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Depression Dr. Cory D. Saunders, C.Psych. Developmental Neuropsychology Windsor Regional Children’s Centre Muscular Dystrophy: 1/6000 Cystic Fibrosis 1/4000 Childhood Cancers 1/500 Diabetes Mellitus 3/100 Autistic Disorder 2-3/500 1/88 1/50 113.54 FTE Social Workers Child & Youth Workers Psychologists Psychometrists Medical Consultants & Child Psychiatrists Number of Children Seen 2011/12: 2725 Number of Visits 2011/12: 10,145 1800 1700 1600 1500 1400 1300 1200 1100 1000 900 800 700 200607 200708 200809 200910 201011 201112 201213* 980 876 589 827 841 786 849 Referrals 855 844 Closed 675 645 545 192 181 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13* What are the most common mental health issues in school aged children? Where do they come from? Is there a common denominator? What is the purpose of the student’s behavior? 5 or more symptoms for at least 2 weeks: Depressed mood Markedly diminished interest or pleasure Significant weight loss or gain Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or inappropriate guilt Diminished concentration or indecisiveness Recurrent thoughts of death or suicide Family history An imbalance of chemicals in the brain Difficult life events Traumatic events in childhood abuse neglect divorce family violence Gender Increased stress Chronic illness Four different categories: emotional signs, cognitive signs, physical complaints, and behavioral changes Not every child who is depressed experiences every symptom Typical moods or emotions experienced: Sadness Loss of pleasure or interest Anxiety Anger or Irritability A depressive mood can bring on negative, self-defeating thoughts The signs to look for are: Difficulty organizing thoughts Negative view Worthlessness and guilt Helplessness and hopelessness Feelings of isolation Suicidal Thoughts Depression is not just an illness of the mind - it also causes physical changes Changes in appetite or weight Sleep disturbances Sluggishness Agitation These signs will be the most obvious and easy for your detect Avoidance and withdrawal Clinging and demanding Activities in excess Restlessness Self-Harm Most symptoms are similar to those in adulthood Depression can be difficult to diagnose in teens because adults may expect teens to act moody Adolescents do not always understand or express their feelings well - they may not be aware of the symptoms and may not seek help These symptoms may indicate depression: Poor performance in school Withdrawal from friends and activities Sadness and hopelessness Lack of enthusiasm, energy or motivation Anger and rage Overreaction to criticism Feelings of being unable to satisfy ideals Poor self-esteem or guilt Indecision, lack of concentration or forgetfulness Restlessness and agitation Changes in eating or sleeping patterns Substance abuse Problems with authority Suicidal thoughts or actions Teens may experiment with drugs or alcohol or become sexually promiscuous to avoid feelings of depression Teens also may express their depression through hostile, aggressive, and/or risk-taking behavior Such behaviors often lead to new problems, deeper levels of depression, and destroyed relationships Four out of five teens who attempt suicide have given clear warnings: Suicide threats, direct and indirect Obsession with death Poems, essays, and drawings that refer to death Giving away belongings Dramatic change in personality or appearance Irrational, bizarre behavior Overwhelming sense of guilt, shame or rejection Changed eating or sleeping patterns Severe drop in school performance ER Visits 444 388 Admissions 409 337 285 280 151 150 116 300 139 146 164 181 195 91 Children Young children –medication with some simple cognitive behavior therapy if appropriate Older children – Cognitive behavior therapy and medication (SSRI) Adolescents Cognitive behavior therapy Medication (SSRI) If SSRI used an initial period of monitoring Immediate Risk: Proceed to the ED at WRH Met campus Urgent Care: Walk In Clinic: Monday, Tuesday, Thursday 12-6pm. Referrals for Service Windsor Regional Children’s Centre (aged 6-18) Maryvale Adolescent and Family Services (aged 13-18) Coordinated Access HelpLink, Intake, Service Coordination Children’s Crisis Services Walk In Clinic, ERCR Children's Treatment Services Clinic Services Youth Justice Services Probation Diversion, Adolescent Sex Offender, Youth Mental Health Court Worker (pre-charge diversion) Intensive Family Services Milieu Continuum (Residential through Day Treatment) Assessment and Consultation Services Developmental Services, Psychological Assessment, Medical Services Child and Adolescent Mental Health Beds Sexual Assault Domestic Violence Treatment/SAFE Kids