Unipolar or Bipolar Mood Disorders Major Depressive Disorders Bipolar Disorders Dysthymic Disorder Cyclothymic Disorder

Current Research – NIMH Report (July 2003) Stress-sensitive version of serotonin transporter gene Noted as “short version” Confers vulnerability to stresses (job loss, relationship breaks, deaths of loved ones, prolonged illness) at high risk for depression 43% versus 17% w different version of gene Individuals abused as children also high risk Found by study of “stress histories” Not yet ready for diagnostic testing Needs confirmation May predispose

Necessary Clinical Information History of: financial difficulties/failed businesses increased sexual activity & sexual indiscretions previous depression, hypomania, or mania rapid switches in mood substance abuse medical illness Current mood Guilty feelings, quality of self-esteem Current hallucinations or delusions Current & previous suicide ideation/attempts Change in energy level or fatigue Change in pattern of sleep

Mood Disorders Share a disturbance of mood Mania/depression not due to another physical or mental disorder Mood may/may not affect social or occupational functioning (clinical significance) Prolonged emotion generally affects entire life Distinguished by intensity of abnormal mood duration impairment produced behavioral, cognitive or physical symptoms

Major or Unipolar Depression Profound sadness & related problems, such as sleep & appetite disturbance, loss of energy & self-esteem issues Meds – Luvox, Prozac, Zoloft, Paxil, others

Major Depressive Episode core syndrome of severe depression Some specific diagnoses distinguished by # of major depressive episodes & presence/absence of manic or hypomanic episodes Child may present different symptoms Mixed Episodes – criteria from both manic & depressive

Manic Episode Mania must result in marked dysfunction for Bipolar I Unusually & persistently elevated, expansive, & irritable mood Individual usually unaware of problem No clue that they make no sense Appears to come on suddenly Frequently resistant to treatment

Bipolar Disorders Episodes of either mania alone or of both mania & depression Mania episode involved Mania indicates: Mood elevated or irritable Extreme activity, talkativeness Distractible Frequently resists treatment Meds – Lithium, Zoloft, Wellbutrin, Prozac, Depakote

Symptoms: Major Depressive Disorder Depressed mood; no mania Loss of pleasure in activities Weight loss or gain Change inapposite Change in sleep pattern Agitation Loss of energy Sense of worthlessness Difficulty concentrating High mortality rate Thoughts of death Suicidal ideation

Chronic Mood Disorders Cyclothymia frequent periods of depressed & hypomania for at least 2 years Hypomania episodes disturbances of mania not severe enough to cause major impairment Dysthymia chronic depression Persistent depression for 2 years or more May or may not significantly impair activities Determine whether opposite behavior ever present

Specifiers Use specifiers with all mood disorders to describe most recent episode Code specifiers in 5th digit If psychotic features specify whether mood congruent or mood-incongruent Use with course of recurrent episodes also Rapid cycling Seasonal cycling etc

Ask yourself these questions Is client’s mood abnormal? Could client’s symptoms be produced by drugs or a nonpsychiatric medical illness? Does client have symptoms of psychosis? Do these symptoms occur only in presence of mood symptoms? Has client ever had a manic, hypomanic, or mixed episode? Is the client’s current mood depressed?

Depression in Children & Adolescents Increased risk for illness, interpersonal & psychosocial difficulties May persist long after episode passes Increased risk for substance for suicidal behavior Often unrecognized Symptoms often seen as normal mood swings typical of development Health care workers reluctant to prematurely “label” Early diagnosis & treatment Critical to healthy emotional, social, & behavioral development Can reduce duration & severity

Scope of Problem with Youth 2.5 % of children 8.3% of adolescents (other study 7-14% total) Onset earlier today Recovery rate Single episode of MDD is high Dysthymia may lead to MDD MDD - likely family history Childhood Risk Boys & girls equal risk Adolescence Risk Girls twice as likely NIMH study of 9-17 yr olds Estimate prevalence 6% in 6-mo period With 4.9 major depression Often co-occurs commonly anxiety, disruptive behavior, or substance abuse Symptoms expressed differently acting out or irritable toward others Talking with parents important Medications controversial

Signs Associated with children & adolescents Frequent, vague non-specific complaints School Frequent absences Poor performance Talk of or efforts to runaway Outbursts of shouting, unexplained irritability, complaining, or crying Being bored Alcohol or substance abuse Social isolation, poor communication Fear of death Extreme sensitivity to rejection or failure Increased irritability, anger, or hostility Reckless behavior Difficulty with relationships Lack of interest in playing with friends