Mixed disorders of behavior and emotions in children: causes, symptoms, diagnosis, treatment

Mixed behavioral and emotional disorders are a group of disorders characterized by a combination of persistent aggressive, dissocial or defiant behavior with obvious symptoms of depression, anxiety, or other emotional disorders.

Synonyms:

• depression with psychopathic behavior; about psychopathic depression;
• Depression with behavioral disorders;
• neurotic depression with behavioral disorders.

ICD-10 code

F92 Mixed behavioral and emotional disorders.

Epidemiology

The true prevalence of mixed behavioral and emotional disorders in children and adolescents is unknown, but there is reason to consider them to be one of the most frequent variants of the depressive syndrome in prepubertal age and in adolescents.

Causes

Mixed disorders of behavior and emotions are encountered in various mental illnesses in children and adolescents - in schizophrenia, affective mood disorders, epilepsy, some forms of residual organic lesion of the central nervous system, early childhood autism, pathological puberty crisis, neurotic reactions.

Symptoms of mixed disorders of behavior and emotions

A depressive behavior disorder is characterized by a combination of such symptoms. As an excessive suffering, loss of interest, anhedonia (joylessness in ordinary life), hopelessness with disorders that mimic the pathology of the character (affective excitability, rudeness, spitefulness, aggressiveness), manifested by persistent violations of aggressive, dissocial or oppositional-defiant behavior.

For this category of children, the term "masked depression" (psychopath-like masks of depression) is most often used. In this behavior disorders can be so pronounced that almost completely hide the symptoms of depression. Behavior of a teenager is considered in the framework of non-pathological deviations, requiring corrective-educational measures of influence. This creates a vicious circle: the behavior of a teen provokes a negative reaction from parents, teachers, peers, which, in turn, strengthens his depressive feelings, opposition to others, reducing the attractiveness of positive behavior and benevolent relationships for him. Often, minor psychogenic factors (quarrels with parents, classmates, teachers, unfairly, in the opinion of a teenager, a bad mark) can play a fatal role, pushing the adolescent to long-nurtured suicidal actions. As a rule, with masked depression, suicides are unexpected and incomprehensible to others.

Diagnosis of mixed behavioral and emotional disorders

Diagnosis is built on the detection of hidden manifestations of the depressive syndrome. First of all, we should be alarmed by sufficiently pronounced changes in the behavior of a teenager that occurred over a relatively short period of time. Previously, a young man (or girl) that was no different from the others became gloomy, embittered, and sarcastic. For no apparent reason, the learning motivation is lost. They note absenteeism, non-fulfillment of homework and, as a consequence, a sharp decline in academic performance. In the utterances, a pessimistic assessment of the future, the meaninglessness and vanity of the present existence, the sounding of thoughts about death as a natural result of the earthly vanity slip. As a rule, patients listen to music of depressive content for a long time (music for the lost ), some read relevant literature. Along with the other manifestations of hidden depression, the previously unaccustomed adolescent computer dependence can also serve as an indirect sign of the onset of the disease.

Indications for consultation of other specialists

All of the above features of behavior and affective manifestations of the patient require the pediatrician to refer to a psychiatrist for consultation, which requires great delicacy and caution in the formulations. You can recommend to contact the regional center of psychological, medical and social support, located in the educational system, where there are full-time psychologists and a psychiatrist. Already from there the psychiatrist after consultation of the psychologist can give a referral for treatment to a specialized medical institution. This stage is determined by the mitigation in most cases of a painful reaction to the recommendation of treatment by a psychiatrist. In the case of a suicidal attempt, the psychiatrist's consultation is mandatory and must be carried out as soon as possible because of the possibility of repeated suicidal actions.

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