Table 3.
Differential diagnosis of depressive illness in physically ill children.
| Major depressive episode (MDE) | MDE is defined by the presence of five (or more) of the following symptoms occurring most of the day, virtually every day, over the course of a two-week period: depressed mood; apathy; weight change due to appetite change; insomnia or hypersomnia; indecisiveness or impaired focus; weariness or lack of energy; feeling of worthlessness or guilt; psychomotor agitation or retardation; and repeated thoughts of death or suicide. |
| Normal bereavement in terminally ill patients | Grief, rumination about the loss, sleeplessness, poor appetite, and weight loss may emerge. The dysphoria associated with grief is likely to fade in severity over days to weeks and it comes in waves or “pangs of grief”. Grief can be accompanied by feelings of positivity and happiness, whereas MDE is usually characterized by overwhelming sadness and misery. Grief-related thought content is often preoccupied with thoughts and recollections of the object of loss (e.g., good health), as opposed to the self-critical or gloomy ruminations observed in an MDE. In grief, self-esteem is usually maintained. |
| Adjustment disorder | Stressful life experiences such as chronic illness can result in psychological changes. An adjustment disorder is present when these changes are clinically significant but do not meet criteria for another mental disorder. |
| Depressive disorder due to another medical condition and induced by a substance or medication | A prominent and persistent period of depressed mood or anhedonia resulting from the direct pathophysiological consequence of another medical condition (e.g., hypothyroidism) or from the use of a substance/medication. |
| Delirium presenting as depression in a chronically ill child | Delirium may be difficult to distinguish from depression in a chronically ill child, especially when delirium has hypoactive features. In the presence of delirium, symptoms of depression have less diagnostic certainty. |