Therapy for Pediatric Clients With Mood Disorders Essay Paper

Therapy for Pediatric Clients With Mood Disorders Essay Paper

What are mood disorders?

A category of mental health problems that includes all types of depression and bipolar disorder, mood disorders are sometimes called affective disorders.Depression is a psychological mood disorder that is common in today’s world. The effect of depression affects the person’s ability to control their feelings and thoughts, resulting in their activities of daily living being negatively affected. For a person to be diagnosed with depression they must have had the symptoms present for 2 continuous weeks at minimum (Nimh.nih.gov, 2015). Correspondingly, depression in females and the symptoms thereof are different to that of men. From social pressures to pregnancy hormones females have varying factors that alter their depressive experience from the male sex often making depression more difficult to treat ("Depression in Women: Causes, Symptoms, Treatment, and Self-Help", 2016).Therapy for Pediatric Clients With Mood Disorders Essay Paper

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Due to the unique encounter of depression in females it makes postnatal depression that much more complex. Postnatal depression’s occurrence rate, of non-psychotic postpartum depression, based on the results of many studies carried out is, 13%. The main reasons of postnatal depression were, past history of psychopathology and psychological disturbance during pregnancy, poor marital relationship and low social support, and stressful life events. Also, it is shown that patients of a low economic status are more likely to be diagnosed with postnatal depression (O 'hara & Swain, 1996).Overview
Citalopram is a prescription only, anti-depressant drug used to treat depressive illness, panic disorder and mood disorders (Hammen, 1997). Like most anti-depressants, Citalopram is a selective serotonin re-uptake inhibitor (SSRI). This means it prevents the neurotransmitter Serotonin from being reabsorbed by neurones and hence increasing its concentration in the brain (Fernández-Pastor & Ortega & Meana, 2013). Serotonin is responsible for maintaining mood balance and a feeling of happiness, and so increasing its levels can successfully relieve the symptoms of depression. Therapy for Pediatric Clients With Mood Disorders Essay Paper

Throughout our culture we often see people who do not fall under regular norms. These people can sometimes be defined as abnormal or unusual. Sometimes these abnormal behaviors can be caused by psychological issues in the mind, rather than extrinsic forces. These issues are not always easy to detect, but can range from things as simple as stress and anxiety to disorders such as dissociative disorder. A huge category of disorders is called the mood disorder. This paper will delve in to the mood disorder, particularly bipolar disorder, how it is diagnosed, how it develops, and what it is like to have this disorder. Moods are a common part of everyday life. They fluctuate every second of the day. It is normal to be happy, depressed, content, or even excited depending on the events that happen in your day, and how you perceive these events. A mood disorder is recognized when moods become “impairing” and hard to cope with (Parker et al, 2012, p.419). People have extreme swings from extreme happiness to sadness. These moods cannot be controlled, causing them to react inappropriately to events that are happening in their lives. Mood disorders can cause a person to be unstable in certain aspects of their lives, causing a disruption in a person’s daily activities. Therapy for Pediatric Clients With Mood Disorders Essay Paper

Even though the current criteria are reasonably applicable to older adolescents, symptoms such as excessive guilt, indecisiveness or suicidal ideation have little applicability among young children. Moreover, even in adolescents, depression is often less recognized than in adults, possibly due to factors such as fluctuation of symptoms, mood reactivity, and strong irritability.³

The presentation of depressive symptoms may vary according to age groups. Regarding mood changes, younger children show more temporal variability, making harder to characterize a mood episode. Adolescents often conceal their mood changes, frequently presenting as social isolation. Anhedonia may be manifested as difficulty in having fun in younger children, but in adolescents it may be manifested as boredom. The melancholic aspects of depression (reduction of energy, sleep changes, and appetite/weight disturbances) are more often seen in adolescents than in younger individuals. Conversely, somatic complaints are more common in children, but can also be found in adolescents Therapy for Pediatric Clients With Mood Disorders Essay Paper

Treatment

Every treatment plan for depression in children and adolescents should take into consideration developmental aspects, including psychoeducation, family support, assessment of comorbid conditions, and risk behaviors. Moreover, given the nature of chronic and recurrent depressive disorders, clear objectives should be established together with patients and their families not only for the acute treatment of the current episode, but also for phases of consolidation and maintenance, monitoring and preventing new episodes.

Similarly to the management of depression in adults, mild episodes can be addressed satisfactorily with psychoeducation and support measures targeting environmental stressors. A recent meta-analysis suggests the benefit of physical activity on depressive symptomatology among children and adolescents, with a small but significant effect size for the intervention.¹⁶ However, for cases in which the symptoms are more intense, more specific strategies are often necessary.Therapy for Pediatric Clients With Mood Disorders Essay Paper

In the pediatric population, evidence suggests the efficacy of pharmacological agents, cognitive behavioral therapy (CBT) or interpersonal therapy (IPT) - all these interventions, however, present only intermediate effect sizes in randomized controlled trials. Given that studies with children and adolescents usually focus on the treatment of depressive episodes, the management of dysthymic or unspecified depressive disorders is frequently extrapolated from the available literature on major depression.¹⁷

The psychotherapeutic techniques with the largest evidence base in terms of efficacy for the treatment of depressive episodes in children and adolescents are CBT and IPT. Psychodynamic approaches have also been widely employed, despite the absence of clinical trials evaluating this type of intervention.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Meta-analyses that investigated the efficacy of psychotherapy in the pediatric population (including 35 trials with children and adolescents¹⁸ and 11 trials only with adolescents¹⁹) suggested the efficacy of CBT, but with effect sizes around 0.3. The largest clinical trial for adolescents with depression performed to date (Treatment of Adolescent Depression Study, TADS) randomized 439 individuals to one of four options: CBT, fluoxetine, CBT + fluoxetine combination, or placebo.²⁰ In this study, however, no significant differences in the response between CBT and placebo were detected (43 and 35%, respectively). Another large clinical trial (Treatment of Resistant Depression in Adolescents, TORDIA, n=334) evaluated strategies for resistant depression and suggested that adding CBT to antidepressants may be beneficial.²¹ A role played by CBT may be preventing new episodes, as demonstrated in a clinical trial that suggested an eight times reduction in the risk of relapse in the first 6 months Therapy for Pediatric Clients With Mood Disorders Essay Paper

A smaller body of evidence also points to the efficacy of IPT in the treatment of depressive episodes in adolescents. Clinical trials to date have compared IPT to conventional treatment, with no high quality controlled studies assessing IPT vs. antidepressants or placebo.¹⁷ There is a general idea that IPT is especially beneficial for adolescents with high levels of interpersonal conflict with parents, high levels of depressive symptoms, and comorbid anxiety.²³ Family-focused interventions also have the advantage of approaching critical issues of the child's context, emerging as a promising strategy in recent years, especially in young children.⁵,²⁴

