Transcript Dammy Kolade, The Correlation Between Adolescent Major

The Correlation Between Adolescent Major
Depression Disorder and The Types Of
Treatment
By Dammy Kolade
Mentor: 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
study
My 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 longterm 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 interview
Followed by a visit to the clinic in which consent
and assent were obtained before an evaluation
of study eligibility.
Materials and Methods
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
Results
Demographics
Sample size
Age range (yr) 12-17
120
% 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/ethnicity
White
African American
Hispanic
73.80%
2.53%
8.88%
Results
Residence and School
n (% )
Two-parent
(52.85)
Lives with both
(41.91)
biological/adoptive
parents
Lives with one
(10.93)
biological/adoptive parent
Results
Single-parent home
(41.46 %)
Currently enrolled 98.63%)
in school
Lives with
biological/adoptive
mother
(38.04 %)
Lives with
biological/adoptive
father
(3.42% )
(Currently
enrolled in gifted
and talented
classes
Lives with
biological/adoptive
father
(3.42% )
Not living with one or
both parents
(5.69%)
(7.29 %)
Currently enrolled (6.61%)
in a special
education
program
Ever repeated a
grade in school
(15.53 %)
Results
Currently enrolled in
school
(98.63%)
(Currently enrolled in gifted (7.29 %)
and talented classes
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
Substance abuse
(1.59)
(1.14)
(7.29)
(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)
Results
DSM-IV Diagnosis
n (% )
current diagnosis
n (% )
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
90
80
70
60
50
40
30
current
past
20
10
0
FLX
CBT
COMB
Pill
DSM-IV scores before and after the study
50
45
40
35
30
25
20
15
10
5
0
East
West
North
1st Qtr
2nd Qtr
Results
Summary Scores
Mean +/- SD
Median
Range
CDRS-R
Total score (depression severity) 60.10 +/- 10.39 59.00 45.00-98.00
T score (depression severity)
75.48 +/- 6.43
76.00 66.00-85.00
CGI
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
RADS
Mean +/- SD
Median
Total score
79.24 +/- 14.35 80.50
(depression
severity)
Percentile rank 82.96 +/- 20.50 91.50
(depression
severity)
Range
32.00- 116.00
1.00-99.00
CDRS = Children's Depression Rating Scale; CGAS = Children's
Global Assessment Scale
CGI = Clinical Global Impressions
RADS = Reynolds Adolescent Depression Scale
Results
On the CDRS a score of (45) represents mild
depression where as a score of 98 represents
severe depression
On 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