Week 6 - Mood and anxiety disorders Flashcards
Three categories of depression during childhood and adolescence
‣ Major depressive disorder
‣ Dysthymic disorder
‣ Adjustment disorder with depression
Major Depressive Disorder (MDD)
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.
Dysthymic disorder
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.
Adjustment disorder with depressed mood
occurs within 3 months after a major life stressor, involves less-severe symptoms, and is relatively mild and brief.
Psychotic depression
affected individuals have hallucinations or delusion
Atypical depression
Majordepression with symptoms including hypersomnia, increased appetite, psychomotor retardation, and weight gain
Seasonal affective disorder
common during the fall and winter months when there is less daylight
Premenstrual dysmorphic disorder
PMS symptoms (bloating, headaches and breast tenderness) in the weeks before their period. But PMDD also causes severe anxiety, depression and mood changes.
Causes of depression
‣ impaired neurotransmission,
‣ endocrine dysfunction
‣ biologic rhythm dysfunction
Given a biologic predisposition, certain life events may trigger the onset of depression.
S/S of depression
‣ 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
Diagnosis of major depressive disorder
Two plus weeks of depressed mood or loss of interest and at least four additional s/s of depression
Things to assess when you suspect depression
‣ Recent life events/losses
‣ Family history of depression
‣ Family dysfunction
‣ Changes in school performance
‣ Risk taking behavior
‣ Deteriorating relationships
‣ Changes in peer relations
Management for MDD
‣ 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
Bipolar depression
characterized by unusual shifts in mood, energy, and functioning and may begin with manic, depressive, or a mixed set of manic and depressive symptoms
Cause of bipolar depression
‣ May be structural changes in the brain
‣ Evidence of familial clusters
Which psychiatric disorder has the highest risk of suicide?
Bipolar disorder
S/S of Bipolar Disorder
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
Management of bipolar disorder
‣ 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
Generalized Anxiety Disorder
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”
S/S of Generalized Anxiety Disorder
‣ 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
Management of Generalized Anxiety Disorder
‣ 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
Obsessive-compulsive disorder
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
Medications for Generalized Anxiety Disorder
‣ SSRIs - sertraline, and fluoxetine
‣ SNRIs - venlafaxine and duloxetine; and other medications like buspirone
Obsessions
recurrent thoughts, images, or impulses that are disturbing to the child and difficult to dislodge
Compulsions
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
Cause of OCD
Unknown. Strong genetic component
Management of OCD
‣ Child and family therapy to help child manage anxiety and distress
‣ CBT is most effective treatment First line thearpy
‣ SSRIs are first line medication