On the path to define the best treatment option for depression, the Improving the Mood with Psychoanalytic and Cognitive Therapies (IMPACT) trial is an ongoing study that is planned to recruit 540 individuals to compare effectiveness and define superiority in reducing relapse among three approaches, combined with the use of fluoxetine as needed: CBT, short term psychoanalytic therapy, and specialist clinical Therapy for Pediatric Clients With Mood Disorders Essay Paper

Children and adolescents appear to show a response pattern different from that observed in adults with respect to antidepressants - both in terms of efficacy and adverse effects (Table 1). Nonetheless, except for the use of lower initial doses to avoid side effects, the use of antidepressants in children and adolescents generally follows the same doses used in adults.Anxiety and mood disorders are among the most common disorders in children and adolescents. They presage later emotional difficulties and disabilities. An understanding of the disorders’ presentation, common contributing factors and methods of intervention will enable paediatricians and family doctors to provide optimal support to these children and their families. The present paper briefly reviews the epidemiology of anxiety and mood disorders in children and adolescents. Phenomenology is referred to according to the major diagnostic categories for anxiety and depression. Contributing factors, including genetic and environmental components and their possible interaction, are discussed. The management of the disorders, including common strategies for encouraging coping responses, stress reduction and medication, is also described.Therapy for Pediatric Clients With Mood Disorders Essay Paper

BP is a recurrent familial disorder that occurs in 1–3% of youth, particularly in adolescents. Except for subsyndromal BP, the prevalence of BP-I is similar across most countries. Due to the child’s immaturity, the presence of comorbid disorders, and divergent interpretations of manic symptomatology it is difficult to diagnose BP in youth. Youth with subsyndromal mania and family history of BP, are at high risk to develop BP-I and BP-II. Both the full and subsyndromal syndromal BP are associated with significant psychosocial difficulties and increased risk for use of substances, suicidality, legal problems, and services utilization.Therapy for Pediatric Clients With Mood Disorders Essay Paper

DSM-IV (5) criteria are the gold standard for diagnosis, but may be cumbersome in paediatric and primary care settings. DSM-PC (6) provides a simplified framework for assessing common anxiety and mood symptoms. Because anxiety and mood symptoms are common in children and adolescents, the assessment of impairment is most important. Even when a child does not meet symptom criteria, significant impairment may suggest the need for intervention (7). Most importantly, symptoms that interfere with a child’s attendance at school and the capacity to participate in normal peer activities, that consume inordinate amounts of time because of worry or performance of rituals, or that cause conflict within important relationships should be addressed. Suicidal risk is a key issue in the assessment of a child or adolescent with a mood disorder, but it is also important in the assessment of adolescents with severe anxiety that interferes with the ability to participate in normal activities, such as may occur with prolonged panic disorder or social phobia.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Young children with OCD may develop symptoms in conjunction with a streptococcal throat infection. The relationship between the infection and the onset of symptoms has suggested an autoimmune etiology that is now referred to as paediatric autoimmune neuropsychiatric disorder associated with streptococcal infection, for some cases. Throat swabs and monitoring for the presence of streptococcal infection may be useful. In more resistant cases, plasmapheresis and intravenous immunoglobulin have been used to reduce the severity of symptoms. The extent to which this proposed etiology is relevant in the majority of cases remains unclear (16,17).

The psychoeducation of a child and family about the genetic vulnerability and sensitivity of anxious children, and the exacerbation of symptoms through environmental stressors can help parents and their child to understand both the development of the child’s difficulties and how the proposed intervention will alleviate problems. Management includes impairment and risk assessment, as well as an assessment of the child and parents’ motivations for treatment, and the availability of different types of intervention. Several books that are available may provide parents with an understanding of and strategies for helping their anxious child (18,19).Therapy for Pediatric Clients With Mood Disorders Essay Paper

Depression, or major depressive disorder, is a mental health condition marked by an overwhelming feeling of sadness, isolation and despair that affects how a person thinks, feels and functions. The condition may significantly interfere with a person's daily life and may prompt thoughts of suicide. Depression isn't the same as sadness, loneliness or grief caused by a challenging life experience, such as the death of a loved one.

In 2015, an estimated 16.1 million U.S. adults (aged 18 or older), or 6.7 percent of the adult population, had at least one major depressive episode, or experienced depressive symptoms, in the past year, making this condition one of the most common mental disorders in the United States, according to the National Institute of Mental Health (NIMH).Therapy for Pediatric Clients With Mood Disorders Essay Paper

Depression can affect people of all ages, races and socioeconomic classes, and can strike at any time. The condition is found in twice as many women as men, according to the NIMH.

Impairment assessment should direct attention to the aspects of a disorder that require priority with respect to intervention. Refusal to attend school by a separation anxious child suggests that a return to normal function in this domain should precede concern about sleepovers, camp, etc. Because conflict within the family is a common factor that contributes to a disorder but is also exacerbated by the disorder, addressing this factor is usually vital to the success of treatment. Sometimes, parental frustration with their sensitive child will diminish with an understanding of the child’s sensitive nature and support with respect to child management strategies (20).Therapy for Pediatric Clients With Mood Disorders Essay Paper

Risk assessment usually focuses on suicidal risk, but may also include an assessment of the risk of having a child develop further impairment if a condition is not addressed; for example, extreme social phobia that interferes with the child’s capacity to relate to peers. The assessment of suicidal risk includes whether the child has a suicide plan; the potential for the implementation of that plan, for example, the availability of firearms; the lethality of the plan; the extent to which the child feels hopeless about the situation; and the capacity of the family to provide support and ensure the safety of the child (9). When the severity of risk is unclear, sometimes asking the child what keeps him or her from acting on a plan can provide helpful clues as to protective factors that can be used in supporting the child during a crisis period.

