Depression in children and young people: recognition ... ?· Depression in children and young people:…

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<ul><li><p>Depression in children and yDepression in children and young people:oung people:recognition, detection, risk profiling and referrrecognition, detection, risk profiling and referralal</p><p>NICE Pathways bring together everything NICE says on a topic in an interactiveflowchart. NICE Pathways are interactive and designed to be used online.</p><p>They are updated regularly as new NICE guidance is published. To view the latestversion of this NICE Pathway see:</p><p>http://pathways.nice.org.uk/pathways/depressionNICE Pathway last updated: 24 April 2018</p><p>This document contains a single flowchart and uses numbering to link the boxes to theassociated recommendations.</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 1 of 10</p><p>http://pathways.nice.org.uk/pathways/depressionhttp://www.nice.org.uk/https://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>Depression in children and yDepression in children and young people: recognition, detection, risk profiling andoung people: recognition, detection, risk profiling andreferrreferralal</p><p>NICE Pathways</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 2 of 10</p><p>https://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>1 Child or young person at risk of depression</p><p>No additional information</p><p>2 Recognition, detection, risk profiling and referral in tier 1</p><p>No additional information</p><p>3 Child or young person has acute sadness and distress ('situationaldysphoria')</p><p>Consider ongoing social and environmental factors if dysphoria becomes more persistent.</p><p>4 Child or young person exposed to a single recent undesirable lifeevent</p><p>Examples of a single recent undesirable life event include bereavement, parental divorce orseparation, or a severely disappointing experience.</p><p>5 Assessment of risk of depression</p><p>Assess the risks of depression associated with the event.</p><p>Make contact with parent(s)/carer(s) to help integrate parental/carer and professionalresponses.</p><p>Record the risk profile.</p><p>6 No other risk factors for depression</p><p>If there are no other risk factors for depression:</p><p>offer support and the opportunity to talk over the eventdo not normally refer for further assessment or treatment following an undesirable event.</p><p>Depression in children and yDepression in children and young people: recognition, detection, risk profiling andoung people: recognition, detection, risk profiling andreferrreferralal</p><p>NICE Pathways</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 3 of 10</p><p>https://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>7 High risk of depression and/or family history</p><p>If high risk of depression is identified (the presence of two or more other risk factors) and/orwhere one or more family members (parents or children) have multiple-risk histories:</p><p>offer the opportunity to talk over recent negative experiences with a tier 1 professional</p><p>assess for depressionconsider early referral if there is evidence of depression and/or self-harm.</p><p>Also see assessment and treatment considerations.</p><p>8 Tier 1 and referral to tiers 2, 3 or 4 CAMHS</p><p>Criteria for management to remain at tier 1</p><p>Management can remain at tier 1 if one or more of the following factors exist:</p><p>exposure to a single undesirable event in the absence of other risk factors for depressionexposure to a recent undesirable life event in the presence of two or more other risk factorswith no evidence of depression and/or self-harmexposure to a recent undesirable life event where one or more family members (parents orchildren) have multiple-risk histories for depression, providing that there is no evidence ofdepression and/or self-harm in the child/young personmild depression without comorbidity.</p><p>Referral to tier 2 or tier 3</p><p>Refer to tier 2 or tier 3 CAMHS if one or more of the following factors exist:</p><p>depression with two or more other risk factors for depressiondepression where one or more family members (parents or children) have multiple-riskhistories for depressionmild depression in those who have not responded to interventions in tier 1 after 23 monthsmoderate or severe depression (including psychotic depression)signs of a recurrence of depression in those who have recovered from previous moderateor severe depressionunexplained self-neglect of at least 1 month's duration that could be harmful to the child/young person's physical health</p><p>Depression in children and yDepression in children and young people: recognition, detection, risk profiling andoung people: recognition, detection, risk profiling andreferrreferralal</p><p>NICE Pathways</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 4 of 10</p><p>http://pathways.nice.org.uk/pathways/depression/care-for-children-and-young-people-with-depression#content=view-node%3Anodes-assessment-and-treatment-considerationshttps://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>active suicidal ideas or plansyoung person or parent(s)/carer(s) request referral.