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Mood
Disorders
Common Mood Disorders
 Depression
 Dysthymic
 Bi-Polar
Depression
Major Depressive Disorder
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1+ major episode
2 weeks; ave. 4 months
Loss of interest, pleasure
4 of 7 criteria
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Significant weight loss or gain
Insomnia or hypersonmia
Psychomotor retardation or agitation
Fatigue
Feelings of worthlessness,
Inability to concentrate
Recurrent suicide ideation
Pervasive and intense
Impairs occupation, social activities and relationships
Not due to bereavement, substance use, or a medical condition
Dysthymic Disorder-Chronic
Depressive Disorder
 Minor
depression
 Pervasive depressed mood or irritability for
2 years, 1 in children
 2 of 7 criteria
 No symptom relief for greater than 2
months
 No evidence of a Major Depressive
disorder during the 2 years, 1 in children
Bipolar Disorders
 Cyclothymia—numerous
period of manic
and depressive episodes—no full blown
episodes of either
 Bipolar Disorder NOS- Doesn’t fit any
particular category.
 Bipolar—Marked episodes of manic and
depression
BD-Manic
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Abnormally and persistently elevated, expansive or
irritable mood
Lasting at least 1 week
3 + of following symptoms (4 if mood is only irritable)
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Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech or more talkative
Racing thoughts, flight of ideas
Distractibility
psychomotor agitation or increased goal-directed
activity
Hedonistic interests
BD-Manic continued
 Impairs
occupation, social activities and
relationships
 Not due to bereavement, substance use,
or a medical condition
 May necessitate hospitalization to prevent
harm, or have psychotic features
Mixed episode--Rollercoaster
 Both
manic and depressive episodes are
met nearly every day for at least 1 week.
 Impairs occupation, social activities and
relationships
 Not due to bereavement, substance use,
or a medical condition
 May necessitate hospitalization to prevent
harm, or have psychotic features
BD
 Hypomanic
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Criteria
Symptoms same as manic
 Not
as long
 Not as severe, change in functioning, not
impairment
 Not pathological but may trouble other due
to erratic behavior.
BD
 Rapid
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Cycling
4 or more episodes per year
 Manic,
depressive, mixed, hypomanic
 Occurs in any combination
 Must have a period of full remission or polar
switch between episodes.
Juvenile Bipolar
 Longer
duration of episodes
 Higher rate of cycling
 Lower rates of inter-episode recovery
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Chronic and continuous
Juvenile Bipolar
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Other characteristics
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Sleep/wake cycle disturbance
ADHD like symptoms
Aggression/poor frustration tolerance
Intense rage
Bossy and overbearing, extremely oppositional
Fears or social phobias
Hypersexuality
Laughing hysterically
Deep depression
Sensory sensitivities
Carbohydrate craving
Somatic complaints
Prevalence
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Any mood disorder:
14% 13-18 year olds-lifetime
4.7% 13-18 year olds-severe
18.1% girls
10.1% boys
9.4% 13-14
15.3% 15-16
19.2% 17-19
Depression most common mood order among
adolescents
Of those diagnosed approx. 15% commit suicide.
Risk factors for Depression
 Predisposition
to depression-genetic link
 First degree relative
 Poverty
 Peer rejection.
Prevalence BD
 Adolescents;
 Genetic
1-3%
link?
 Abnormal brain function and structure
Mood Disorders-General
Symptoms
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Disruptive Behavior
Academic difficulties or declining school
performance
Problems with peers
Increadse irritabilitya nd aggression compared to
peers
Suicidal threates
Anhedonia (joylessness)
Statements they they hate themselves and
everything around them
Sleeping too much or too little
Mood Disorders-General
Symptoms
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Rapid unpredictable emotional changes
Racing thoughts
Increased strength and energy along with
decreased sleep
Increased interest in problematic activities
such as overspending and drug use.
Grandiosity and inflated self-esteem
Greatly increased or decreased sexual drive
Uncharacteristically poor judgment
Bipolar in Adolescents
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More mixed episodes
More cyclic
Frequent irritability and aggressive behavior
Sexual disinhibition
High rates of co-morbidity with:
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ADHD
Substance abuse
Conduct and anxiety disorders,
Panic disorder
OCD
ODD
Eating disorders
Personality disorders
Severe Medical conditions
What’s new?
 Disruptive
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 Is
mood Dysregulation Disorder
New Category in DSM-V
Accurately differentiate between bipolar,
HDHD, ODD
More clearly define boundaries of BD.
it a catch-all for those who don’t fit into
the other categories???????
Symptoms
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Temper outbursts in response to common stressors
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3+ times a week
Mood between outbursts
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Rage, aggression
Grossly out of proportion for situation
Nearly every day---negative
Observable by others
Above criteria must be present for at least 12 months
Across settings (at least 2 different)
At least 6 years old
Onset before age 10
Past year no manic episode lasting longer than a day
Behavior is no accounted for by another mental disorder.
PDD, PTSD or separation anxiety disorder
Co-existing Disabilities with
mood disorders
 ADHD—11-75%
 ODD--46.4-75%
 Conduct
Disorder--5.6-37%
 Anxiety Disorder—12.5-56%
 Substance abuse—0-40%
 Other OCD, Tourette’s RAD, intermittent
explosive disorder
Academic impairments
 Executive
function
 Attention
 Memory
 Organization
 Problem
solving
 Coordination
 Sensory-Motor
integration
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Nonverbal problem
solving
Skill deficits
Impulsive
Talkative
Distractible
Withdrawn
Unmotivated
Difficult to engage
Educational Implications
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Grade retention
L.D.
Sped or 504 placement
Required tutoring
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Adolescent
onset=significant
disruptions (Lofthouse
and Fristad-2006)
Before
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71% good to
excellent work
58% specific
academic strengths
83% college prep
classes
After
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67% significant
difficulties in math
38% graduated from
high school
As a teacher
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Flexible
Ignore minor negative
behaviors
Encourage positive
Model
Stay calm
Non confrontations
manner
Adaptable-receptive
to change
Develop rapport with
student
Identify triggers
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Humor
Consistency
Minimize distractions
Announce transitions
and changes to
routine
Plan for “down time”
Scheduling
Classroom and testing
accommodations
Shortened assignments
when needed.
Teach coping skills
Psychopharmacological
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Depressive
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Lamictal
Paxil
Wellbutrin
Celexa
Lexpro
Prozac
Remeron
Serzon,
Zoloft
Zyprexa
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Mania
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Lithium
Depakote
Depacon
Tegretol
Gabitril
Lamictal
Topomax
Trileptal
Zypexa
Seroquil
Risperdal
Geodon
Abilify
Clozaril
Clonidene
Tenex
Benzodazepines