Mood Disorders Depression Major depressive episode Major depressive disorder Dysthymic Disorder Bipolar Disorder – Both mania and depressive episodes at some point in life Mood Disorders Depression as symptom, syndrome, disorder Symptom = feeling sad, down, blue Syndrome = group of symptoms that occur together Affective changes Vegetative or psychomotor disturbances Cognitive changes (depressive triad) Disorder = syndrome defined by DSM criteria DSM criteria for Major Depressive Episode Need 5 symptoms present for at least 2 weeks – Must include depressed mood or loss of interest/pleasure: persistent feelings of sadness (can be irritability in children) – restlessness, reduced activity, slowed speech, excessive crying – Feelings of worthlessness and low self-esteem – Changes in appetite or weight – Fatigue or loss of energy – Sleep disturbances – Difficulty thinking or concentrating – Thoughts of death and suicide See case study Additional information about depression Prevalence: 2 – 8% of children ages 4 – 18 Rare among preschool-aged children, prevalence increases with age 70% comorbidity First episode age of onset 13 – 15 years Myths about depression in children A. Depression doesn’t exist B. “masked” depression: bedwetting, sleep problems, hyperactivity, etc. C. Childhood depression is same/different than adult depression Childhood depression as different than adult depression Different gender ratio Missing some major symptoms (vegetative symptoms, suicide) in childhood Antidepressants don’t work as well More irritability High rates of comorbidity Much lower base rates Associated characteristics in children Intellectual and academic problems Cognitive disturbances – depressive triad Low self-esteem and unstable self-esteem Social withdrawal More on age differences Depressive feelings Mania Suicide rare Self-esteem Why these age differences? Genetics Sex hormones Stressors Family less operative Cognitive changes Causes of depression in children 1. Genetic and family risk 2. Neurobiological influences 3. Family influences 4. Stressful life events 5. Emotion regulation Treatment of depression 1. Psychosocial interventions A. Cognitive techniques B. Behavioral techniques C. Affective education D. Family context 2. Medications 3. prevention Bipolar Disorder Expansive, elevated or irritable mood with one or more depressive episodes Several subtypes Less common until adolesc. Causes Onset and course Treatment of bipolar 1. Education 2. Medication 3. Symptom management and relapse prevention Suicide Handouts Suicidal thoughts – common Suicidal intent – involves specific plan and motivation to carry it out “suicidal gestures” = instrumental behavior Suicide attempts – Low lethality – High lethality