Psychotherapy adolescents

Psychopharmacotherapy is the combined use of psychoactive medication and psychotherapy. Brent and Kolko (1998) define the latter as a treatment modality in which therapist and patient collaborate to ease functional psychopathological impairment through attention to (1) the therapeutic relationship, (2) the patient s behavior, thoughts, attitudes and affect (the working diagnosis), and (3) the social context and development (this is especially salient in the work of the child and adolescent psychiatrist). 

O Brien, J. and Perlmutter I. (1997) The effect of medication on the process of psychotherapy. Child Adolesc Psychiatr Clin North Am 6 185-96. 

March, J., Mulle, K., and Herbel, B. (1994) Behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder an open trial of a new protocol driven treatment package. J Am Acad Child Adoles Psychiatry 33 333—341. 

Weisz, J.R. (2000) Agenda for child and adolescent psychotherapy research on the need to put science into practice [comment]. Arch Gen Psychiatry 57 837-838. 

The main aim of this chapter is to review the current pharmacological treatments for children and adolescents with MDD. Although psychotherapy interventions, including cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT) have also been found efficacious for the acute treatment of adolescents with MDD (e.g., Brent et ah, 1997 Mufson et ah, 1999), they will not be reviewed here. 

Wood et al., 1996 Emslie et al., 1998 Birmaher et al., 2000a). Naturalistic studies of children and adolescents and controlled trials in adults show that continuation medication and/or psychotherapy can reduce relapses (Fava et al., 1996 Kroll et ah, 1996 Mufson and Fairbanks, 1996 Emslie et ah, 1998). Patients treated with psychotherapy alone or in combination with medications should continue psychotherapy biweekly to monthly, depending on the presence of factors that increase the risk of relapse. The patient and family should be taught to recognize early signs of relapse. 

Birmaher, B., Brent, D.A., Kolko, D., Baugher, M., Bridge,/., Holder, D., Iyengar S., and Ulloa, R.E (2000a) Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder. Arch Gen Psychiatry 57 29—36. 

Mufson, L. and Fairbanks, J. (1996) Interpersonal psychotherapy for depressed adolescents a one-year naturalistic follow-up study. / Am Acad Child Adolesc Psychiatry 35 1145—1155. 

Mufson, L., Weissman, M.M., Moreau, D., and Garfinkel R. (1999) Efficacy of interpersonal psychotherapy for depressed adolescents. Arch Gen Psychiatry 56 573—579. 

Francis, G. and Beidel, D. (1995) Cognitive Behavioral Psychotherapy in March, J.S. Anxiety Disorders in Children and Adolescents New York Guilford Press, pp. 321—340. 

March, J.S., Amaya-Jackson, L., Murray, M.C., and Schulte, A. (1998). Cognitive-behavioral psychotherapy for children and adolescents with posttraumatic stress disorder after single-incident stressor. / Am Acad Child Adolesc Psychiatry 37 585—593. 

Kaminer, Y. and Burleson, J. (1999) Psychotherapies for adolescent substance abusers 15-month follow-up of a pilot study. Am J Addict 8 114-119. 

Weisz, J.R., and Jensen, P.S. (1999) Efficacy and effectiveness of psychotherapy and pharmacotherapy with children and adolescents. Ment Health Servi Res 1 125—158. 

Despite the diagnostic challenges that remain in trying to understand the nature of MDD in children and adolescents, advances in its treatment has progressed considerably since the last edition of this textbook. Over this interval, selective serotonin reuptake inhibitors (SSRIs) have superseded TCAs as the treatment of first choice based both on efficacy and safety considerations. As in adults, specific psychotherapies (cognitive therapy, cognitive-behavioral therapy, and interpersonal therapy) may be as effective as antidepressant medication, at least in mild to moderate depression in children and adolescents ( 111, 112). Also, evidence indicates that depression in children and adolescents may be more influenced than is depression in adults by psychosocial variables such as peers and family, as well as other environmental factors (113). 

OCD typically begins in adolescence, but may also become apparent in childhood. Features are the same regardless of the age of onset, with the illness tending to run a chronic course. Until recently, patients were given a series of medications, as well as psychotherapy, frequently without substantial improvement. 

Brent DA, Holder D, Kolko D, et al. A clinical psychotherapy trial for adolescent depression comparing cognitive, family and supportive treatments. Arch Gen Psychiatry 1997 54 877-885. 

In any case, there is a pressing need for a systematic study of adolescent depression, comparing psychotherapy or cognitive behavioral thereapy (CBT) and antidepressants, or the combination of both treatments. The National Institute of Mental Health (NIMH) has organized a multicenter study which will analyze the long-term effectiveness of Prozac versus CBT. Results of the study, called Treatment for Adolescent Depression Study (TADS), will not be published for several years, but it is hoped that the results will help resolve whether antidepressants in teens are beneficial and safe. 

This is a mild, chronic depression that lasts for 2 years (1 year for children and adolescents) or longer and is characterized by chronic symptoms that do not disable but that keep one from functioning well or from feeling good about themselves (5). Many of those with dysthymia also experience major depressive episodes at some point in their lives. Most people may not realize that they are depressed and continue to function at work or school, but often with the feeling that they are just going through the motions. Antidepressants or psychotherapy can help. 

About one-third of patients initially present with psychiatric abnormalities. Symptoms can inclnde reduced performance in school or at work, depression, very labile mood, sexual exhibitionism, and frank psychosis. Frequently, adolescents with problems in school or work are referred for psychological counseling and psychotherapy. Among our patients two were hospitalized in psychiatric institutions for psychosis, one having conunitted several suicide attempts and two for severe alcohol abuse before the diagnosis of Wilson disease was made. The delay in diagnosis in one case was 12 years. 

Weist, M. D Christodulu, K. V. (2000). Expanded school mental health programs Advancing reform and closing the gap between research and practice. Journal of School Health, 70(5), 195-200. Weisz, J. R., Weiss, B. (1993). Effects of psychotherapy with children and adolescents. Newbury Park, CA Sage. 

Hoagwood, K., Hibbs, E., Brent, D Jensen, P. (1995). Introduction to the special section Efficacy and effectiveness in studies of child and adolescent psychotherapy. Journal of Consulting Clinical Psychology, 55(5), 683-687. 

Kazdin, A. (2000). Psychotherapy for children and adolescents Directions for research and practice. New York Oxford University Press. 

Prout, S. M., DeMartino, R. A., Prout, H. T. (1999). Ethical and legal issues in psychological interventions with children and adolescents. In H. T. Prout D. T. Brown (Eds.), Counseling and psychotherapy with children and adolescents Theory and practice for school and clinical settings [3rd ed., pp. 26-48). New York Wiley. 

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