Transcript Mood Disorders

Mood Disorders
October 9, 2007
Mood Disorders
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Any disturbance in mood
Extreme, persistent, or poorly regulated
emotional states
Major Depressive Disorder
 Dysthymic Disorder
 Bipolar Disorder
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Major Depressive
Disorder
Prior to 1970’s
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Before 1970's childhood depression was rarely
discussed
Children and depression?
WHY?
Depression in Children
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One of the most disabling childhood disorders
Prevalence is increasing and age of onset is
decreasing
Experience and expression changes with age
Under age 7 tends  diffuse and less easily
identified
Developmental Course
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Age of onset usually between 13-15 years
Average episode = 8 months
Often continue to experience adjustment and
health problems and chronic stress
Gender differences:
Pre-puberty: 50/50
 Post-puberty: Girls 2-3x more likely
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Developmental Course of
MDD
Figure 8.1 Adapted from “Development of Depression from Preadolescence to Young
Adulthood: Emerging Gender Differences in a 10-year-Longitudinal Study,” by B. L.
Hankin, L. Y. Abramson, T. E. Moffitt, P. A. Silva, R. McGee & K. E. Andell, 1998,
Journal of Abnormal Psychology, 107, 128-140. Copyright (c) 1998 by the American
Psychological Association. Reprinted by permission of the author.
DSM-IV Criteria A
depressed mood/sadness most of the day, most days
 diminished interest or pleasure in activities
 changes in appetite or weight
 sleep disturbances
 psychomotor retardation or agitation
 fatigue or loss of energy
 feelings of worthlessness or inappropriate guilt
 difficulty thinking or concentrating
 thoughts of death or suicidal ideation
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Criteria B-D
B. The symptoms do not meet criteria for a Mixed
Episode (Mania + Depression)
C. The symptoms cause significant distress or
impairment in social, occupational, or other
important areas of functioning
D. Symptoms are not due to the direct effects of a
substance (e.g., a drug of abuse, a medication) or
a general medical condition (e.g.,
hypothyroidism).
Criteria E
E. Symptoms are not accounted for by
Bereavement; or the bereavement symptoms
persist for longer than 2 months or are
characterized by marked functional impairment,
morbid preoccupation with worthlessness,
suicidal ideation, psychotic symptoms, or
psychomotor retardation
DSM-IV Criteria A
depressed mood/sadness most of the day, most days
 diminished interest or pleasure in activities
 changes in appetite or weight
 sleep disturbances
 psychomotor retardation or agitation
 fatigue or loss of energy
 feelings of worthlessness or inappropriate guilt
 difficulty thinking or concentrating
 thoughts of death or suicidal ideation
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Prevalence & Comorbidity
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Prevalence:
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2-8% of children ages 4-18
more rare among preschool and school-age children,
increases into adolescence and adulthood
Most common comorbid disorders are:
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anxiety disorders
dysthymia
conduct problems
ADHD
substance use disorder
Dysthymic Disorder
Dysthymic Disorder
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Features:
less severe than MDD
 less anhedonia, social withdrawal, impaired
concentration, death thoughts, and physical
complaints
 more constant sadness, self-depreciation, low selfesteem, anxiety, irritability, anger, and temper
tantrums
 “Double depression”
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Prevalence & Comorbidity
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1% of children and 5% of adolescents
Most common comorbid disorder is MDD
Assessment
Assessment
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Multiple methods of assessment are critical
Older children better self-reporters
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Self-report unhelpful before age 8
Parents may or may not have insight
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Obtain parent ratings of general child functioning
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CBCL, BASC
Interview
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Interviews
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Parents, child interviewed separately
With child, cover
General and specific self-reports
 Discussion of mood and daily activities
 Suicidal ideation, behavior
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Challenges in Assessment
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Younger children cannot describe their
emotional experiences
Caregivers limited reports of younger children’s
internal states
May reflect problems of parent rather than child
Lack of agreement between children, parents,
and teachers on symptoms
Depression in Adolescents
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Depression in late adolescence may have some
developmental distinctiveness
Common symptoms in adolescents include:
anhedonia (lack of pleasure)
 psychomotor retardation (slowing down)
