Kovacs Maria, Yaroslavsky Ilya
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Child Psychol Psychiatry. 2014 Jul;55(7):741-57. doi: 10.1111/jcpp.12172. Epub 2013 Nov 21.
By emphasizing the importance of emotions, the 'affect revolution' in how human behavior is conceptualized has inspired a new generation of studies on dysphoric experience and its regulation in clinical depression, and novel efforts to characterize the precursors of affective disorders in juveniles at familial risk for depression.
We review clinical, behavioral, and functional neuroimaging studies of dysphoric experience and its regulation in depressed children and adolescents, and in juvenile offspring of parents with histories of clinical depression. We discuss the implication of the literature in the context of maternal depression.
Findings confirm the high rate of clinically significant dysphoria in depressed children and adolescents and reveal notable affective lability in daily life as a function of context and activity. Findings also show that depressed youngsters have problems in attenuating dysphoria. Similarly, never-depressed offspring at familial risk for depression display problems in mood repair and impaired mood repair mechanisms. Brain neuroimaging findings indicate that, overall, depressed, and high-risk youngsters differ from never depressed controls in neural functioning (activation, connectivity) both at rest and in response to emotion triggers.
The evaluation of depressed youngsters should include questions about reactivity of dysphoric mood to the changing contexts of daily life and about how they manage (respond to) their own sadness and distress. The resultant information may help the clinician to restructure a young patient's day for the better and identify helpful mood repair responses. Evidence of impaired mood repair mechanisms in youngsters at high-risk for depression suggests the need for early intervention. But interventions must consider that many depressed and high-risk children have depressed mothers, who may be constrained in their ability to help offspring's emotion regulation efforts. To optimize treatment response of offspring, mothers of depressed children should therefore be routinely screened for depression and treated, as warranted.
通过强调情绪的重要性，人类行为概念化方面的“情感革命”激发了关于烦躁情绪体验及其在临床抑郁症中的调节的新一代研究，以及为表征有抑郁症家族风险的青少年情感障碍先兆所做的新努力。
我们回顾了关于抑郁儿童和青少年以及有临床抑郁症病史的父母的青少年后代中烦躁情绪体验及其调节的临床、行为和功能性神经影像学研究。我们在母亲抑郁的背景下讨论了文献的意义。
研究结果证实了抑郁儿童和青少年中具有临床意义的烦躁情绪的高发生率，并揭示了日常生活中明显的情感易变性是情境和活动的函数。研究结果还表明，抑郁的青少年在减轻烦躁情绪方面存在问题。同样，有抑郁症家族风险的未患抑郁症的后代在情绪修复和受损的情绪修复机制方面也存在问题。脑神经影像学研究结果表明，总体而言，抑郁和高风险的青少年在静息状态和对情绪触发的反应中，其神经功能（激活、连接性）与未患抑郁症的对照组不同。
对抑郁青少年的评估应包括询问烦躁情绪对日常生活变化情境的反应性，以及他们如何管理（应对）自己的悲伤和痛苦。由此获得的信息可能有助于临床医生更好地重新安排年轻患者的一天，并识别出有益的情绪修复反应。有抑郁症高风险的青少年情绪修复机制受损的证据表明需要早期干预。但干预措施必须考虑到许多抑郁和高风险儿童的母亲患有抑郁症，她们在帮助后代进行情绪调节方面的能力可能受到限制。因此，为了优化后代的治疗反应，应对抑郁儿童的母亲进行常规抑郁症筛查，并在必要时进行治疗。
