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Mood Disorders

Mood Disorders. Common Mood Disorders. Depression Dysthymic Depression Bi-Polar. Major Depressive Disorder. 1+ major episode 2 weeks; ave. 4 months Loss of interest, pleasure 4 of 7 criteria Significant weight loss or gain Insomnia or hypersonmia Psychomotor retardation or agitation

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Mood Disorders

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  1. Mood Disorders

  2. Common Mood Disorders • Depression • Dysthymic Depression • Bi-Polar

  3. Major Depressive Disorder • 1+ major episode • 2 weeks; ave. 4 months • Loss of interest, pleasure • 4 of 7 criteria • Significant weight loss or gain • Insomnia or hypersonmia • Psychomotor retardation or agitation • Fatigue • Feelings of worthlessness, • Inability to concentrate • Recurrent suicide ideation • Pervasive and intense • Impairs occupation, social activities and relationships • Not due to bereavement, substance use, or a medical condition

  4. Dysthymic Disorder-Chronic Depressive Disorder • Minor depression • Pervasive depressed mood or irritability for 2 years, 1 in children • 2 of 7 criteria • No symptom relief for greater than 2 months • No evidence of a Major Depressive disorder during the 2 years, 1 in children

  5. Bipolar Disorders • Cyclothymia—numerous period of manic and depressive episodes—no full blown episodes of either • Bipolar Disorder NOS- Doesn’t fit any particular category. • Bipolar—Marked episodes of manic and depression

  6. BD-Manic • Abnormally and persistently elevated, expansive or irritable mood • Lasting at least 1 week • 3 + of following symptoms (4 if mood is only irritable) • Inflated self-esteem or grandiosity • Decreased need for sleep • Pressured speech or more talkative • Racing thoughts, flight of ideas • Distractibility • psychomotor agitation or increased goal-directed activity • Hedonistic interests

  7. BD-Manic continued • Impairs occupation, social activities and relationships • Not due to bereavement, substance use, or a medical condition • May necessitate hospitalization to prevent harm, or have psychotic features

  8. Mixed episode--Rollercoaster • Both manic and depressive episodes are met nearly every day for at least 1 week. • Impairs occupation, social activities and relationships • Not due to bereavement, substance use, or a medical condition • May necessitate hospitalization to prevent harm, or have psychotic features

  9. BD • Hypomanic Criteria • Symptoms same as manic • Not as long • Not as severe, change in functioning, not impairment • Not pathological but may trouble other due to erratic behavior.

  10. BD • Rapid Cycling • 4 or more episodes per year • Manic, depressive, mixed, hypomanic • Occurs in any combination • Must have a period of full remission or polar switch between episodes.

  11. Juvenile Bipolar • Longer duration of episodes • Higher rate of cycling • Lower rates of inter-episode recovery • Chronic and continuous

  12. Juvenile Bipolar • Other characteristics • Sleep/wake cycle disturbance • ADHD like symptoms • Aggression/poor frustration tolerance • Intense rage • Bossy and overbearing, extremely oppositional • Fears or social phobias • Hypersexuality • Laughing hysterically • Deep depression • Sensory sensitivities • Carbohydrate craving • Somatic complaints

  13. Prevalence • Any mood disorder: • 14% 13-18 year olds-lifetime • 4.7% 13-18 year olds-severe • 18.1% girls • 10.1% boys • 9.4% 13-14 • 15.3% 15-16 • 19.2% 17-19 • Depression most common mood order among adolescents • Of those diagnosed approx. 15% commit suicide.

  14. Risk factors for Depression • Predisposition to depression-genetic link • First degree relative • Poverty • Peer rejection.

  15. Prevalence BD • Adolescents; 1-3% • Genetic link? • Abnormal brain function and structure

  16. Mood Disorders-General Symptoms • Disruptive Behavior • Academic difficulties or declining school performance • Problems with peers • Increadseirritabilityand aggression compared to peers • Suicidal threates • Anhedonia (joylessness) • Statements they they hate themselves and everything around them • Sleeping too much or too little

  17. Mood Disorders-General Symptoms • Rapid unpredictable emotional changes • Racing thoughts • Increased strength and energy along with decreased sleep • Increased interest in problematic activities such as overspending and drug use. • Grandiosity and inflated self-esteem • Greatly increased or decreased sexual drive • Uncharacteristically poor judgment

  18. Bipolar in Adolescents • More mixed episodes • More cyclic • Frequent irritability and aggressive behavior • Sexual disinhibition • High rates of co-morbidity with: • ADHD • Substance abuse • Conduct and anxiety disorders, • Panic disorder • OCD • ODD • Eating disorders • Personality disorders • Severe Medical conditions

  19. What’s new? • Disruptive mood Dysregulation Disorder • New Category in DSM-V • Accurately differentiate between bipolar, HDHD, ODD • More clearly define boundaries of BD. • Is it a catch-all for those who don’t fit into the other categories???????

  20. Symptoms • Temper outbursts in response to common stressors • Rage, aggression • Grossly out of proportion for situation • 3+ times a week • Mood between outbursts • Nearly every day---negative • Observable by others • Above criteria must be present for at least 12 months • Across settings (at least 2 different) • At least 6 years old • Onset before age 10 • Past year no manic episode lasting longer than a day • Behavior is no accounted for by another mental disorder. PDD, PTSD or separation anxiety disorder

  21. Co-existing Disabilities with mood disorders • ADHD—11-75% • ODD--46.4-75% • Conduct Disorder--5.6-37% • Anxiety Disorder—12.5-56% • Substance abuse—0-40% • Other OCD, Tourette’s RAD, intermittent explosive disorder

  22. Academic impairments • Executive function • Attention • Memory • Organization • Problem solving • Coordination • Sensory-Motor integration • Nonverbal problem solving • Skill deficits • Impulsive • Talkative • Distractible • Withdrawn • Unmotivated • Difficult to engage

  23. Educational Implications • Grade retention • L.D. • Sped or 504 placement • Required tutoring • Adolescent onset=significant disruptions (Lofthouse and Fristad-2006) • Before • 71% good to excellent work • 58% specific academic strengths • 83% college prep classes • After • 67% significant difficulties in math • 38% graduated from high school

  24. As a teacher • Flexible • Ignore minor negative behaviors • Encourage positive • Model • Stay calm • Non confrontations manner • Adaptable-receptive to change • Develop rapport with student • Identify triggers • Humor • Consistency • Minimize distractions • Announce transitions and changes to routine • Plan for “down time” • Scheduling • Classroom and testing accommodations • Shortened assignments when needed. • Teach coping skills

  25. Psychopharmacological • Depressive • Lamictal • Paxil • Wellbutrin • Celexa • Lexpro • Prozac • Remeron • Serzon, • Zoloft • Zyprexa • Mania • Lithium • Depakote • Depacon • Tegretol • Gabitril • Lamictal • Topomax • Trileptal • Zypexa • Seroquil • Risperdal • Geodon • Abilify • Clozaril • Clonidene • Tenex • Benzodazepines

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