+ What is a Mood Disorder? Is a category of mental health problems May also be called affective disorders Mood disorders in children are recognized as one of the most under diagnosed psychiatric illnesses Clinically there are only five mood disorders Depression Dysthymia Bipolar Mood disorder due to a medical condition Mood disorder due to substance abuse Out of 100,000 adolescents, two to three thousand will have mood disorders out of which 8-10 will commit suicide.
+ Major Depression A two week period of a depressed or irritable mood or a noticeable decrease interest or pleasure in usual activities along with other signs of a mood disorder As many as one in every 33 children and one in eight adolescents may have depression. (U.S. Center for Mental Health Services [CMHS], 1996).
+ Dysthymic Disorder (Dysthymia) A chronic, low-grade, depressed or irritable mood for at least one year
+ Bipolar disorder At least one episode of a depressed or irritable mood and at least one period of a manic (persistently elevated) mood. Almost one-third of six- to twelve- year-old children diagnosed with major depression will develop bipolar disorder within a few years. (AACAP, 1995)
+ Mood Disorder due to Medical Condition Many medical illnesses (including cancer, injuries, infections, and chronic medical illnesses) can trigger symptoms of depression
+ Substance Induced Mood Disorder Symptoms of depression that are due to the effects of medication, drug abuse, exposure to toxins or other forms of treatment
+ Scope of the problem Main scope of focus is that children can develop mood disorders from heredity and environmental factors.
+ Heredity Chemicals in the brain called neurotransmitters regulate the brain chemicals that affect your mood When these are altered or are in an imbalance they can cause mood swings which can lead to mood disorders
+ Environmental Any types of abuse, neglect, and/or maltreatment Traumatic life changes Death Major illness
+ All population ages can be effected however we will be focusing on children and adolescents Population likely to be effected
+ Course of the Disease Course of the disease can be ongoing until proper investigation or treatment is used
+ Presentation of Topic Signs of mood disorder Loss of interest in usual activities Sleep disturbances Changes in appetite or weight Decreased energy Feeling sad Feeling hopeless or helpless Having low self esteem Feeling inadequate or worthless Difficulty concentrating Decrease in ability to make decisions Feeling or wanting to die Difficulty achieving in school Constant anger Rebellious acts Trouble with family Difficulty with friends and peers
+ Treatment of Illness Your child/adolescents age, overall health, and medical history The extent of your child/adolescent’s symptoms Type of mood disorder Child/adolescent’s tolerance of specific medications, procedures or therapies Expectations for the course of the mood disorder Your opinion of preference Specific treatment should be determined by the child’s physician or qualified mental health professional based on: Mood disorders can be effectively treated. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Treatment recommendations may include individual therapy for the adolescent, family therapy, and sometimes consultation with the adolescent’s school. Some adolescents may also benefit from treatment with an antidepressant medication and/or mood stabilizers. Parents play a vital supportive role in any treatment process.
+ Prevention of mood disorders Preventive measures to reduce the incidence of mood disorders in adolescents are not known at this time Early detection and intervention can reduce the severity of symptoms, enhance the child/adolescent's normal growth and development and improve the quality of life experienced by children/adolescents with mood disorders
+ Role of the professional Recognition Recognizing the symptoms and being able to tell if the child is suffering from a mood disorder(s), also routine screening for psychological disorders in youth by nurses at both inpatient and outpatient settings would allow for more accurate hypotheses about what is causing a child’s presenting problem. Assessment Typical areas of assessment include current symptoms and symptom development, developmental history, family history of psychological previous term disorders, next term and current and previous levels of psychosocial functioning, as reported by the previous term child, next term parents, and other caretaking adults (e.g., teachers). In general, there are two types of instruments that can aid one in making a diagnosis: diagnostic interviews and self-report or other-report scales. Diagnostic interviews can be divided into structured and semi structured formats. Another commonly used diagnostic interview is the semistructured Kiddie Schedule of affective disorders. Self-report and other report scales can also be used as diagnostic interview tools. Intervention Weekly checkups with a professional, possible medication, multidisciplinary team with specialized knowledge and experience, traditional or non-traditional medications Referral Counseling, support groups
+ What would you do? Education Contact a social worker Social Work Assessment, intervention, possible treatment options, work with the interdisciplinary team Nursing Assessment, referral to doctor, work with the interdisciplinary team Law Enforcement Interview family to make sure there are no other problems
+ Quick Facts According to several studies, a significant proportion of the approximately 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder, but have not yet experienced the manic phase of the illness. 7-14% of children will experience an episode of major depression before the age of 15 20-30% of adult bipolar patients report having their first episode before the age of 20 Recent studies have shown that greater than 20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatry clinics suffer from depression. (The Canadian Journal of CME) Recent studies show that, at any given time, as many as one in every 33 children may have clinical depression. The rate of depression among adolescents may be as high as one in eight. (Department of Health and Human Services)
+ Annotated Bibliography Bipolar Disorder. (2008). National Institute of Mental Health. Biotech Business Week, (2007, May, 28th). Harvard Mental Health Letter. Biotech Business Week, Retrieved 2-2-09, from http://www.lexisnexis.com:80/us/lnacademic/results/docview/docview.do?docLinkInd=true&risb=21_T 5688170221&format=GNBFI&sort=RELEVANCE&startDocNo=1&resultsUrlKey=29_T5688170226&cisb=22 _T5688170225&treeMax=true&treeWidth=0&csi=246798&docNo=3 Cicchetti, D. (1998 ). The development of depression in children and adolescents. EBSCOhost, 221-241. Family Resource Center, (2007, July). Mental Health Conditions and Diagnoses. Retrieved January 27, 2009, from Cincinnati Children's Web site: http://www.cincinnatichildrens.org/health/info/mental/diagnose/mood.html Lack, Caleb W. PhD and Green, Amy L. BA. “Mood Disorders in Children and Adolescents.” Journal of Pediatric Nursing. Vol 24, No 1. February 2009. Pub Med. Winona State University Lib., Winona, MN. 25 January 2009. Molnar, B., Buka, S., & Kessler, R. (2001). Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity survey. American Journal of Public Health, 91(5), 753-761. Mulder, R., Beautrais, A., Joyce, P., Fergusson, D. (1998). Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample. The American Journal of Psychiatry, 155(6), 806-812. Tyrka, Audrey R., Wyche, Margaret C., Price, Lawrence H., Carpenter, Linda L. “Childhood maltreatment and adult personality disorder symptoms: Influence of maltreatment type.” Science Direct. 30 October 2007. PubMed. Winona State University Lib., Winona, MN. 25 January 2009 http://www.sciencedirect.com.wsuproxy.mnpals.net/science?_ob=ArticleURL&_udi=B6TBV-4VF0XPK 1&_user=1822448&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000054579&_version=1&_ur lVersion=0&_userid=1822448&md5=55ac8b73cf30e2b6bd572d188c150fc1 http://www.sciencedirect.com.wsuproxy.mnpals.net/science?_ob=ArticleURL&_udi=B6TBV-4VF0XPK 1&_user=1822448&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000054579&_version=1&_ur lVersion=0&_userid=1822448&md5=55ac8b73cf30e2b6bd572d188c150fc1