5 - Childhood depression: clinical phenomenology and classification

Summary

The concept of depression in childhood

Contribution of adult psychiatry to the concept of depression in childhood

Research into the nature and characteristics of depression in adults has provided an important framework for wider investigations of depression. In a clinical sense, the term ‘depression’ denotes an illness characterized by a change in mood that is persistent and sufficiently severe for it to be labelled a disorder. In adult psychiatry, much research attention has focused on the classification of depression. Two major distinctions have emerged: first, between bipolar and unipolar affective disorders and second, between psychotic (or endogenous) and neurotic (or reactive) depression (Paykel & Priest, 1992; Ramana & Paykel, 1992).

Using multivariate analysis methods, the Newcastle school asserted that two separate depressive syndromes could be distinguished in adult patients: neurotic (reactive) and psychotic (endogenous) (Kiloh & Garside, 1963; Carney et al., 1965). The distinctions within unipolar depression have not been replicated (Kendell, 1968, 1975). The term ‘endogenous’ has, however, come to reflect, clinically, a more severe and persistent depressive disorder, possibly unrelated to environmental adversities (diagnostic criteria include somatic symptoms of anorexia or weight loss; insomnia; early-morning wakening; diurnal variation of mood; severe guilt; hopelessness and psychomotor retardation or agitation; Ramana & Paykel, 1992). By contrast, neurotic or reactive depression is considered clinically to be a milder disorder and possibly reactive to environmental adversities (accompanied by anxiety, initial insomnia, self-pity rather than self-blame, and complaints of anorexia rather than complaints of weight loss; Ramana & Paykel, 1992).