Managing Depression in Adolescents Part 3
Screening & Evaluation
SCREENING:
Due to the previously stated risks associated with untreated depression, it should be abundantly clear that each and every adolescent should be assessed for symptoms of depression. This ought to be the case regardless of their chief complaint or purpose for visit. This can be done quickly as you assess for presence of key symptoms of depression such as:
depressed/sad mood
irritability
anhedonia
If it is determined that these symptoms are present most of the time and create distress in the patient’s day to day life, then perhaps a diagnosis of MDD should be considered by means of a more thorough evaluation.
EVALUATION
A comprehensive psychiatric diagnostic evaluation is the best tool for diagnosing depressive disorders in children and adolescents. The assessment should be performed by a clinician who is sensitive to the child's developmental stage and able to build good rapport with them. This is important because children may have trouble expressing their feelings or may deny being depressed, so the clinician should also pay attention to observable signs such as changes in sleep or school performance.
You ought to look beyond the child’s experienced symptoms and also consider the strengths of the child & family. Exploring the family dynamic and viewing behaviors through the lens of present religious or cultural factors are two ways this can be done. Furthermore, it may be appropriate to speak with primary care providers in order to better understand medical hx.
While it is true that there are standardized interviews available for assessing psychiatric symptoms in children, many of these are too long to practically use. It’s important to seek information from multiple sources including the patient and his or her family. As we know, there are no biological or imaging tests that can diagnose depression.
In addition to evaluating symptoms, it is important to assess the child's overall functioning using rating scales such as the Children's Global Assessment Scale or Global Assessment of Functioning. The PMHNP should also assess for self injurious behaviors or suicidal ideation. Depending on risks, it may be appropriate to refer pt to a higher level of care. Or… an inpatient unit. Remember a guiding principle is to use the least restrictive level of care. if you do find that an inpatient unit is the least restrictive, yet appropriate level of care, then be prepared to offer a bit of info about the facility local to your patient.
Next post will dig in a bit more specifically on how to assess for suicidal ideation and more generally parasuicidal behaviors.
DISCLAIMER
This is not Medical Advice and while the writer believes what he has shared, substack dot com does not equate to strong evidence. Please do not treat patients based on what is read in this post, these are opinions of an internet stranger. Instead use these posts as a starting point for furthering your own study & education.