CDS

Depressive Disorders

Dennis McGuire, PH.D.
Brian A. Chicoine, M.D.

Depression is one of the most diagnosed psychiatric disorders for persons with mental retardation, especially individuals with Down Syndrome. For adults, case studies describe depressive symptoms presenting as behavioral changes including: withdrawal, loss of adaptive living skills, and observable changes in mood.

Mental health clinicians use the standard diagnostic criteria developed by the American Psychiatric Association with is based on self-report of feelings. It has limited value in diagnosing an individual with diminished ability for communication. Also care providers, may be aware of critical changes, but not report them due to a lack of understanding of the significance.

To further complicate matters, depression may coexist with Alzheimer’s dementia. The following symptoms can be seen in both: loss of adaptive skills, disruption of sleep cycle, appetite changes, apathy, moodiness, irritability, aggressiveness and memory loss. Alzheimer's dementia is difficult to rule out because there is not definite test for this disorder.

The diagnostic validity is enhanced when behaviors rather that subjective feelings are emphasized as care is taken to rule out all other medical conditions. Differentiating between depression and Alzheimer’s dementia can be accomplished by paying close attention to symptom course. Depression tends to show an up-an-down pattern of decline that with time and treatment will show improvement and an eventual return to previous levels of functioning. Symptoms of Alzheimer’s dementia tend to fluctuate in the earl stages, but over time will show a progressive and nonreversible pattern of decline.

Web Resources:

The Habilitative Mental Health Newsletter, Jan/Feb 1996 volume 15 no.1

TOP