Mood Disorders October 9 2007 Mood Disorders Any

Mood Disorders October 9, 2007

Mood Disorders Any disturbance in mood n Extreme, persistent, or poorly regulated emotional states n Major Depressive Disorder n Dysthymic Disorder n Bipolar Disorder n

Major Depressive Disorder

Prior to 1970’s Before 1970's childhood depression was rarely discussed n Children and depression? n WHY? n

Depression in Children One of the most disabling childhood disorders n Prevalence is increasing and age of onset is decreasing n Experience and expression changes with age n Under age 7 tends diffuse and less easily identified n

Developmental Course Age of onset usually between 13 -15 years n Average episode = 8 months n Often continue to experience adjustment and health problems and chronic stress n Gender differences: n Pre-puberty: 50/50 n Post-puberty: Girls 2 -3 x more likely n

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. Mc. Gee & 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 n diminished interest or pleasure in activities n changes in appetite or weight n sleep disturbances n psychomotor retardation or agitation n fatigue or loss of energy n feelings of worthlessness or inappropriate guilt n difficulty thinking or concentrating n thoughts of death or suicidal ideation n

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 n diminished interest or pleasure in activities n changes in appetite or weight n sleep disturbances n psychomotor retardation or agitation n fatigue or loss of energy n feelings of worthlessness or inappropriate guilt n difficulty thinking or concentrating n thoughts of death or suicidal ideation n

Prevalence & Comorbidity n Prevalence: n n n 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: n n n anxiety disorders dysthymia conduct problems ADHD substance use disorder

Dysthymic Disorder

Dysthymic Disorder n Features: less severe than MDD n less anhedonia, social withdrawal, impaired concentration, death thoughts, and physical complaints n more constant sadness, self-depreciation, low selfesteem, anxiety, irritability, anger, and temper tantrums n “Double depression” n

Prevalence & Comorbidity 1% of children and 5% of adolescents n Most common comorbid disorder is MDD n

Assessment

Assessment Multiple methods of assessment are critical n Older children better self-reporters n n n Self-report unhelpful before age 8 Parents may or may not have insight n Obtain parent ratings of general child functioning n CBCL, BASC

Interview n Interviews n n Parents, child interviewed separately With child, cover General and specific self-reports n Discussion of mood and daily activities n Suicidal ideation, behavior n

Challenges in Assessment Younger children cannot describe their emotional experiences n Caregivers limited reports of younger children’s internal states n May reflect problems of parent rather than child n Lack of agreement between children, parents, and teachers on symptoms n

Depression in Adolescents Depression in late adolescence may have some developmental distinctiveness n Common symptoms in adolescents include: n anhedonia (lack of pleasure) n psychomotor retardation (slowing down) n

Children’s Depression Inventory (CDI) n Purpose: It’s a 27 item self-report n measures depression in children and adolescents n n Administration: 8 -17 years n 10 -15 minutes to complete n

Reynolds Adolescent Depression Scale (RADS) n Purpose: It’s a 30 item self-report measure designed to assess depressive affective symptomatology in adolescents ages 13 -18 n It assesses clinically relevant levels of depressive symptomatology in individual adolescents n

Suicide 3 rd leading cause of deaths in adolescents n Suicide has quadrupled in adolescence in the last 50 years n National Youth Risk Behavior Survey: n 24. 1% - seriously considered attempting suicide n 17. 7% - had a specific plan n 8. 7% - made an attempt n

Suicide Risk Factors n n n Gender History of depression Previous suicide attempt Family hx of mental illness Hx of sexual/physical abuse Social isolation n n n Family disruption Chronic or debilitating illness Alcohol use Living out of the home Psychosocial problems Easy access to lethal methods Sexuality

Suicide Resources n Alachua County Crisis Center 24 -hour telephone crisis intervention and counseling service n Mobile outreach team n Survivors of Suicide support group n http: //crisiscenter. alachua. fl. us/ n 1(352) 264 -6789 n n National Suicide Hotline n 1(800) SUICIDE

Baker Act n 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 n He or she is unable to determine for himself or herself whether placement is necessary; and n

Baker Act n Florida Statute 394. 467 n 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 n 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) n Features periods of abnormally and persistently elevated, expansive, or irritable mood, alternating with one or more major depressive episodes n may display symptoms such as over-excitement, restlessness, agitation, sleeplessness, pressured speech, flight of ideas, sexual disinhibition, inflated self-esteem, reckless behavior n several DSM subtypes, based on whether youngster displays a manic, mixed, or hypomanic episode n

Prevalence and Comorbidity of BP Lifetime estimates of 0. 4%-1. 2% n Extremely rare in young children, but increases after puberty (when rates are as high as for adults) n Affects males and females equally n Most commonly comorbid with anxiety disorders, ADHD, conduct disorders, and substance abuse n

Developmental Course of BP Peak age of onset between 15 - 19 years of age n Depression usually appears first n Chronic and resistant to treatment, with poor long-term prognosis n

Causes of BP In adults suggests: the result of a genetic vulnerability in combination with environmental factors (e. g. , life stress, family disturbances) n Understudied in children!!! n

Treatment of BP n Treatment must be multi-modal and often includes: education of the patient and the family about the illness n medication, usually lithium n psychotherapeutic interventions to address symptoms and related psychosocial impairments n

Treatment for Depression n Medications tricyclic antidepressant medications n Fluoxetine (Prozac) n n Antidepressants and suicide risk? n Prevention n CBT is most effective at lowering risk for depression, as well as preventing recurrences

Treatment for Depression n Psychosocial Interventions Cognitive-behavioral therapy (CBT) n Interpersonal therapy n