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1、NeurolClinNAm21(2003)953–960DepressioninchildrenandadolescentsAnnM.Lagges,PhD,DavidW.Dunn,MD*IndianaUniversitySchoolofMedicine,Indianapolis,IN46202,USAThediagnosticcriteriaformajordepressivedisorder(MDD)intheDiagnosticandStatisticalManualofMentalDisorders,FourthEdition(
2、DSM-IV)isthesameforchildren,adolescents,andadultswithtwoexceptions:inchildrenandadolescents,moodmaybeirritableratherthandepressed;andfailuretomakeexpectedweightgainsmaybeconsideredalongwithweightloss.Therefore,tomakeadiagnosisofMDDinachildoradolescent,fiveofthefollowingc
3、riteriamustbemetforatleasttwoweeks:depressedorirritablemood;lossofinterestorpleasureinalmostallactivities;significantweightlossorgain;changeinappetite;failuretomakeexpectedweightgains;insomniaorhypersomnia;psychomotorretardationoragitation;fatigue;feelingsofworthlessness
4、orguilt;troubleconcentrating;andthoughtsofdeathorsuicide.Thesesymptomsmustbesevereenoughtointerferewiththechild’sfunctioningandmustnotbebetteraccountedforbybereavement,substanceabuse,orthedirectphysiologiceffectsofamedicalcondition[1].Diagnosisismorecomplicatedinchildren
5、andadolescentsthaninadultsbecausechildrenandadolescentsoftenhavedifficultygivingprecisede-scriptionsoftheirthoughtsandfeelings.Inaddition,adolescentswhoarecapableofverbalizingtheirthoughtsandfeelingsmaybelessthanco-operativeinsharingthisinformationwithanunfamiliaradult.Th
6、erefore,theclinicianmustrelyonthepatient’sandfamilymembers’descriptionsofbehaviorchangesratherthansolelydependingondescriptionsofthoughtsandfeelingstomakeadiagnosisofMDD.AssuggestedintheDSM-IVcriteria,childrenandadolescentswithMDDaremorelikelytopresentwithirritablemood,
7、ratherthansadmood[2].Thisirritabilitymaybeexpressedintheformofangryoutbursts,arguing,ordisruptivebehaviorandmayinitiallybedismissedbyfamilyasage-appropriatemoodchanges.Childrenandadolescentswhoarebecomingdepressedsuddenlymaydropoutoforganizedactivitiesandwithdrawfromfri
8、ends.Theymaycite*Correspondingauthor.IndianaUniversitySchoolofMedicine,702BarnhillDrive,Indianapolis,IN46202.E
