Case history #1
A 15-year-old girl, at a private school, presents with poor concentration. She lives with her biological mother and a 13-year-old sister. Her mother describes her as an outgoing and straight-A student until about 2 months ago. Her grades have slipped from As to Cs, and she has been feeling sad and irritable. She has started avoiding her friends, and has been worrying about her appearance and her grades. She states that she feels dumb, and that her classmates don't like her. Recently, she started to think that life was not worth living, and wished she would fall asleep and never wake up. Her boyfriend broke up with her about 3 months ago. The last time she felt this sad was 5 years ago when her parents divorced.
Case history #2
A 9-year-old boy presents with a change in his behaviour over the past 4 weeks, from being an outgoing child who loved school to frequently complaining of stomach aches and refusing to go to school. He lives with his biological parents and a 5-year-old sister. He is attending a local school. His parents say that he has been unkind to his 5-year-old sister, and frequently screams at her. He used to like to play outside after school, but recently has stayed in his room a lot and played video games. He cannot identify any precipitants, but his parents recall that his mother was hospitalised for surgery about 3 months ago.
Depression in children and adolescents may sometimes present as 'acting out', aggression, and defiance. Depression in younger children can present as somatic complaints and school refusal. Young people with a chronic medical illness may present with decreased concern about their medical illness and/or decreased compliance with medical treatment. Careful interviews with both the child and the parents are important to discover potential causes of the presentation, other depressive symptoms, and other concurrent conditions (both medical and psychiatric) that may exacerbate the depression.
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