An assessment of the motivation for treatment includes the assessment of which interventions are appropriate given the child and parents’ understanding of the problem. Some families will perceive the child’s behaviour as an extension of normal fears and worries, and may do best in interventions that emphasize learning improved coping strategies to deal with anxieties. In more severe situations, parents may see their child as being very disabled physiologically and believe that medication will be more helpful. Many parents wonder about an ‘underlying earlier and unexpressed trauma or fear’ that must be understood before the child can become less anxious. In such situations, it helps parents to understand that anxious symptoms are not usually related to a hidden trauma, but generally represent the reaction of a sensitive child who feels stressed in a current situation. Some parents tend to see their child as being largely oppositional and may need support to understand the anxiety that accompanies the oppositional behaviour.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Anxiety and mood disorders are among the more common emotional disorders in youth. Depending on the methods of case ascertainment used, anxiety disorders affect 5% to 15% of children and adolescents (for a recent review see Bernstein et al [1]). Although depression is less common in younger children, by adolescence it may affect about 10% to 15% of patients (2). Anxiety and mood disorders affect boys and girls more or less equally, but adolescent girls are much more vulnerable to depression than boys. Suicidal ideation is not uncommon in adolescents, affecting as much as 50% of youth. However, actual suicide attempts are less common and occur disproportionately more frequently in female adolescents than in male adolescents. Males, however, are more likely to complete suicide. Children and adolescents with anxiety or mood disorders are vulnerable to anxiety and mood disorders, as well as increased cardiac, and other somatic problems, in adulthood (3,4).Therapy for Pediatric Clients With Mood Disorders Essay Paper

BP disorder exists in youth, but it is difficult to diagnose. The recurrent nature and psychosocial morbidity associated with this illness during critical developmental stages calls for comprehensive longitudinal evaluation and accurate recognition and treatment because delays in treatment are associated with poor outcome.

Tom is a 12-year-old boy whose parents sought psychiatric consultation because he experienced a one-month episode of depression which improved without intervention. Thereafter, he became very happy and silly, talkative, energetic, and hypersexual. At the same time, he slept only for few hours at night, was unable to sit still in class, his self-esteem was elevated, or irritable. Due to recurrent disruptive behaviors, Tom was suspended from school. He responded readily to treatment with a second-generation antipsychotic and returned to his regular academic and social activities. Discontinuation of the medication resulted in a recurrence of the depressive and later on, manic symptoms. Tom resumed the same medication and began psychotherapy and he has been asymptomatic for one year.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Amy is a 9-year-old girl who for the last 2 years has been experiencing intermittent 2–3 day episodes of increased activity, silliness, poor concentration, increased creativeness and self-esteem, and lack of need for sleep without noticeable tiredness the next day. In addition, she has had periods lasting 3–5 weeks where she is more sullen, angry, sad, tired, tearful, distractible, and with less motivation and more defiant behaviors at home and at school. Amy was diagnosed with attention deficit hyperactive disorder (ADHD) and oppositional defiant disorder (ODD) and treated with individual and family psychotherapy and thereafter with stimulants, without response. After presenting to our clinic, it was decided to start psychotherapy and observe her mood using mood diaries and frequent communication with our clinic through visits, phone calls and emails. Six months later, it became clear that Amy was experiencing recurrent episodes of major depression that lasted between 3–8 weeks, interspersed with periods of normal mood or 3–4 days of hypomanic-like episodes. During the hypomanic episodes she was very fidgety, very happy and silly above what is expected for her age, disinhibited (talking to strangers, doing push-ups in the clinic’s waiting room), very talkative, disorganized, and with less need for sleep. While in this mood, Amy described herself as being “on fast-forward”. Treatment with mood stabilizers and psychotherapy resulted in normalization of her mood and behavior at school and at home.Therapy for Pediatric Clients With Mood Disorders Essay Paper

As reviewed in this article, there is growing literature showing that similar to the examples of Tom and Amy, there are children and adolescents with symptoms that suggest bipolar disorder (BP). In fact, several studies across the world have consistently reported that up to 60% of adult patients with BP report the onset of their mood symptoms before age 21 years old (e.g., Baldessarini, Bolzani, Cruz, Jones, Lai, Lepri, Perez, Salvatore, Tohen, Tondo, & Vieta, 2010; Chengappa, Kupfer, Frank, Houck, Grochocinski, Cluss, & Stapf, 2003; Goodwin & Jamison, 2007). Despite the above information and multiple studies that have shown that BP disorder can be reliably diagnosed in children and adolescents, the presence of BP in youth continues to be controversial and often discounted. Moreover, there are disagreements among clinicians within and among countries how to ascertain and interpret the symptoms of mania or hypomania in youth (Dubidka et al., 2008; Diler 2007; Diler & Birmaher 2012). The main goal of this article is to summarize the current literature and complexities in diagnosing BP in youth with special emphasis on the areas of controversy. Throughout this article, unless specified, the word youth denotes both, children and adolescents.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Children may have difficulty verbalizing their feelings or may even deny that they are depressed. Thus, special attention should be given to observable manifestations such as changes in sleep patterns, irritability, poor academic performance, and social withdrawal.¹³ For the longitudinal assessment of mood symptoms, it may be useful to adopt a mood diary or timelines, and use special dates like birthdays, holidays or school holidays as anchors. Mood is recorded ranging from very happy to very sad/angry; in addition, stressful events and possible treatments should also be registered. The use of timelines can be extremely valuable in identifying triggers, in assessing treatment response, and in the identification of possible manic or hypomanic episodes (especially in the differentiation of these in relation to return to euthymia) Therapy for Pediatric Clients With Mood Disorders Essay Paper

The diagnostic assessment of depressive disorders can make use of formal procedures such as structured/semi-structured interviews or rating scales. In addition to general interviews to assess mental disorders in childhood and adolescence (e.g., the Schedule for Affective Disorders and Schizophrenia for School-Age Children [K-SADS] and the Development and Well-Being Assessment [DAWBA]), specific instruments have been developed for the assessment of depressive symptoms in children and adolescents. Among the specific scales more frequently used worldwide and available in Brazilian versions are the Children's Depression Rating Scale (CDRS), the Children's Depression Inventory (CDI), and the Kutcher Adolescent Depression Scale (KADS).

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Several other problems in childhood and adolescence may present as depressive symptoms and should always be considered in the differential diagnosis: bereavement or adjustment disorders, oppositional defiant disorder, substance use disorders, hypothyroidism, anemia, infections, cancer, and autoimmune diseases. Conversely, one should remember that depression may end up not being diagnosed in cases where the chief complaint or reason for the consultation is physical symptoms, anxiety, school refusal, decline in academic performance, substance use or externalizing problems Therapy for Pediatric Clients With Mood Disorders Essay Paper

Depending on the clinical context, 40 to 90% of children and adolescents with depressive disorders have at least one psychiatric comorbidity, and 50% of young people have two or more concurrent diagnoses. Among the most prevalent comorbid diagnoses are anxiety disorders, followed by disruptive disorders, attention deficit disorder/hyperactivity (ADHD), and in adolescents, substance use disorders.¹³

One of the areas of greatest uncertainty in the evaluation of a first depressive episode in a child or adolescent is whether the episode is part of a unipolar or a BD. Some risk factors for BD may be useful in the diagnostic decision, although none of them has sufficient predictive power to differentiate both disorders: among them are a strong family history of BD or psychosis and a history of pharmacologically induced mania or hypomania.¹³Schizophrenia is another rare diagnosis in adolescence, but also a differential diagnosis to be considered, given that depressive symptoms may precede or accompany psychotic features.³ Another problematic area is the assessment of depressive symptoms in patients with intellectual disabilities or mental retardation. Because these individuals often present with symptoms on multiple domains, greater efforts are needed for the identification of mood symptoms in this high-risk population Therapy for Pediatric Clients With Mood Disorders Essay Paper

Similarly to what happens to adults, risk assessment is essential in children and adolescents with depression. Among young individuals, it is also important to differentiate suicidal from other self-injury behavior, in which the goal is to alleviate negative feelings. This type of behavior usually involves repetitive cuts, seeking more relief from anger, sadness or loneliness than the end of life.

