Recognizing depression in children is difficult
Recognizing a child who is depressed or has a suicidal tendency is often very difficult because the patient is not divided. It is even more difficult to identify children and adolescents who are at high risk of harm to life. Suicide attempts are no exception if a child suffers from depression, a serious and long-lasting mental disorder. Among other things, it can erase any experience of pleasure in the patient.
Signs of depression
- depressed mood,
- loss of appetite,
- engine idle,
- frequent fatigue,
- headache or abdominal pain.
- Other mental disorders, such as ADHD or eating disorders, may accompany depression.
- Depressed children often self-harm and have suicidal thoughts.
Source: Association of General Practitioners
According to psychiatrists, it is highly desirable for a pediatrician he could say a child with suicidal tendencies and sent him to the hospital or to a psychiatrist. “For simpler mental disorders, a pediatrician can help with treatment, but for more serious ones, children and adolescents need professional help quickly. » emphasizes Jana Schmidtová.
There are few child psychiatric care providers
But that’s a problem. “We have nowhere to send such children,” the president of the Syndicate of General Practitioners of Childhood and Adolescence (SPLDD) Ilona Hulleova. There are not enough child psychiatrists, psychologists or clinical psychologists in the Czech Republic. And the coronavirus has exposed this problem in all its nakedness.
According to Jana Schmidtová, we missed 60% of child psychiatrists before the pandemic, but their number does not change significantly, so today this percentage is even higher, because the number of child and adolescent patients has increased. For example, the number of children with depressive disorders has increased by 10% over the past year. According to the press release of the Association of General Practitioners, up to 4% of children aged 12 to 17 suffer from depression in the Czech Republic, most often girls.
According to data from the Institute for Health Information and Statistics (IHIS), this was in the Czech Republic in 2020 registered 135 outpatient child and adolescent psychiatry providers. For comparison, in 2019 there were 142 providers. It is not the number of psychiatrists, but the number of workplaces with which the mutuals have concluded contracts. Several doctors can work at the same workplace. Last year, 55,000 children were treated. “Boys predominated among pediatric patients (approximately 61%). The most frequent diagnosis in patients under 19 was developmental psychotic disorders, the second were, as in adults, neurotic disorders, stress and somatoforms. says the IHIS report on psychiatric care for 2020. More recent data is not yet available.
Consequently, it happens more and more that the intervention of experts does not arrive in time. “I recently hired a patient who had been seeking professional help from a child psychiatrist for six months. She even attempted suicide. She took a lot of drugs. I heard about her from her depressed friend and suicidal, which I took care of urgently.” adds the psychiatrist.
Jana Schmidtová practices in two private institutions – in Prague and in Jesenice near Prague. She used to have 15 new admissions to care in a month, now there are 100 in the same period. “It is a huge number and the patients and their parents are desperate. For example, I have come across that they are willing to drive up to 200 kilometers, especially when we take them,” describes the doctor.
What can cause depression
- family trauma,
- domestic violence,
- sexual abuse,
- spend many hours in front of a computer, mobile phone or television,
- house insulation,
- fear of war,
- bad mood,
- legacy in the family – children of depressed parents have a 25% higher risk of being affected by the same mental illness than children who do not have this burden in the family.
Source: Association of General Practitioners, Jana Schmidtová
Better a checkup at the pediatrician than nothing.
According to her, if there is a suspicion of mental illness in a child, treatment by a general practitioner is better than nothing at all. So what can a general practitioner ideally do for a small patient?
He may use a 27-item questionnaire called a CDI, which measures the child’s current mental state. Based on the answers, he can assess the patient’s degree of depression and judge the severity of the risk.
Two-page questionnaire to help pediatricians detect depression in patients (CDI, Children’s Depression Inventory)
An interview is also an important help if a child or adolescent consents to it. And observe the behavior of the child. The doctor should see the high-risk patient more often and invite him for a check-up, for example, once a week. The pediatrician also has the option of prescribing antidepressants to a small patient. “Sertraline, for example. It’s much better than giving benzodiazepines, which are highly addictive and can put you at risk of addiction in the future, so they should only be given to children for a short time. , preferably not at all. describes child psychiatry.
However, pediatrician Ilona Hülleová points to other issues that can complicate the treatment of depressed children. For example, the high workload of general practitioners for children and adolescents. Already in the fall, an unprecedented and large wave of respiratory infections arrived, followed by new waves of coronavirus, and now the effects of the pandemic have overshadowed the need to help people fleeing war-torn Ukraine. , even though practitioners currently relieve if- called AU POINTS.
In addition, some general practitioner practices have a very heavy file. It can count up to 2500 children. This carries the risk that the general practitioner does not have enough time for the little patient and therefore cannot give him a helping hand. “With so much overcapacity, there’s no time for the questionnaires. We can let the children fill them out, but then we run into the problem of what happens next when they’re not hospitalized in psychiatry. Then , it remains only to prescribe medications and agree with the family on diet measures, but that’s it. ” Ilona Hülleová describes that if the search for a way to increase the number of paediatricians does not begin, primary care for children in the Czech Republic will collapse over time.
Pediatricians want to prescribe more types of drugs
General practitioners also see that they have limited options when prescribing antidepressants or other psychotropic drugs as an obstacle in the treatment of children with mental disorders. But they would like to change that. Years ago, therefore, they asked the National Institute for Drug Control to partially release the possibilities of prescription.
“For psychotropic drugs, prescription restrictions still exist for drugs containing the molecule risperidone and atomoxetine. And we would like to obtain a modification of the prescription of the molecule of atomoxetine at least in the form of the so-called delegated prescription, that is, the medicine with this active substance could be prescribed by a general practitioner with the written permission of a specialist, “ declares the vice-president of the SPLDD Ctirad Kozderka.
However, some psychiatrists warn that GPs, which are used to treat ADHD in children over 6 and adults, should not be prescribed by GPs at all. In children without other associated diseases, it is a so-called second-choice drug (it is only used if they are not taking other drugs, in this case stimulants). Atomoxetine affects norepinephrine levels in the brain and can cause, among other things, increased heart rate and increased blood pressure.
MUDr. Jana Schmidtova
Psychiatrist and psychotherapist specializing in the care of children and adults. It operates private medical practices in Prague and in Jesenice near Prague.