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Children’s Depression Inventory
(CDI)
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Purpose:
It’s a 27 item self-report
 measures depression in children and adolescents
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Administration:
8-17 years
 10-15 minutes to complete
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Reynolds Adolescent Depression Scale
(RADS)
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Purpose:
It’s a 30 item self-report measure designed to assess
depressive affective symptomatology in adolescents
ages 13-18
 It assesses clinically relevant levels of depressive
symptomatology in individual adolescents
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Suicide
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3rd leading cause of deaths in adolescents
Suicide has quadrupled in adolescence in the last
50 years
National Youth Risk Behavior Survey:
24.1% - seriously considered attempting suicide
 17.7% - had a specific plan
 8.7% - made an attempt
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Suicide Risk Factors
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Gender
History of depression
Previous suicide attempt
Family hx of mental
illness
Hx of sexual/physical
abuse
Social isolation
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Family disruption
Chronic or debilitating
illness
Alcohol use
Living out of the home
Psychosocial problems
Easy access to lethal
methods
Sexuality
Suicide Resources
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Alachua County Crisis Center
24-hour telephone crisis intervention and counseling
service
 Mobile outreach team
 Survivors of Suicide support group
 http://crisiscenter.alachua.fl.us/
 1(352) 264-6789
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National Suicide Hotline
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1(800) SUICIDE
Baker Act
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Florida Statute 394.467
He or she has refused voluntary placement for
treatment after sufficient and conscientious
explanation and disclosure of the purpose of
placement for treatment; or
 He or she is unable to determine for himself or
herself whether placement is necessary; and
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Baker Act
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Florida Statute 394.467
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He or she is manifestly incapable of surviving alone
or with the help of willing and responsible family or
friends, including available alternative services, and,
without treatment, is likely to suffer from neglect or
refuse to care for himself or herself, and such
neglect or refusal poses a real and present threat of
substantial harm to his or her well-being; or
Baker Act
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There is substantial likelihood that in the near
future he or she will inflict serious bodily harm
on himself or herself or another person, as
evidenced by recent behavior
Bipolar Disorder
Bipolar Disorder (BD)
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Features
periods of abnormally and persistently elevated,
expansive, or irritable mood, alternating with one or
more major depressive episodes
 may display symptoms such as over-excitement,
restlessness, agitation, sleeplessness, pressured
speech, flight of ideas, sexual disinhibition, inflated
self-esteem, reckless behavior
 several DSM subtypes, based on whether youngster
displays a manic, mixed, or hypomanic episode
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Prevalence and Comorbidity of
BP
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Lifetime estimates of 0.4%-1.2%
Extremely rare in young children, but increases
after puberty (when rates are as high as for
adults)
Affects males and females equally
Most commonly comorbid with anxiety
disorders, ADHD, conduct disorders, and
substance abuse
Developmental Course of BP
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Peak age of onset between 15 - 19 years of age
Depression usually appears first
Chronic and resistant to treatment, with poor
long-term prognosis
Causes of BP
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In adults suggests: the result of a genetic
vulnerability in combination with environmental
factors (e.g., life stress, family disturbances)
Understudied in children!!!
Treatment of BP
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Treatment must be multi-modal and often
includes:
education of the patient and the family about the
illness
 medication, usually lithium
 psychotherapeutic interventions to address
symptoms and related psychosocial impairments
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Treatment for Depression
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Medications
tricyclic antidepressant medications
 Fluoxetine (Prozac)
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Antidepressants and suicide risk?
Prevention
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CBT is most effective at lowering risk for
depression, as well as preventing recurrences
Treatment for Depression
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Psychosocial Interventions
Cognitive-behavioral therapy (CBT)
 Interpersonal therapy
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