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Down Syndrome Abstract
of the Month: Jan 2002

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Mood Disorders and Down Syndrome

Pary RJ, Loschen EL, Tomkowiak SB
Semin Clin Neuropsychiatry 1996 Apr;1(2):148-153

Department of Psychiatry, SIU School of Medicine, Springfield, USA

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Even clinical neuropsychiatrists who do not focus on mental illness and mental retardation may be intrigued by the subject of mood disorders in persons with Down syndrome. This article reviews the following subjects in persons with Down syndrome: epidemiology of major depression and bipolar disorder; clinical symptoms including "psychotoform," differential diagnosis of mood disorders, comorbid diagnoses, and treatment.

My comments:

This is a review article, with no new research, but it pulls together a lot of research on this topic.

Depression appears to be very common in people with DS, but bipolar disease is less common than in the general population. Symptoms of depression in people with DS include a depressed affect (facial expressions and demeanor), social withdrawal, decreased energy, inability to enjoy things that were enjoyable in the past, decreased appetite, sleep disturbance, regression in self-help skills, reduced speech, aggressive behavior/tantrums, tearfulness, and increased dependency upon others. Depression must be distinguished from medical conditions such as thyroid disorders, allergic conditions, infections, and sleep apnea. Depression must also be distinguished from a grief reaction, which can occur not just from the loss of a close relative or friend, but the loss of a staff member, a work position, or a residential site.

Depression can be complicated by Alzheimer's disease. All people with DS suspected of having dementia should be evaluated for depression, and for those under 35 years of age, depression should be the primary focus instead of dementia (since dementia in people with DS under 35 is uncommon). For the older people with DS, depression can co-exist with Alzheimer's disease.

The article states that to treat depression, the groups of drugs known as tricyclic antidepressents and serotonin reuptake inhibitors should be used. In treatment-resistant depression, a trial of thyroid supplementation may be worthwhile. Psychotherapy can be effective if the person with DS has the verbal skills needed and can relate to the therapist.

Psychosis is less common in the DS population than in the general population, and can be very hard to diagnose in the person with DS with limited verbal skills. The authors mention features to look for such as grandiose or bizarre behaviors. The term "psychotoform" was coined in a previous article to describe behaviors that may appear to be psychotic in nature, but instead are indicative of a mood disorder, emphasizing the need to distinguish between the two before starting medication.

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