given the combination of FLX and CBT that were making progress continued with the same treatment .The patients that were making some progress had their dosages of FLX to 60 mg and their CBT to 50 to 60 minute sessions
Materials and Methods
Results Demographics
Sample size 120
Age range (yr) 12-17 % of sample
Age 12 12.07%
Age 13 15.72%
Age 14 19.13%
Age 15 21.87%
Age 16 19.82%
Age 17 11.39%
Results
Gender
Male 45.56%
Female 54.44%
Race/ethnicityWhite 73.80%
African American 2.53%
Hispanic 8.88%
Results
Residence and School n (% )
Two-parent (52.85)
Lives with both biological/adoptive parents
(41.91)
Lives with one biological/adoptive parent
(10.93)
Results
Single-parent home (41.46 %)
Lives with biological/adoptive mother
(38.04 %)
Lives with biological/adoptive father
(3.42% )
Lives with biological/adoptive father
(3.42% )
Not living with one or both parents
(5.69%)
Currently enrolled in school
98.63%)
(Currently enrolled in gifted and talented classes
(7.29 %)
Currently enrolled in a special education program
(6.61%)
Ever repeated a grade in school
(15.53 %)
Results
Currently enrolled in school (98.63%)
(Currently enrolled in gifted and talented classes
(7.29 %)
Currently enrolled in a special education program
(6.61%)
Ever repeated a grade in school
(15.53 %)
Results
Diagnosis n (% ) n (% )
DSM-IV Diagnosis past episode After stage 3
Attention-deficit/hyperactivity (13.67) (10.96)
Oppositional defiant disorder (13.21) (4.33)
Social phobia (10.71) (3.42)
Special phobia (5.24) (2.28)
Generalized anxiety disorder (15.26) (3.20)
Result
DSM-IV Diagnosis
n (% ) n (% )
Panic disorder (0.23) (0.46)Separation
anxiety disorder(2.05) (2.28)
Enuresis (1.59) (7.29)
Substance abuse
(1.14) (1.37)
Transient tic disorder
(0.68) (0.68)
Alcohol abuse (0.68) (1.14)
DSM-IV Diagnosis n (% )current diagnosis
n (% )past episode
Bulimia (0.46) (0.46)
Conduct disorder (0.23) (0.46)
Agoraphobia (0.00) (0.23)
Substance dependence ( 0.00) (0.68)
Acute stress disorder (0.23) (0.68)
Encopresis (0.23) (0.91)
ResultsDSM-IV Diagnosis n (% )
current diagnosisn (% )
past episode
Anorexia nervosa
(0.23) (0.64)
Adjustment disorder with disturbance of conduct
(0.00)
(0.23)
Alcohol dependence (0.00) (0.23)
Adjustment disorder with mixed mood and conduct
( 0.00) (0.23)
Results Summary categories
n (% )past episode
n (% )current diagnosis
Anxiety disorders
(27.40) (10.32)
Disruptive behavior disorders
(23.46 ) (13.70)
OCD/tic disorders
(2.73) (1.14)
Substance use disorders)
(1.59) (2.51)
Results
The Table presents the percentage of adolescents who met DSM-IV criteria for other current or past psychiatric disorders. In all subjects with a coexisting psychiatric illness, MDD was determined to be the primary diagnosis and the other disorder was considered secondary to depression
Results
0
10
20
30
40
50
60
70
80
90
FLX CBT COMB Pill
current
past
DSM-IV scores before and after the study
05
101520253035404550
1st Qtr 2nd Qtr
East
West
North
Results
Summary Scores Mean +/- SD Median RangeCDRS-R Total score (depression severity) 60.10 +/- 10.39 59.00 45.00-98.00T score (depression severity) 75.48 +/- 6.43 76.00 66.00-85.00CGI CGI-S (depression severity) 4.77 +/- 0.83 5.00 3.00-7.00 CGAS (general functioning) 49.64 +/- 7.47 50.00 32.00-80.00
Results
CDRS = Children's Depression Rating Scale; CGAS = Children's Global Assessment ScaleCGI = Clinical Global ImpressionsRADS = Reynolds Adolescent Depression Scale
RADS Mean +/- SD Median Range
Total score (depression severity)
79.24 +/- 14.35 80.50 32.00- 116.00
Percentile rank (depression severity)
82.96 +/- 20.50 91.50 1.00-99.00
Results
On the CDRS a score of (45) represents mild depression where as a score of 98 represents severe depressionOn the RADS Most of the subjects fell in the moderately (40.6%) and markedly (37.8%) mentally ill categories, whereas (19.6%) adolescents were rated to be in the severely or most extremely mentally ill categories
Conclusion
After analyzing the data the treatment that was most efficient was the combination of both fluxentine and Cognitive Behavioral Therapy .When the study was finish it showed that females are two times as likely to have more severe cases of depression that males
Review of Literature
American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Washington, DC: American Psychiatric Association Angold A, Messer SC, Stangl D, Farmer EMZ, Costello EJ, Burns BJ (1998), Perceived parental burden and service use for child and adolescent psychiatric disorders. Am J Public Health 88:75-80 Arias E, MacDorman MF, Strobino DM, Guyer B (2003), Annual summary of vital statistics-2002. Pediatrics 112:1215-1230
Review of Literature
Ascher BH, Farmer EMZ, Burns BJ, Angold A (1996), The Child and Adolescent Services Assessment (CASA): description and psychometrics. J Emot Behav Disord 4:12-20 Beck AT, Steer RA (1993), Manual for the Beck Hopelessness Scale (BHS). San Antonio, TX: The Psychological Corporation Beck AT, Steer RA, Brown GK (1996), Manual for the Beck Depression Inventory-II. San Antonio, TX: The Psychological Corporation Brent DA, Moritz G, Bridge J, Perper J, Canobbio R (1996), The impact of adolescent suicide on siblings and parents: a longitudinal follow-up. Suicide Life Threat Behav 26:253-259 Brent DA, Holder D, Kolko D et al. (1997), A clinical psychotherapy trial for adolescent depression comparing cognitive, family and supportive therapy. Arch Gen Psychiatry 54:877-885