Martsenkovskyi D. Depression in post-traumatic stress disorder in children and adolescents (clinical polymorphism, comorbidity, therapy, prevention)

The thesis deals with a relevant problem of diagnosis, prevention, and treatment of depression in post-traumatic stress disorder (PTSD) in children and adolescents. Symptoms of depression complicate the diagnosis, adversely affect the course, increase the risk of self-injurious behavior and suicide, and reduce the efficacy of therapy in children and adolescents with PTSD. Based on the high prevalence of psychological trauma in children and adolescents, and low resources for care provision in developing countries, in particular in Ukraine, there is an urgent need to search for new effective therapeutic and preventive strategies. This work aims to increase the efficacy of diagnosis, treatment, and prevention of depressive disorders in children and adolescents with PTSD. Objectives of the research: 1. To investigate the prevalence and features of clinical polymorphism in the dual diagnosis of depressive and post-traumatic stress disorders in children and adolescents. 2. To establish the causal relationships of the clinical phenotype of depressive disorders with premorbid risk factors in children and adolescents with PTSD. 3. To establish the features of the course of depressive disorder in PTSD in children and adolescents. 4. To investigate the influence of the features of traumatic events on the clinical and dynamic features of depressive disorder in children and adolescents with PTSD. 5. To investigate the mechanisms of chronicity of mental disorders caused by psychological trauma in children and adolescents, and to describe the clinical presentation with internalization (somatization) and externalization (formation of behavioral disorders). 6. To evaluate the efficacy of trauma-focused cognitive-behavioral therapy (TF-CPT), short-term psychosocial interventions (CPV), and psycho- pharmacotherapy with fluoxetine (FL) for PTSD with depressive symptoms in children and adolescents. 7. To develop, evaluate the efficacy and implement a management model for mental disorders caused by psychological trauma in children and adolescents, which will include primary and secondary prevention in specific risk groups, and treatment of PTSD and depressive disorders in children and adolescents.