Regarding suicide assessment, recent findings show that a 4-question screening instrument, the Ask Suicide-Screening Questions (ASQ), can identify the risk for suicide in patients presenting to pediatric emergency departments, with high sensitivity and negative predictive value. This new screening tool comprises questions assessing current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt, with a sensitivity of 96.9% (95% confidence interval [95%CI] 91.3-99.4) and a specificity of 87.6% (95%CI 84.0-90.5) Therapy for Pediatric Clients With Mood Disorders Essay Paper

Children and adolescents are frequently referred to psychiatric consultation due to mood complaints. Over the last decades, there has been an increase in the recognition of mood disorders among young individuals, a reflection of the adoption of a developmental perspective to psychopathology. Longitudinal studies clearly indicate mood disorders begin early in life, with the majority of first episodes occurring before adulthood.¹ Diagnostic criteria originally created for the adult population are also progressively being adapted to capture the specificities of depressive and maniac episodes in childhood and adolescence.Therapy for Pediatric Clients With Mood Disorders Essay Paper

This review will focus on the clinical aspects of the two major diagnostic categories of mood disorders: unipolar depression and bipolar disorder (BD). Together, they represent a large burden to young people worldwide, accounting for more than one-tenth of the global burden of disease among 10 to 24 year-olds.² Unipolar depression is the single most important source of disability (among all causes) for this age group, corresponding to 8.2% of the disability-adjusted life-years (DALYs); and BD is ranked fourth, with 3.8% of the DALYs. The impact of mood disorders on mortality is also marked. Suicide, one of the leading causes of death among young people, is associated with depression in at least half of the cases in adolescence.³ This effect is even more common in the pediatric bipolar population, with twice the number of suicide attempts in comparison with individuals with unipolar depression Therapy for Pediatric Clients With Mood Disorders Essay Paper

Data on the prevalence of depression in the first years of life are limited due to the scarcity of appropriate diagnostic criteria from a developmental point of view. Studies to date suggest a relatively low occurrence of depressive episodes in preschool children, affecting approximately 1 to 2.5% of this population, with no significant gender differences. Conversely, the estimates of unipolar depression prevalence up to the end of adolescence resemble those found in the adult population, with 4 to 9% of subjects presenting with a depressive episode in a 12-month period.⁵,⁶

During adolescence, the cumulative risk for the occurrence of a depressive episode rises from 5 to 20%.³,⁷ Many factors may explain this increase in the incidence of depression after puberty. Adolescence is a crucial developmental period, with the confluence of biological, psychological, and social changes that can predispose to the occurrence of mental disorders.⁸ With the onset of puberty, there is a rapid physical maturation process and cognitive growth (with increased capacity for abstract thinking and generalizations) as well as social and interpersonal transitions, with changes in the relationship with school, family, and peers Therapy for Pediatric Clients With Mood Disorders Essay Paper

One of the most consistent findings in the literature is the increase in the female/male ratio of individuals presenting with depression symptoms after puberty. This discrepancy has been shown not only in referred samples, but also in population-based studies, and thus is not likely to occur due to referral bias. Although the reasons for such difference are not completely understood, it is suggested that hormonal changes have a role in this phenomenon, acting more in order to increase the sensitivity to environmental stressors than actually causing depression per se.

A major risk factor for the development of depressive disorders is the high familial loading of depression.¹⁰Different types of investigation, such as adoption, twins or high-risk studies, corroborate the pivotal role of the familial component in the etiology of major depression, probably through gene-environment interactions.¹¹ As for the adult population, it is believed that the incidence and recurrence of depressive episodes can be mediated or moderated by stress factors such as losses, neglect or abuse, conflicts, and frustrations. However, the effects of such stressors seem to be mainly conditioned by the way the child interprets and deals with such adversities.Therapy for Pediatric Clients With Mood Disorders Essay Paper

The median duration of a major depressive episode in children and adolescents referred to treatment is approximately 8 months. Although the majority of patients recover from a first episode, data from clinical and community studies suggest probabilities of recurrence from 20 to 60% in the first 2 years after remission, reaching 70% after 5 years.¹²

Even though depressive symptoms can be understood as a continuum, a diagnostic decision is usually necessary to define the need for treatment. The American Association of Child and Adolescent Psychiatry recommends key screening questions for depression (sad or irritable mood and anhedonia) in every psychiatric evaluation.¹³

As with any assessment of children and adolescents, it is essential to establish a connection and a confidential relationship with the child or young person, and information gathering from the largest number of informants (child/adolescent, parents, school) is the best strategy to capture the underlying psychopathology. When there is need to prioritize one source of information, the literature seems to suggest that internalizing symptoms in general - and depressive symptoms particularly - tend to be more frequently reported by patients in comparison with caregivers or teachers.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Several lines of evidence point to the importance of including the family in the understanding, prevention, and treatment of depressive disorders. Unfortunately, the currently available diagnostic criteria neglect the importance of this issue.⁵ It is recommended that family assessment takes into account various sociocultural factors that may influence the presentation, description, and interpretation of symptoms, focusing not only on problems, but also including positive aspects, which could be essential in planning therapeutic approaches Therapy for Pediatric Clients With Mood Disorders Essay Paper

Despite the advances achieved with the adoption of operational classification systems (DSM and ICD), the difficulties in diagnosing depression in children and adolescents are higher than those found in older individuals. This is because the current diagnostic criteria were developed for the adult population, neglecting many of the developmental differences between children/adolescents and adults.

With regard to age differences, the only adaptations of the DSM-IV-TR for the diagnosis of a major depressive episode in children are inclusions of irritable mood as one possible cardinal symptom and of failure to make expected weight gain as a marker of appetite or weight change. Furthermore, the DSM-IV-TR also reduces from 2 to 1 year the minimum duration of symptoms required for characterizing a dysthymic disorder. ICD-10 has no adjustments related to developmental aspects. Figure 1 shows a suggestion of diagnostic algorithm for depressive episodes.

