Diagnostic Interview

In the assessment of complex adolescent depression, the diagnostic interview is necessary both to establish the diagnosis and to assess for comorbid psychiatric conditions. The most common comorbid conditions are anxiety disorders, substance use disorders, and disruptive behavior disorders (TADS Team, 2005). Clinicians assessing MDD will also need to assess for possible manic, hypomanic, or psychotic symptoms, since these features will be present in a minority of seriously depressed teens, and have implications for treatment.

An example of a diagnostic instrument is the K-SADS (Schedule for Affective Disorders and Schizophrenia for School-Age Children). A recent version, developed by Kaufman and her colleagues (1997), has several advantages over earlier forms of the instrument. Kaufman's edition, the K-SADS-PL, covers both present episode and worst lifetime episode ofvarious disorders. It includes a Screen Interview with key symptom items from all diagnostic domains to determine the probability that various categories of diagnoses need to be assessed further. In addition to the screen interview, modules cover Affective Disorders, Anxiety Disorders, Substance Use Disorders, Disruptive Behavior Disorders, Tic Disorders, and Eating Disorders. Impairment ratings are completed to ensure that the diagnosis is given only if symptoms are accompanied by functional impairment. We recommend that the interviewer also assess age of onset of mood disturbance, age of first episode, and number of prior episodes of MDD.

The interviewer reviews symptoms separately with the adolescent and with the parent, thus ensuring that both internal states and behavioral observations are taken into account. The diagnostician then synthesizes the information to determine the diagnosis. Psychometric properties of the K-SADS-PL, based on a small sample study, are acceptable (Kaufman et al., 1997).

Discriminating unipolar and bipolar depression can be an important challenge when treating a depressed or dysphoric child. The K-SADS-PL is a widely accepted instrument for diagnosing bipolar disorder in children and adolescents. Augmenting this interview with a parent-report screening instrument, such as the Parent Version of the Young Mania Rating Scale (Gracious, Youngstrom, Findling, & Calabrese, 2002), can help to avoid both false-negative and false-positive diagnoses (Youngstrom et al., 2004).

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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