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Mood Disorders

Explore common mood disorders in teens including depression, dysthymic disorder, and bipolar disorders. Learn about symptoms, risk factors, prevalence, and newer diagnostic approaches. Discover how these disorders affect daily life and relationships, and how to differentiate between various conditions.

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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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