Chemical Structure
Citalopram is a chiral molecule and exists as two enantiomers; S-citalopram and R-citalopram. (Hall, 2001) They are optical isomers with the same molecular formula but are non-superimposable mirror images of each other. The drug is essentially a 50/50 racemic mixture containing both the R-citalopram and the S-citalopram. However, studies have shown that only the S enantiomer of Citalopram is responsible for the desired pharmacological effect (Rawe & May, 2009). This is because only this enantiomer can bind to the serotonin re-uptake channels due to its complementary shape.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Our pediatricians believe in taking care of not only children, but also the whole family and their needs. Plus, they’re specialists in the type of treatment everyone wants to receive: kindness. There are many different varieties of mood disorders however this paper is focused on cyclothymic and dysthymic disorders. Dysthymic mood disorder has long term effects where cyclothymic has short term effects. Mood disorders can happen to anyone at any time. It can be hereditary or simply caused by chronic stress. This paper will look at what each of these disorders are, how the come about, symptoms, and treatment. This paper will also talk about some case studies involved in each disorder to give examples of what it is like to live with a mood disorder. The entire scholarly journal authors used in this paper has a degree in phycology or education. Key Words: Dysthymic, Cyclothymic Therapy for Pediatric Clients With Mood Disorders Essay Paper

Tina is a 25 year old that lives a very happy productive life most of the time. She goes through highs where she is super happy and excited but that doesn’t last forever, she then goes into a depression where all she wants to do is stay at home and sleep. Tina doesn’t know what to do, she wants to be able to live her life to the fullest but unable to do so due to her constant misunderstood emotions.

Part of our commitment means making your visit as easy possible with the availability of same-day appointments and online scheduling, too. That way, both you and your child can feel better quicker.Therapy for Pediatric Clients With Mood Disorders Essay Paper

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During the 1980s, mental health professionals began to recognize symptoms of mood disorders in children and adolescents, as well as adults. However, children and adolescents do not necessarily have or exhibit the same symptoms as adults. It is more difficult to diagnose mood disorders in children, especially because children are not always able to express how they feel. Today, clinicians and researchers believe that mood disorders in children and adolescents remain one of the most underdiagnosed mental health problems. Mood disorders in adolescents also put them at risk for other conditions (most often anxiety disorder, disruptive behavior, and substance abuse disorders) that may persist long after the initial episodes of depression are resolved.Therapy for Pediatric Clients With Mood Disorders Essay Paper

What causes mood disorders?

What causes mood disorders in adolescents is not well known. There are chemicals in the brain that are responsible for positive moods. Other chemicals in the brain, called neurotransmitters, regulate the brain chemicals that affect mood. Mood disorders may be caused by a chemical imbalance in the brain, on its own or along with environmental factors, such as unexpected life events and/or chronic stress.

Mood disorders can run in families and are considered to be "multifactorially inherited," meaning that many factors are involved. The factors that produce the trait or condition are usually both genetic and environmental, involving a combination of genes from both parents. If a mother passes a mood disorder trait to her children, a daughter is more likely to have the disorder. If a father passes a mood disorder trait to his children, a son is more likely to have the disorder. Therapy for Pediatric Clients With Mood Disorders Essay Paper

Who is affected by mood disorders?

Anyone can feel sad or depressed at times. But mood disorders are more intense and difficult to manage than normal feelings of sadness. Children, adolescents, or adults who have a parent with a mood disorder have a greater chance of also having a mood disorder, although it is not a guarantee that this will happen. However, life events and stress can expose or exaggerate feelings of sadness or depression, making the feelings more difficult to manage.

Sometimes, life's problems can trigger depression. Being fired from a job, getting divorced, losing a loved one, death in the family, and financial trouble, to name a few, all can be difficult and coping with the pressure may be troublesome. These life events and stress can bring on feelings of sadness or depression or make a mood disorder harder to manage, depending on your coping skills and resiliency.

Females in the general population are 70% more likely to experience depression than males. Once a person in the family has this diagnosis, the chance for his or her siblings or children to have the same diagnosis is increased. In addition, relatives of people with depression are also at increased risk for bipolar disorder.Therapy for Pediatric Clients With Mood Disorders Essay Paper

The chance for bipolar disorder in males and females in the general population is about 2.6%. Once a person in the family has this diagnosis, the chance for his or her siblings or children to have the same diagnosis is increased. In addition, relatives of people with bipolar disorder are also at increased risk for other forms of depression.

What are the different types of mood disorders?

The following are the most common types of mood disorders experienced by children and adolescents:Therapy for Pediatric Clients With Mood Disorders Essay Paper

Major depression. A period of a depressed or irritable mood or a noticeable decrease in interest or pleasure in usual activities, along with other signs, lasting at least two weeks.
Persistent depressive disorder (dysthymia). A chronic, low-grade, depressed or irritable mood for at least 1 year.
Bipolar disorder. Manic episodes (period of persistently elevated mood), interspersed with depressed periods, or periods of flat or blunted emotional response.
Disruptive mood dysregulation disorder. A persistent irritability and extreme inability to control behavior exhibited in children under the age of 18.
Premenstrual dysmorphic disorder. This includes depressive symptoms, irritability, and tension before menstruation.
Mood disorder due to a general medical condition. Many medical illnesses (including cancer, injuries, infections, and chronic medical illnesses) can trigger symptoms of depression.Therapy for Pediatric Clients With Mood Disorders Essay Paper
Substance-induced mood disorder. Symptoms of depression that are due to the effects of medication or other forms of treatment, drug abuse, or exposure to toxins.

What are the symptoms of mood disorders?

Adolescents, depending on their age and the type of mood disorder present, may show different symptoms of depression. The following are the most common symptoms of a mood disorder. But each adolescent and adolescent may show symptoms differently. Symptoms may include:

Persistent feelings of sadness
Feeling hopeless or helpless
Having low self-esteem
Feeling inadequate
Excessive guilt
Feelings of wanting to die
Loss of interest in usual activities or activities once enjoyed
Difficulty with relationships
Sleep disturbances (for example, insomnia, or hypersomnia)
Changes in appetite or weight Therapy for Pediatric Clients With Mood Disorders Essay Paper
Decreased energy
Difficulty concentrating
A decrease in the ability to make decisions
Suicidal thoughts or attempts
Frequent physical complaints (for example, headache, stomachache, or fatigue)
Running away or threats of running away from home
Hypersensitivity to failure or rejection
Irritability, hostility, aggression

In mood disorders, these feelings appear more intense than adolescents normally feel from time to time. It is also of concern if these feelings continue over a period of time, or interfere with an adolescent's interest in being with friends or taking part in daily activities at home or school. Any adolescent who expresses thoughts of suicide should be evaluated immediately.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Other signs of possible mood disorders in adolescents may include:

Difficulty achieving in school
Constant anger
Rebellious behaviors
Trouble with family
Difficulty with friends and peers

The symptoms of mood disorders may resemble other conditions or psychiatric problems. Always consult your adolescent's health care provider for a diagnosis.

