Clinical: Managing depression in children and young people

Key learning points - How to identify the signs and symptoms of depression in children and adolescents - Treatment options for young people experiencing depression - The Nurse (primary care/Health Visitors/School Nurse) role in supporting young people experiencing depressio

Cross-sectional and longitudinal associations between psychotic and depressive symptoms in depressed adolescents

Adults with major depressive disorder (MDD) with psychotic features (delusions and/or hallucinations) have more severe symptoms and a worse prognosis. Subclinical psychotic symptoms are more common in adolescents than adults. However, the effects of psychotic symptoms on outcome of depressive symptoms have not been well studied in adolescents. Depressed adolescents aged 11–17 with and without psychotic symptoms were compared on depression severity scores at baseline and at 28- or 42-week follow-up in two large UK cohorts. Psychotic symptoms were weakly associated with more severe depression at baseline in both cohorts. At follow-up, baseline psychotic symptoms were only associated with depressive symptoms in one sample; in the other, the effect size was close to zero. This supports the DSM5 system of psychotic symptoms being a separate code to severity rather than the ICD10 system which only allows the diagnosis of psychotic depression with severe depression. There was no clear support for psychotic symptoms being a baseline marker of treatment response

Adolescents' experiences of brief psychosocial intervention for depression: An interpretative phenomenological analysis of good-outcome cases

BACKGROUND: Brief psychosocial intervention (BPI) is a treatment for adolescent depression that has recently demonstrated clinical effectiveness in a controlled trial. The aim of this study is to explore experiences of adolescents with major depression receiving BPI treatment in the context of good treatment outcomes. METHOD: A subsample of five interviews from a larger study of adolescents' experiences of BPI was purposively selected, focusing on good-outcome cases. Interviews were analysed using interpretative phenomenological analysis to provide a richer understanding of participants' experiences of overcoming depression in the BPI group. RESULTS: Four central themes were identified: 'Being heard and feeling safe', 'Collaborative working enhancing therapy', 'Gaining a different perspective on one's self and relationships' and 'A positive therapeutic relationship'. CONCLUSION: BPI is a novel approach with promising clinical effectiveness. Utilising adolescents' experiences has revealed potential psychological mechanisms of good treatment response to BPI. Overall implications for clinical practice with depressed adolescents are discussed

Evolution and extinction of Maastrichtian (Late Cretaceous) cephalopods from the López de Bertodano Formation, Seymour Island, Antarctica

One of the most expanded records to contain the final fortunes of ammonoid cephalopods is within the López de Bertodano Formation of Seymour Island, James Ross Basin, Antarctica. Located at 65° South now, and during the Cretaceous, this sequence is the highest southern latitude onshore outcrop containing the Cretaceous-Paleogene (K-Pg) transition. We present comprehensive new biostratigraphic range data for 14 ammonite and one nautiloid species based on the collection of >. 700 macrofossils from high-resolution sampling of parallel sedimentary sections, dated Maastrichtian to earliest Danian in age, across southern Seymour Island. We find evidence for only a single, abrupt pulse of cephalopod extinction at the end of the Cretaceous when the final seven ammonite species disappeared, consistent with most evidence globally. In the lead up to the K-Pg extinction in the James Ross Basin, starting during the Campanian, ammonite diversity decreased overall, but the number of endemic taxa belonging to the family Kossmaticeratidae actually increased. This pattern continued into the Maastrichtian and may be facies controlled, linked to changes in sea level and seawater temperature. During the early Maastrichtian, ammonite diversity dropped significantly with only two species recorded from the basal López de Bertodano Formation on Seymour Island. The subsequent diversification of endemic taxa and reappearance of long-ranging, widespread species into the basin resulted in an increase in ammonite diversity and abundance during the mid-Maastrichtian. This was coincident with an apparent period of warming temperatures and sea level rise interpreted from palynology and sedimentology, perhaps reflecting a high latitude expression of the Mid-Maastrichtian Event. Late Maastrichtian diversity levels remained stable despite reported climatic and environmental variation. Ammonite diversity patterns during the Maastrichtian parallel those of microfossil species such as nannofossil and planktonic foraminifera, suggesting that dynamic climatic and environmental changes affected many planktonic and nektonic organisms during the latest Cretaceous. However, we suggest that these perturbations had a minimal effect on overall diversity prior to the catastrophic extinction event at the K-Pg boundary

Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children

<p>Abstract</p> <p>Background</p> <p>Post-traumatic stress disorder (PTSD) is diagnosed in 20% to 53% of sexually abused children and adolescents. Living with PTSD is associated with a loss of health-related quality of life. Based on the best available evidence, the NICE Guideline for PTSD in children and adolescents recommends cognitive behavioural therapy (TF-CBT) over non-directive counselling as a more efficacious treatment.</p> <p>Methods</p> <p>A modelled economic evaluation conducted from the Australian mental health care system perspective estimates incremental costs and Quality Adjusted Life Years (QALYs) of TF-CBT, TF-CBT combined with selective serotonin reuptake inhibitor (SSRI), and non-directive counselling. The "no treatment" alternative is included as a comparator. The first part of the model consists of a decision tree corresponding to 12 month follow-up outcomes observed in clinical trials. The second part consists of a 30 year Markov model representing the slow process of recovery in non-respondents and the untreated population yielding estimates of long-term quality-adjusted survival and costs. Data from the 2007 Australian Mental Health Survey was used to populate the decision analytic model.</p> <p>Results</p> <p>In the base-case and sensitivity analyses, incremental cost-effectiveness ratios (ICERs) for all three active treatment alternatives remained less than A$7,000 per QALY gained. The base-case results indicated that non-directive counselling is dominated by TF-CBT and TF-CBT + SSRI, and that efficiency gain can be achieved by allocating more resources toward these therapies. However, this result was sensitive to variation in the clinical effectiveness parameters with non-directive counselling dominating TF-CBT and TF-CBT + SSRI under certain assumptions. The base-case results also suggest that TF-CBT + SSRI is more cost-effective than TF-CBT.</p> <p>Conclusion</p> <p>Even after accounting for uncertainty in parameter estimates, the results of the modelled economic evaluation demonstrated that all psychotherapy treatments for PTSD in sexually abused children have a favourable ICER relative to no treatment. The results also highlighted the loss of quality of life in children who do not receive any psychotherapy. Results of the base-case analysis suggest that TF-CBT + SSRI is more cost-effective than TF-CBT alone, however, considering the uncertainty associated with prescribing SSRIs to children and adolescents, clinicians and parents may exercise some caution in choosing this treatment alternative.</p

The impact of the Cretaceous–Paleogene (K–Pg) mass extinction event on the global sulfur cycle: Evidence from Seymour Island, Antarctica

The Cretaceous–Paleogene (K–Pg) mass extinction event 66 million years ago led to large changes to the global carbon cycle, primarily via a decrease in primary or export productivity of the oceans. However, the effects of this event and longer-term environmental changes during the Late Cretaceous on the global sulfur cycle are not well understood. We report new carbonate associated sulfate (CAS) sulfur isotope data derived from marine macrofossil shell material from a highly expanded high latitude Maastrichtian to Danian (69–65.5 Ma) succession located on Seymour Island, Antarctica. These data represent the highest resolution seawater sulfate record ever generated for this time interval, and are broadly in agreement with previous low-resolution estimates for the latest Cretaceous and Paleocene. A vigorous assessment of CAS preservation using sulfate oxygen, carbonate carbon and oxygen isotopes and trace element data, suggests factors affecting preservation of primary seawater CAS isotopes in ancient biogenic samples are complex, and not necessarily linked to the preservation of original carbonate mineralogy or chemistry. Primary data indicate a generally stable sulfur cycle in the early-mid Maastrichtian (69 Ma), with some fluctuations that could be related to increased pyrite burial during the ‘mid-Maastrichtian Event’. This is followed by an enigmatic +4‰ increase in δ³⁴SCAS during the late Maastrichtian (68–66 Ma), culminating in a peak in values in the immediate aftermath of the K–Pg extinction which may be related to temporary development of oceanic anoxia in the aftermath of the Chicxulub bolide impact. There is no evidence of the direct influence of Deccan volcanism on the seawater sulfate isotopic record during the late Maastrichtian, nor of a direct influence by the Chicxulub impact itself. During the early Paleocene (magnetochron C29R) a prominent negative excursion in seawater δ³⁴S of 3–4‰ suggests that a global decline in organic carbon burial related to collapse in export productivity, also impacted the sulfur cycle via a significant drop in pyrite burial. Box modelling suggests that to achieve an excursion of this magnitude, pyrite burial must be reduced by >15%, with a possible role for a short term increase in global weathering rates. Recovery of the sulfur cycle to pre-extinction values occurs at the same time (∼320 kyrs) as initial carbon cycle recovery globally. These recoveries are also contemporaneous with an initial increase in local alpha diversity of marine macrofossil faunas, suggesting biosphere-geosphere links during recovery from the mass extinction. Modelling further indicates that concentrations of sulfate in the oceans must have been 2 mM, lower than previous estimates for the Late Cretaceous and Paleocene and an order of magnitude lower than today