Chapter 7
Mood Disorders
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History
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Psychoanalytic View
Masked Depression
Transient episodes due to development
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Mood Disorders
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Major Depressive Disorder (MDD)
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Depressed or irritable mood
Loss of interest or pleasure
Weight changes
Sleep problems
Motor agitation or retardation
Loss of energy
Feeling worthless or guilty
Poor concentration
Thoughts of death or suicide
Need five symptoms for 2 weeks
Problems must cause impairment
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Mood Disorders
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Dysthymic Disorder
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Depression less severe, but more chronic
Depressed or irritable mood
Appetite disturbance
Sleep disturbance
Low energy
Low self esteem
Poor concentration
Hopelessness
Symptoms last for a year or more
Double depression is a term used when the child has both
MDD and dysthymia
Dysthymia usually begins before MDD
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Mood Disorders
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Adjustment Disorder with Depressed Mood
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Child has depressive symptoms in response to a
clear stressor (e.g., move, divorce)
Bipolar Disorder
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Mania
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Elevated or irritable mood
Inflated self esteem
High activity
Rapid speech and thinking
Distractibility
Exaggerated well being and confidence
Hypomania-milder form of mania
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Mood Disorders
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Bipolar Disorder
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Bipolar I –person has periods of mania and
depression (manic depression)
Bipolar II-person has periods of hypomania
and depression
Cyclothymia-chronic but mild fluctuations
in mood that do not meet the criteria for
mania or depression
May be hard to diagnose in children
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Epidemiology
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MDD the most common
type
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80% of kids with
depression have MDD
10% have double
depression
10% dysthymia
May be underestimated
Episodes common in
adolescence
Gender differences do
not occur until age 13
when girls report
depression more often
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Epidemiology
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MDD
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Lower SES
associated with
higher rates
Ethnic differences
may exist when the
effects of age or
gender are examined
40-70% have
another disorder
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Epidemiology
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Bipolar
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Rare in children (1%)
Peak onset between 15-19
Males and females equally represented
Co-occur with ADHD, ODD, substance
dependence
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Course
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Depression
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Infancy
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Preschool
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Lethargy
Feeding problem
Sleep problem
Irritability
Sad expression
Crying
Failure to thrive
Associated with
maternal depression
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Irritability
Sad facial expression
Mood changes
Feeding and sleep
problems
Lethargy
Crying
Hard to assess
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Course
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Depression
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Middle childhood
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Begin to report
hopelessness and self
deprecation around age
9-12
Adolescent
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Begins to look more like
adult depression
Median duration was 8
weeks
Clinic samples have
longer episodes
Earlier onset correlated
with longer episodes
70% have recurrent
episodes (Kovacs, 1996)
May be differences
between prepubertal and
postpubertal depression
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Course
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Bipolar
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Median duration of manic episode 10.8
months
For children with the disorder, onset is
earlier than those with MDD
Non remitting symptoms and relapse not
uncommon
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Etiology
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Biological influences
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Heritability 80% for bipolar disorders
Onset of depression before age 20 associated with
family history
For depression genetic effects may be indirect
Neurochemistry
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Norepinephrine
Serotonin
Acetylcholine
Neuroendocrine system dysregulation
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Etiology
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Social Psychological Influences
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Separation and Loss
Cognitive Behavioral/Interpersonal
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Interpersonal
Learned Helplessness
Attributions
Beck’s Theory
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Etiology
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Parental Depression
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Increased risk of depression
for children of depressed
parents (including infants)
Increased risk of other
disorders
Less likely to receive
treatment
Parental depression may
cause the parent to
withdraw, offer poor
supervision, irritable,
engage in frequent conflict
Can effect attachment
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Etiology
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Peer Relations
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Rejected boys and girls and neglected girls
are more likely to be depressed
Cause and effect cannot be determined
Children may feel or be less competent or
have negative views of peers
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Suicide
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3rd leading cause of death in 10-19 age group
Rate highest for white males
Rates for black males age 10-14 have increased
slightly since 1995
Native American males have the highest rate
proportionally
Increased use of guns
Females have higher rates of ideation and attempts
than males
High rate of reattempt
Teens report problems coping; desire to escape
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Suicide
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Risk Factors
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Hopelessness
Comorbid disorders
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Conduct disorder
Substance abuse
Prior attempts
Poor interpersonal problem solving
Family history of suicide
Abuse
Low parental monitoring
High stress
Media reports of suicide
Neurotransmitter dysfunction
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Assessment
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Interviews
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Rating Scales
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Structured
Clinical
CBCL
CDI
RCDS
Low levels of correlation between child and parent measures
Peer nominations
Assessment of cognitions and attributions
Observations
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Treatment
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Pharmacological
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Antidepressant medication use controversial
TCAs
SSRIs
Side effects
Lack of research
Recent controversy over link of SSRIs to suicide in
youth
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Treatment
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Cognitive Behavioral
Treatments
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Challenge cognitions and
attributions
Increase pleasurable
experiences
Enhance social skills
Improve communication
and conflict resolution
Manualized treatment
has support, particularly
with teens.
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Treatment
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Research comparing
methods has found that
Cognitive Behavioral
Therapy (CBT) very
effective
Most programs are not
long enough
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Lingering symptoms
Relapse in long term
Interpersonal
Psychotherapy (IPT)
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Treat grief, interpersonal
disputes, role transitions,
interpersonal deficits
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Treatment
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Bipolar
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May need hospitalization
Mood stabilizing drugs such as Lithium
SSRIs
Education about disorder for family and patient
Cognitive behavioral and psychosocial
interventions
Educational interventions
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handouts
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One illustrates the multiple influences in the
dev of depression, the biol, the env, the
family, life stress, and the effect on the child
in terms of cognition and interpersonal skills
The second points out that more recent
studies of the effectiveness of therapy for
depression show a modest effect, not a
strong one, and that behavioural activation
may be more important than cognitive
therapy
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text
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It starts out by pointing out the controversies
about a diagnostic category being a distinct
entity
The empirical approach does not really
separate depression from anxiety, seeing
them as part of one continuum, for example
Remember that the empirical approach
emphasized dimensions, not categories
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etc
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For example, is the diagnostic category of
mania separate and valid, or is mania simply
a sign of any of a number of severe disorders
In terms of influences, there are distal and
proximal ones, e.g., SES influences
depression indirectly through its effects on
the family, which has its caregiving and
supervisory functions affected
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etc
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Another example about dimensions, the book
mentions a continuum or spectrum of
disorders related to mania, from simpler traits
to more severe disorders, and with
subsyndromal levels in between
About distal and proximal, in terms of biol
and genes, they do not cause depression
directly, but lead to poorer social skills,
thinking capacity, through effects on the child
and family, and then the school experience
and peers
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