</p><p>Referral to tier 4</p><p>Refer to tier 4 CAMHS if one or more of the following factors exist:</p><p>high recurrent risk of acts of self-harm or suicidesignificant ongoing self-neglect (such as poor personal hygiene or significant reduction ineating that could be harmful to physical health)requirement for intensity of assessment/treatment and/or level of supervision that is notavailable in tier 2 or 3.</p><p>Quality standards</p><p>The following quality statements are relevant to this part of the interactive flowchart.</p><p>Depression in children and young people</p><p>3. Suspected severe depression and at high risk of suicide</p><p>4. Suspected severe depression without high risk of suicide</p><p>9 Management of mild depression tiers 1 and 2</p><p>See Depression / Management of mild depression in children and young people tiers 1 and 2</p><p>10 Management of moderate to severe (including psychotic) depression tiers 24</p><p>See Depression / Management of moderate to severe (including psychotic) depression inchildren and young people tiers 24</p><p>11 Recognition in tiers 24</p><p>If a child or young person aged 11 years or older is referred to CAMHS without a diagnosis ofdepression, routinely screen with a self-report questionnaire for depression as part of generalassessment.</p><p>Depression in children and yDepression in children and young people: recognition, detection, risk profiling andoung people: recognition, detection, risk profiling andreferrreferralal</p><p>NICE Pathways</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 5 of 10</p><p>http://pathways.nice.org.uk/pathways/depression/management-of-mild-depression-in-children-and-young-people-tiers-1-and-2http://pathways.nice.org.uk/pathways/depression/management-of-moderate-to-severe-including-psychotic-depression-in-children-and-young-people-tiers-24https://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>Glossary</p><p>CAMHS</p><p>child and adolescent mental health services</p><p>CAPA</p><p>child and adolescent psychiatric assessment</p><p>CBT</p><p>cognitive behavioural therapy</p><p>CCBT</p><p>computerised cognitive behavioural therapy</p><p>DSM-IV</p><p>diagnostic and Statistical Manual of Mental Disorders</p><p>ECT</p><p>electroconvulsive therapy</p><p>HoNOSCA</p><p>Health of the Nation Outcome Scales for Children and Adolescents</p><p>ICD-10</p><p>International Statistical Classification of Diseases and Related Health Problems (tenth edition)</p><p>IPT</p><p>interpersonal therapy</p><p>K-SADS</p><p>schedule for affective disorders and schizophrenia for school-age children</p><p>Depression in children and yDepression in children and young people: recognition, detection, risk profiling andoung people: recognition, detection, risk profiling andreferrreferralal</p><p>NICE Pathways</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 6 of 10</p><p>https://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>MAOI</p><p>monoamine oxidase inhibitor</p><p>MFQ</p><p>mood and feelings questionnaire</p><p>Mild depression</p><p>few, if any, symptoms of depression in excess of the 5 required to make the diagnosis, andsymptoms result in only minor functional impairment, according to DSM-IV</p><p>Moderate depression</p><p>symptoms of depression or functional impairment are between mild and severe</p><p>NSAID</p><p>non-steroidal anti-inflammatory drug</p><p>SDQ</p><p>strengths and difficulties questionnaire</p><p>Severe depression</p><p>most symptoms of depression according to DSM-IV, and the symptoms markedly interfere withfunctioning. Can occur with or without psychotic symptoms</p><p>SSRI</p><p>selective serotonin reuptake inhibitor</p><p>Subthreshold depressive symptoms</p><p>fewer than 5 symptoms according to DSM-IV</p><p>TCA</p><p>tricyclic antidepressant</p><p>Depression in children and yDepression in children and young people: recognition, detection, risk profiling andoung people: recognition, detection, risk profiling andreferrreferralal</p><p>NICE Pathways</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 7 of 10</p><p>https://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>Tier 1</p><p>primary care services including GPs, paediatricians, health visitors, school nurses, socialworkers, teachers, juvenile justice workers, voluntary agencies and social services</p><p>Tier 2</p><p>child and adolescent mental health services relating to workers in primary care including clinicalchild psychologists, paediatricians with specialist training in mental health, educationalpsychologists, child and adolescent psychiatrists, child and adolescent psychotherapists,counsellors, community nurses/nurse specialists and family therapists</p><p>Tier 3</p><p>specialised child and adolescent mental health services for more severe, complex or persistentdisorders including child and adolescent psychiatrists, clinical child psychologists, nurses(community or inpatient), child and adolescent psychotherapists, occupational therapists,speech and language therapists, art, music and drama therapists, and family therapists</p><p>Tier 4</p><p>tertiary-level child and adolescent mental health services such as day units, highly specialisedoutpatient teams and inpatient