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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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?

13. 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

14. 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

15. 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