Lecture 20 - Mood Disorders

Question 1

Major Affective Disorders

Answer 1

Major affective disorders
• Bipolar 1: At least one episode of mania
• Bipolar 2: At least one episode of Hypomania (at least 4 days, but no major impairment) and one episode of major depression.
• Major depressive disorder: At least one depressive episode.
- No hypomania or mania.
• Disruptive Mood Dysregulation Disorder: Persistent
irritability and frequent episodes of extreme behavioral
dyscontrol in the form of temper tantrums in children. No hypomania or mania
- NEW DSM-V DISORDER FOR CHILDREN, Part of Depressive Disorders

Question 2

DISRUPTIVE MOOD DYSREGULATION DISORDER

Answer 2

Severe recurrent temper outburst manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
• The temper outbursts are inconsistent with developmental level.
• The temper outbursts occur, on average, three or more times per week.
• The mood between temper outbursts is persistently irritable or angry most of the day,
nearly every day, and is observable by others (e.g., parents, teachers, peers).
• Symptoms have been present for 12 or more months.
• Symptoms are present in at least two of three settings (i.e., at home, at school, with
peers) and are severe in at least one of these.
• The diagnosis should not be made for the first time before age 6 years or after age 18 years.
• By history or observation, the age at onset is before 10 years.
• No evidence of a manic or hypomanic episode.

Question 3

Bipolar Disorder

Answer 3

Prevalence of BD is approx 0.4% to 1.9% in
childhood/adolescence
• Comorbid with ADHD, conduct disorder, ODD,
substance problems, and anxiety disorders
• Peak onset is between 15 and 19 yrs of age, and
rarely is the onset prior to the the age of 10.
• Chronic disorder
• High estimates of heritability (85%)
• Early externalizing problems occurring with (or prior
to) BD are predictive of worse prognosis (more
severe course, poor functioning, more substance
problems, and psychotic symptoms) than BD with
no history of externalizing problems.

Question 4

Developmental course of bipolar disorder

Answer 4

From childhood–>adolescence

Well -> Non- mood disorder(anxiety disorder strongest predictor) –> minor mood disturbance –> depression –> mania

Question 5

Pediatric BD- what are three likely areas of brain dysfunction

Answer 5

Mechanisms underlying extreme mood change and emotion regulation
Mechanisms associated with positive affective states, approach and reward
Mechanisms associated neurocognitive processing (attention,memory) and processing facial expressions of emotion

Question 6

Pediatric BD- what’s going on

Answer 6

• more responsive to emotional stimuli and less able to regulate emtotions –> Evidence of smaller amygdala (structure) and increased fMRI response in amygdala to pictures of emotional faces, and decreased prefrontal cortex response
• Probable exaggerated response to reward-related stimuli –> related to dysfunctional attentional control
• High prevalence of ADHD –> deficit attentional response to emotional cues, where poor attentional control is associated with poor emotion regulation
• Speculate that brain systems associated with processing emotion in faces are dysfunctional
• Poor functional connectivity between amygdala and other cortical areas like fusiform gyrus (face processing area; Rich et al, 2008)-also may be related to
poor emotion regulation

Question 7

How do you treat pediatric BD?

Answer 7

Lithium (12 older)
Anticonvulsants (carbamapazine; divalproex, etc.) Newer antipsychotics (risperidone, quetiapine, olanzapine, etc.)

BUT psychosocial intervention also important
- Child and Family Focused CBT