How are mood disorders diagnosed?

Mood disorders are real medical conditions. They are not something an adolescent will likely just "get over."

A child psychiatrist or other mental health professional usually diagnoses mood disorders following a comprehensive psychiatric evaluation. An evaluation of the adolescent's family, when possible, in addition to information provided by teachers and care providers may also be helpful in making a diagnosis.

Treatment for mood disorders

Specific treatment for mood disorders will be determined by your adolescent's health care provider based on:Therapy for Pediatric Clients With Mood Disorders Essay Paper

Your adolescent's age, overall health, and medical history
Extent of your adolescent's symptoms
Type of mood disorder
Your adolescent's tolerance for specific medications or therapies
Expectations for the course of the condition
Your opinion or preference

Mood disorders can often be effectively treated. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Treatment may include one, or more, of the following:

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Medications (especially when combined with psychotherapy has shown to be very effective in the treatment of mood disorders in children and teens)Therapy for Pediatric Clients With Mood Disorders Essay Paper
Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the adolescent (focused on changing the adolescent's distorted views of themselves and the environment around them; working through difficult relationships; identifying stressors in the adolescent's environment and how to avoid them)
Family therapy
Consultation with the adolescent's school

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. However, early detection and intervention can reduce the severity of symptoms, enhance the adolescent's normal growth and development, and improve the quality of life experienced by adolescents with mood disorders.

Mental health problems ranging from depression to bipolar disorder are known as mood disorders, or affective disorders. In any of these disorders, a serious change in mood shapes your child’s emotional state. Unlike a normal bad mood a child feels occasionally, a mood disorder involves thoughts and feelings that are intense, difficult to manage, and persistent. A mood disorder is a real medical condition, not something a child will likely just "get over” on his own.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Today, clinicians and researchers believe that mood disorders in children remain one of the most underdiagnosed health problems. Mood disorders that go undiagnosed can put kids at risk for other conditions, like disruptive behavior and substance use disorders, that remain after the mood disorder is treated. Children and teens with a mood disorder don’t always show the same symptoms as adults. So it can be difficult for parents to recognize a problem in their child, especially since he or she may not easily express his or her thoughts or feelings.

Bipolar disorder is a chronic, impairing disorder that is characterized by significant disturbance in mood, as well as grandiosity or unstable self-esteem, hypersexual behavior, a decreased need for sleep, poor judgment, racing thoughts, and pressured speech. Bipolar disorder is associated with substantial impairments, economic distress, chronic and debilitating medical conditions, and a 10 to 20 times increased risk for suicide.^1–3 Bipolar disorder is the 6^th leading cause of disability in adults⁴ and is associated with a 10 to 20 times increase in risk for suicide when compared to the general population in the United States Therapy for Pediatric Clients With Mood Disorders Essay Paper

Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute treatment, and maintenance treatment. These guidelines are not intended to serve as an absolute standard of medical or psychological care but rather to serve as clinically useful guidelines for evaluation and treatment that can be used in the care of children and adolescents with bipolar disorder. These guidelines are subject to change as our evidence base increases and practice patterns evolve.

Bipolar disorder in children is possible. It's most often diagnosed in older children and teenagers, but bipolar disorder can occur in children of any age. As in adults, bipolar disorder in children can cause mood swings from the highs of hyperactivity or euphoria (mania) to the lows of serious depression.Therapy for Pediatric Clients With Mood Disorders Essay Paper

The diagnosis of all mental disorders is largely based on a carefully taken history designed to bring out signs and symptoms that, when grouped together, constitute a recognizable syndrome. The problem of diagnosis in mental health arises from the remarkable overlap of symptoms among conditions. Our current method of naming mental disorders, the DSM-IV, has 295 separately named disorders but only 167 symptoms. Consequently, overlap and sharing of symptoms among disorders is common.

To complicate matters further, ADHD is highly comorbid; that is, it is commonly found co-existing with other mental and physical disorders. A recent review of adults at the time they were diagnosed with ADHD demonstrated that 42 percent also had another active major psychiatric disorder. Thirty-eight percent (in other words, virtually all of them) had two or more other mental disorders active at the time they were diagnosed with ADHD. Therefore, the diagnostic question is not, “Is it one or the other?” but rather “Is it both?”Therapy for Pediatric Clients With Mood Disorders Essay Paper

Perhaps the most difficult differential diagnosis to make is that of ADHD versus Bipolar Mood Disorder (BMD). Both of these disorders share primary features:

Mood instability
Bursts of energy and restlessness
Talkativeness
“Racing thoughts”
Impulsivity
Impatience
Impaired judgment
Irritability
A chronic course
Lifelong impairment
A strong genetic clustering

In adults the two disorders commonly occur together. Recent estimates find that 15 to 17 percent of persons with BMD also have ADHD. Conversely, 6 to 7 percent of people with ADHD also have BMD (10 times the prevalence found in the general population). Unless care is taken during the diagnostic assessment there is a substantial risk of either misdiagnosis or of a missed diagnosis. Nonetheless, a few key pieces of history can guide us to an accurate diagnosis.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Affective Disorders

Affect is a technical term that means the level or intensity of mood. By definition then an affective or mood disorder is a disorder of the level or intensity of an individual’s mood. The quality of mood (happy, sad, irritable, hopeless) is readily recognizable by everyone. What makes it a disorder are two other factors.

First, the moods are intense, either high energy (called mania) or low energy (depressed moods). Secondly, the moods take on a life of their own unrelated to the events of the person’s life and outside their conscious will and control. Although some environmental triggers have been identified for episodes of mood disorders, usually the abnormal moods gradually shift for no apparent reason over a period of days to weeks and persist for weeks to months. Commonly, there are periods of months to years during which the individual is essentially back to normal and experiences no impairment. Although we now are doing a much better job of recognizing that children can and do have all types of mood disorders, the majority of people develop their first episode of affective illness after the age of 18.Therapy for Pediatric Clients With Mood Disorders Essay Paper

This is a highly genetic neuro-psychiatric disorder characterized by high levels of inattention/distractibility and/or high impulsivity/physical restlessness that are significantly greater than would be expected in a person of similar age and developmental attainment. To make the diagnosis of ADHD this triad of distractibility, impulsivity and (sometimes) restlessness must be consistently present and impairing throughout the lifespan. ADHD is about ten times more common than bipolar mood disorder in the general population.

