Week 6 - Mood and anxiety disorders

Question 1

Three categories of depression during childhood and adolescence

Answer 1

‣ Major depressive disorder
‣ Dysthymic disorder
‣ Adjustment disorder with depression

Question 2

Major Depressive Disorder (MDD)

Answer 2

a depressed or irritable mood or a markedly diminished interest and pleasure in almost all of the usual activities, or both, for a period of at least 2 weeks.

Question 3

Dysthymic disorder

Answer 3

depressed or irritable mood for the majority of days in the past 2 years that is less intense but more chronic than major depressive episodes.

Question 4

Adjustment disorder with depressed mood

Answer 4

occurs within 3 months after a major life stressor, involves less-severe symptoms, and is relatively mild and brief.

Question 5

Psychotic depression

Answer 5

affected individuals have hallucinations or delusion

Question 6

Atypical depression

Answer 6

Majordepression with symptoms including hypersomnia, increased appetite, psychomotor retardation, and weight gain

Question 7

Seasonal affective disorder

Answer 7

common during the fall and winter months when there is less daylight

Question 8

Premenstrual dysmorphic disorder

Answer 8

PMS symptoms (bloating, headaches and breast tenderness) in the weeks before their period. But PMDD also causes severe anxiety, depression and mood changes.

Question 9

Causes of depression

Answer 9

‣ impaired neurotransmission,
‣ endocrine dysfunction
‣ biologic rhythm dysfunction

Given a biologic predisposition, certain life events may trigger the onset of depression.

Question 10

S/S of depression

Answer 10

‣ decreased mood
‣ Impaired concentration
‣ Inattention
‣ Irritability
‣ fluctuating mood
‣ temper tantrums
‣ social withdrawal
‣ somatic complaints
‣ agitation
‣ separation anxiety
‣ behavioral problems
‣ Loss of interest/pleasure in doing things
‣ Appetite changes
‣ Low energy/fatigue
‣ Difficulty concentration
‣ Worthlessness
‣ Recurrent thoughts of death/ suicidal ideation

Question 11

Diagnosis of major depressive disorder

Answer 11

Two plus weeks of depressed mood or loss of interest and at least four additional s/s of depression

Question 12

Things to assess when you suspect depression

Answer 12

‣ Recent life events/losses
‣ Family history of depression
‣ Family dysfunction
‣ Changes in school performance
‣ Risk taking behavior
‣ Deteriorating relationships
‣ Changes in peer relations

Question 13

Management for MDD

Answer 13

‣ Determine suicidal risk and prevent suicide (greatest first four weeks of episode)
‣ Establish safe home environment (weapons, lethal medications etc)
‣ Refer to community resources (hotlines) and have a plan if the patient becomes suicidal
‣ CBT in individual or group format
‣ SSRIs

Question 14

Bipolar depression

Answer 14

characterized by unusual shifts in mood, energy, and functioning and may begin with manic, depressive, or a mixed set of manic and depressive symptoms

Question 15

Cause of bipolar depression

Answer 15

‣ May be structural changes in the brain
‣ Evidence of familial clusters

Question 16

Which psychiatric disorder has the highest risk of suicide?

Answer 16

Bipolar disorder

Question 17

S/S of Bipolar Disorder

Answer 17

Severe mood changes
‣ Inflated self-esteem or grandiosity
‣ Increased energy and physical agitation
‣ Decreased need for sleep
‣ Talkativeness or compulsion to talk; frequent topic changes or cannot be interrupted
‣ Racing thoughts
‣ Distractibility, with attention moving constantly from one thing to another
‣ Increase in goal-directed activity
‣ Risk-taking behaviors
‣ Hypersexuality
‣ Visual or auditory hallucinations
‣ Suicidal thoughts and behaviors

Question 18

Management of bipolar disorder

Answer 18

‣ Refer to child behavioral health specialist
‣ Medications include:
‣ Mood stabilizers (lithium), alone or in combination with antiseizure medications (valproate, divalproex) and atypical antipsychotics (risperidone)
‣ Family psychotherapy

Question 19

Generalized Anxiety Disorder

Answer 19

cognitive and obsessive in nature and causes excessive anxiety, worry, and apprehension generalized to a number of events or activities. Characterized as “worriers” or “being overwhelmed”

Question 20

S/S of Generalized Anxiety Disorder

Answer 20

‣ Worry about future events and/or preoccupation with past behavior
‣ Poor-quality sleep and unexplained fatigue
‣ Irritability and tantrums in young children
‣ Overconcern about competence and marked preoccupation with performance
‣ Significant self-consciousness and unusual need for reassurance
‣ Restlessness, difficulty concentrating
‣ Somatic complaints without a physical basis
‣ Comorbidity with other anxiety disorders, ADHD, or mood disorder

Question 21

Management of Generalized Anxiety Disorder

Answer 21

‣ Behavioral and family interventions (for preschool children)
‣ Older children refer to behavioral health specialist for mindfulness, psychodynamic therapy and CBT.
‣ Family therapy helpful to address source of anxiety or family discord

Question 22

Obsessive-compulsive disorder

Answer 22

results in marked distress; is time consuming (individuals often spend a minimum of 1 hour a day engaged in the behavior); and interferes with the child’s social, familial, or academic function. Abnormal compulsive behavior is distinguished by a sense of urgency or a profound discomfort until the ritual is completed

Question 23

Medications for Generalized Anxiety Disorder

Answer 23

‣ SSRIs - sertraline, and fluoxetine
‣ SNRIs - venlafaxine and duloxetine; and other medications like buspirone

Question 24

Obsessions

Answer 24

recurrent thoughts, images, or impulses that are disturbing to the child and difficult to dislodge

Question 25

Compulsions

Answer 25

repetitive behaviors or mental acts that the child feels driven to perform with the aim of reducing the anxiety associated with obsessions and include behaviors such as washing (e.g., hands, objects, or body), counting, or arranging objects

Question 26

Cause of OCD

Answer 26

Unknown. Strong genetic component

Question 27

Management of OCD

Answer 27

‣ Child and family therapy to help child manage anxiety and distress
‣ CBT is most effective treatment  First line thearpy
‣ SSRIs are first line medication 