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

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

Synonyms:

• depression with psychopathic behavior; o psychopathic depression;
• depression with behavioral disorder;
• neurotic depression with behavioral disorder.

ICD-10 code

F92 Mixed disorders of conduct and emotions.

Epidemiology

The true prevalence of mixed disorders of conduct and emotions in children and adolescents is unknown, but there is reason to believe that they are among the most common variants of depressive syndrome in prepubertal age and in adolescents.

Reasons

Mixed behavioral and emotional disorders are encountered in various mental illnesses in children and adolescents - schizophrenia, affective mood disorders, epilepsy, some forms of residual organic damage to the central nervous system, early childhood autism, pathologically occurring pubertal crisis, neurotic reactions.

Symptoms of mixed disorders of conduct and emotions

Depressive behavioral disorder is characterized by a combination of symptoms such as excessive suffering, loss of interests, anhedonia (joylessness in everyday life), hopelessness with disorders that imitate character pathology (affective excitability, rudeness, anger, aggressiveness), manifested by persistent violations of aggressive, dissocial or oppositional-defiant behavior.

The term "masked depressions" (psychopathic masks of depression) is most often used for this category of children. In this case, behavioral disorders can be so pronounced that they almost completely hide the symptoms of depression. The teenager's behavior is considered within the framework of non-pathological deviations that require corrective and educational measures. In this case, a vicious circle is formed: the teenager's behavior provokes a negative reaction from parents, teachers, peers, which, in turn, increases his depressive experiences, opposition to others, reducing the attractiveness of positive behavior and friendly relationships for him. Often, minor psychogenic factors (quarrels with parents, classmates, teachers; an unfair, in the teenager's opinion, bad mark) can play a fatal role, pushing the teenager to long-planned suicidal actions. As a rule, with masked depressions, suicides are unexpected and incomprehensible to others.

Diagnosis of mixed disorders of behavior and emotions

Diagnostics is based on identifying latent manifestations of depressive syndrome. First of all, fairly pronounced changes in the teenager's behavior that have occurred over a relatively short period of time should be alarming. A young man (or woman) who was previously no different from others becomes gloomy, embittered, caustic. For no apparent reason, motivation to study is lost. They note truancy, failure to do homework and, as a result, a sharp decline in academic performance. Statements include a pessimistic assessment of the future, the meaninglessness and vanity of the present existence, and thoughts about death as a natural outcome of earthly vanity. As a rule, patients listen to depressive music for a long time ( music for the lost), some read relevant literature. Along with other manifestations of latent depression, computer addiction, previously uncharacteristic of a teenager, can also serve as an indirect sign of the onset of the disease.

Indications for consultation with other specialists

All of the above-mentioned behavioral and affective features of the patient require the pediatrician to refer the patient to a psychiatrist, which requires great delicacy and caution in wording. It is recommended to contact the district center for psychological, medical and social support, located in the educational system, where there are full-time psychologists and a psychiatrist. From there, after consulting a psychologist, the psychiatrist can give a referral for treatment in a specialized medical institution. Such staging 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 suicide attempt, a consultation with a psychiatrist is mandatory and should be carried out as soon as possible due to the possibility of repeated suicidal actions.

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