The two disorders can be distinguished from one another on the basis of six factors:Therapy for Pediatric Clients With Mood Disorders Essay Paper

1. Age of Onset: ADHD symptoms are present lifelong. The current nomenclature requires that the symptoms must be present (although not necessarily impairing) by seven years of age. BMD can be present in prepubertal children but this is so rare that some investigators say it does not occur.

2. Consistency of Impairment and Symptoms: ADHD is always present. BMD comes in episodes that ultimately remit to more or less normal mood levels.

3. Triggered Mood instability: People with ADHD are passionate people who have strong emotional reactions to the events of their lives. However, it is precisely this clear triggering of mood shifts that distinguishes ADHD from Bipolar mood shifts that come and go without any connection to life events. In addition, there is mood congruency in ADHD, that is, the mood reaction is appropriate in kind to the trigger. Happy events in the lives of ADHD individuals result in intensely happy and excited states of mood. Unhappy events and especially the experience of being rejected, criticized or teased elicit intense dysphoric states. This “rejection sensitive dysphoria” is one of the causes for the misdiagnosis of “borderline personality disorder”.Therapy for Pediatric Clients With Mood Disorders Essay Paper

4. Rapidity of Mood Shift: Because ADHD mood shifts are almost always triggered, the shifts themselves are often experienced as being instantaneous complete shifts from one state to another. Typically they are described as “crashes” or “snaps” which emphasize this sudden quality. By contrast, the untriggered mood shifts of BMD take hours or days to move from one state to another.

5. Duration of Mood Shifts: People with ADHD report that their moods shift rapidly according to what is going on in their lives. The response to severe losses and rejections may last weeks but typically mood shifts are much shorter and are usually measured in hours. The mood shifts of BMD are usually sustained. For instance, to get the designation of “rapid cycling” bipolar disorder the person need only experience four shifts of mood from high to low or low to high in a 12 month period of time. Many people with ADHD experience that many mood shifts in a single day.

6. Family History: Both disorders run in families but people with BMD usually have a family history of BMD while individuals with ADHD have a family tree with multiple cases of ADHD.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Treatment of combined ADHD and BMD

There is a grand total of three published articles about the treatment of people who have both ADHD and BMD. Despite this lack of published data the great number of patients involved and the high degree of impairment experienced by people with both disorders has lead their physicians to push the envelope of treatment. For the present, however, what follows must be viewed as anecdotal and experimental. Before embarking on any course of treatment a full exploration of the anticipated risks and benefits of that treatment must be done between the patient and his or her treating clinician.

My own experience with more than 40 patients and the similar experience of other practitioners is that co-existing ADHD and BMD can be treated very well and with extraordinarily good outcomes. The mood disorder MUST be stabilized first. This can be done with any of the standard mood stabilizing agents – lithium, valproic acid or carbamazepine. Mood stabilizers are necessary even when the bipolar patient is without symptoms between episodes of illness. Otherwise there is a significant risk of triggering a manic episode. Once the mood has stabilized and any psychotic level symptoms have resolved the first-line stimulant class of medications can be used without significant risk of triggering either a mania or a return of psychotic symptoms.Therapy for Pediatric Clients With Mood Disorders Essay Paper

There is one published article on the treatment of co-existing ADHD and cyclic mood disorders, mostly bipolar type 2. This research looked at the combination of mood stabilizers plus a second line medication for ADHD, bupropion (Wellbutrin; not FDA approved for the treatment of ADHD). This study also demonstrated the efficacy and safety of treating both disorders with medications initially thought to have the risk of making the bipolar worse. As with the first line stimulant medications, bupropion provided significant benefits for ADHD symptoms and significantly greater levels of mood stability.

The outcomes for my patients treated for both ADHD and BMD have thus far been good. No one has had to be re-hospitalized and all but 3 have been able to return to work. Perhaps more importantly, they report that they feel more “normal” in their moods and in their ability to fulfill their roles as spouses, parents, employees, and as productive human beings. It is impossible to determine at this early stage whether these significantly improved outcomes are due to enhancement of intrinsic mood stability or whether adequate treatment of the ADHD component makes medication compliance better. The key to these better outcomes, however, lies in the recognition that both diagnoses are present and that they will respond to independent but coordinated treatment.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Emotional upheaval and unruly behaviors are a normal part of childhood and the teen years, and in most cases they aren't a sign of a mental health problem that requires treatment. All kids have rough periods — it's normal to feel down, irritable, angry, hyperactive or rebellious at times. However, if your child's symptoms are severe, ongoing or causing significant problems, it may be more than just a phase.

Here are some signs and symptoms of bipolar disorder in children:

Severe mood swings that are different from their usual mood swings
Hyperactive, impulsive, aggressive or socially inappropriate behavior
Risky and reckless behaviors that are out of character, such as having frequent casual sex with many different partners (sexual promiscuity), alcohol or drug abuse, or wild spending sprees
Insomnia or significantly decreased need for sleep
Depressed or irritable mood most of the day, nearly every day during a depressive episode
Grandiose and inflated view of own capabilities
Suicidal thoughts or behaviors in older children and teens Therapy for Pediatric Clients With Mood Disorders Essay Paper

Children with bipolar disorder experience symptoms in distinct episodes. Between these episodes, children return to their usual behavior and mood.

Keep in mind, a number of other childhood disorders cause bipolar-like symptoms, including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, anxiety disorders and major depression. Diagnosis can be challenging because these and other mental health conditions often occur along with bipolar disorder.

If your child has serious mood swings, depression or behavior problems, consult a mental health provider who specializes in working with children and teens. Mood and behavior issues caused by bipolar disorder or other mental health conditions can lead to major difficulties. Early treatment can help prevent serious consequences and decrease the impact of mental health problems on your child as he or she gets older.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Prior to the mid 1990’s, bipolar disorder was rarely diagnosed in children and adolescents. Even on psychiatric inpatient units, which arguably provide treatment to the most acutely disruptive and affectively dysregulated youth, only 10% of child and adolescent discharges in the United States (US) in 1996 had a primary diagnosis of bipolar disorder.⁵ In the later part of the 1990’s, however, increased attention in the academic literature was directed towards bipolar disorder in children and adolescents. Beginning in 1995, articles began to appear in the academic literature that suggested bipolar disorder manifests differently in children than adults, and that it is often underrecognized and undertreated.^6–9 In 1997, the American Academy of Child and Adolescent Psychiatry released practice parameters for the treatment of bipolar disorder in children and adolescents.¹⁰ By 2004, the proportion of US inpatients discharged with a bipolar disorder diagnosis increased to 34.11% for children and 25.86% for adolescents.⁵ A similar trend was found in less acute treatment settings; outpatient visits with US physicians for pediatric bipolar disorder increased by 40-fold from 1994 to 2003 Therapy for Pediatric Clients With Mood Disorders Essay Paper