units</p><p>Sources</p><p>Depression in children and young people: identification and management (2005 updated 2017)NICE guideline CG28</p><p>Your responsibility</p><p>Guidelines</p><p>The recommendations in this guideline represent the view of NICE, arrived at after carefulconsideration of the evidence available. When exercising their judgement, professionals andpractitioners are expected to take this guideline fully into account, alongside the individual</p><p>Depression in children and yDepression in children and young people: recognition, detection, risk profiling andoung people: recognition, detection, risk profiling andreferrreferralal</p><p>NICE Pathways</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 8 of 10</p><p>http://www.nice.org.uk/guidance/CG28https://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>needs, preferences and values of their patients or the people using their service. It is notmandatory to apply the recommendations, and the guideline does not override the responsibilityto make decisions appropriate to the circumstances of the individual, in consultation with themand their families and carers or guardian.</p><p>Local commissioners and providers of healthcare have a responsibility to enable the guidelineto be applied when individual professionals and people using services wish to use it. Theyshould do so in the context of local and national priorities for funding and developing services,and in light of their duties to have due regard to the need to eliminate unlawful discrimination, toadvance equality of opportunity and to reduce health inequalities. Nothing in this guidelineshould be interpreted in a way that would be inconsistent with complying with those duties.</p><p>Commissioners and providers have a responsibility to promote an environmentally sustainablehealth and care system and should assess and reduce the environmental impact ofimplementing NICE recommendations wherever possible.</p><p>Technology appraisals</p><p>The recommendations in this interactive flowchart represent the view of NICE, arrived at aftercareful consideration of the evidence available. When exercising their judgement, healthprofessionals are expected to take these recommendations fully into account, alongside theindividual needs, preferences and values of their patients. The application of therecommendations in this interactive flowchart is at the discretion of health professionals andtheir individual patients and do not override the responsibility of healthcare professionals tomake decisions appropriate to the circumstances of the individual patient, in consultation withthe patient and/or their carer or guardian.</p><p>Commissioners and/or providers have a responsibility to provide the funding required to enablethe recommendations to be applied when individual health professionals and their patients wishto use it, in accordance with the NHS Constitution. They should do so in light of their duties tohave due regard to the need to eliminate unlawful discrimination, to advance equality ofopportunity and to reduce health inequalities.</p><p>Commissioners and providers have a responsibility to promote an environmentally sustainablehealth and care system and should assess and reduce the environmental impact ofimplementing NICE recommendations wherever possible.</p><p>Depression in children and yDepression in children and young people: recognition, detection, risk profiling andoung people: recognition, detection, risk profiling andreferrreferralal</p><p>NICE Pathways</p><p>DepressionDepression NICE 2018. All rights reserved. Subject to Notice of rights.</p><p>Page 9 of 10</p><p>https://www.nice.org.uk/about/who-we-are/sustainabilityhttps://www.nice.org.uk/about/who-we-are/sustainabilityhttps://www.nice.org.uk/about/who-we-are/sustainabilityhttps://www.nice.org.uk/about/who-we-are/sustainabilityhttps://www.nice.org.uk/terms-and-conditions#notice-of-rights</p></li><li><p>Medical technologies guidance, diagnostics guidance and interventional proceduresguidance</p><p>The recommendations in this interactive flowchart represent the view of NICE, arrived at aftercareful consideration of the evidence available. When exercising their judgement, healthcareprofessionals are expected to take these recommendations fully into account. However, theinteractive flowchart does not override the individual responsibility of healthcare professionals tomake decisions appropriate to the circumstances of the individual patient, in consultation withthe patient and/or guardian or carer.</p><p>Commissioners and/or providers have a responsibility to implement the recommendations, intheir local context, in light of their duties to have due regard to the need to eliminate unlawfuldiscrimination, advance equality of opportunity, and foster good relations. Nothing in thisinteractive flowchart should be interpreted in a way that would be inconsistent with compliancewith those duties.</p><p>Commissioners and providers have a responsibility to promote an environmentally sustainablehealth and care system and should assess and reduce the environmental impact ofimplementing NICE recommendations wherever possible.</p><p>Depression in children and yDepression in children an...</p></li></ul>