The increase in the diagnosis and treatment of pediatric bipolar disorder (PBD) has raised concerns of overdiagnosis of the disorder among children and adolescents, although some argue that it remains underdiagnosed.^12, 13 Concerns over the diagnosis of PBD stem from disagreements over what symptoms constitute PBD.^13, 14 Although no child-specific criteria for bipolar disorder are provided in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM),¹⁵ alterations from the standard criteria have been proposed.^6, 8, 16 For example, it has been proposed that bipolar disorder in children and adolescents is characterized by less clearly defined mood episodes, shorter duration of these episodes (e.g., ultradian cycling), and different hallmark symptoms (e.g., elevated mood vs. irritability) than in adults.¹⁶

The disagreements over what characterizes PBD typically fall into two camps: the “narrow” and “broad” phenotypes of PBD.¹⁷ The “narrow” phenotype is defined by recurrent episodes of major depression and mania, with manic symptoms including elated/expansive mood and grandiosity. Yet even a strict focus on manic symptoms as a sole indicator of PBD can be problematic. A recent study of youths with elevated symptoms of mania indicates that while these youths have an increased risk for PBD, 75% of them met diagnoses other than PBD (e.g., attention-deficit/hyperactivity disorder [ADHD], oppositional defiant disorder, conduct disorder).¹⁸ Indeed, the authors suggest that elevated mania may be a better indicator of severe psychopathology rather than a specific marker for PBD.Therapy for Pediatric Clients With Mood Disorders Essay Paper

The “broad” phenotype of PBD is characterized by chronic, severe mood dysregulation and hyperarousal.¹⁹ Although the mood states in the broad phenotype may evidence episodic variations, they are unlikely to be of the intensity or duration necessary to meet criteria for bipolar disorder (type I or II), as defined by the DSM-IV.¹⁵ Debate remains in the literature as to the inclusion of the “broad” phenotype in the bipolar spectrum (e.g. Bipolar Disorder Not Otherwise Specified) or as a distinct diagnostic category (e.g. Severe Mood Dysregulation or Temper Dysregulation Disorder with Dysphoria).^20, 21

Even assuming a consistent and agreed-upon definition of PBD, diagnosis remains challenging.^22, 23 Developmental differences can make the separation of normative behavior and the symptoms of bipolar disorder challenging. Further, the overlap of symptoms as well as the co-occurrence of bipolar disorder with other disorders (e.g., ADHD, disruptive behavior disorders) complicates differential diagnosis. Finally, the variability in symptom presentation across mood states can lead to misdiagnosis, especially when there is limited access to multiple reporters. For example, without an accurate report of current presentation and past history, bipolar symptoms may present as severe ADHD or major depressive disorder.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Mood stabilizers, such as lithium carbonate, sodium divalproex, and carbamazepine, have traditionally been the mainstays of treatment of patients with bipolar disorder. However, atypical antipsychotics are increasingly used in bipolar disorder, with or without psychotic symptoms. This class of medications includes asenapine, risperidone, quetiapine, olanzapine, aripiprazole, ziprasidone, and clozapine. In 2018, the FDA approved lurasidone for the treatment of major depressive episodes associated with bipolar I disorder in children and adolescents aged 10 to 17 years.^[63]Benzodiazepines may be used to improve sleep and to modulate agitation during hospitalization.

Bipolar disorder is a severe affective disorder which can present in adolescence, or sometimes earlier, and often requires a pharmacotherapeutic approach. The phenomenology of bipolar disorder in children and adolescents appears to differ from that of adult patients, prompting the need for specific pharmacotherapy guidelines for long-term management in this patient population. Current treatment guidelines were mainly developed based on evidence from studies in adult patients, highlighting the requirement for further research into the pharmacotherapy of children and adolescents with bipolar disorder. This review compares and critically analyzes the available guidelines, discussing the recommended medication classes, their mechanisms of action, side effect profiles and evidence base.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Although bipolar disorder more commonly develops in older teenagers and young adults, it can appear in children as young as 6. In recent years, it's become a controversial diagnosis. Some experts believe it is rare and being overdiagnosed; others think the opposite. At this point, it's hard to be sure just how common it is.

Another diagnosis, called Disruptive Mood Dysregulation Disorder (DMDD) also has been established to describe children ages 6-18 who have severe and persistent irritability and temper outbursts that don't meet conventional definitions of bipolar disorde

The mood disorders most likely to be experienced by children with ADHD include dysthymic disorder, major depressive disorder (MDD), and bipolar disorder. Dysthymic disorder can be characterized as a chronic low-grade depression, persistent irritability, and a state of demoralization, often with low self-esteem. Major depressive disorder is a more extreme form of depression that can occur in children with ADHD and even more frequently among adults with ADHD. Dysthymic disorder and MDD typically develop several years after a child is diagnosed with ADHD and, if left untreated, may worsen over time. Bipolar disorder is a severe mood disorder that has only recently been recognized as occurring in children. Unlike adults who experience distinct periods of elation and significant depression, children with bipolar disorder present a more complex disturbance of extreme emotional instability, behavioral difficulties, and social problems. There is significant overlap with symptoms of ADHD, and many children with bipolar disorder also qualify for a diagnosis of ADHD.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Medication can be an important and sometimes critical component of treating children and adolescents who have mood disorders. Psychiatrists at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone, provide medication consultations and treatment for children and adolescents with mood disorders and coexisting mental health conditions, such as anxiety disorders and attention deficit hyperactivity disorder. Sometimes, medication is combined with another form of treatment, such as psychotherapy.

Many parents have reservations about treating their children with medication. During a medication consultation, our clinicians meet with you to describe the different medications, how and when they are used, the benefits and potential side effects of each, and how long they may be needed. Parents have the opportunity to raise any questions or concerns with our specialists.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Our child and adolescent psychiatrists select the appropriate medication for your child and can help you and your child to manage any side effects. Your child’s psychiatrist regularly assesses how well the medication is working and whether any adjustments to the dosage or type of medication are necessary.

Among the most commonly prescribed pharmacological treatments for BD are lithium salts, most commonly lithium carbonate. A number of lithium salts are used medically as mood stabilizing drugs, and are commonly referred to simply as “lithium”. The mechanism of action of lithium is complex, and multi-faceted, as it acts by mimicking the role of various cations, entering cells and interfering with transmitter release, thereby inhibiting of a number of enzymes within signal transduction pathways. This is thought to decrease neuronal over-excitability, thus reducing the symptoms of mania [15]. Lithium has been used in the treatment of BD since the 1960s, and a large number of studies have demonstrated its superiority to placebo in long-term treatment of BD [16,17], in the prevention of relapses [17] and of acute manic episodes [18]. Lithium is currently the only drug used in the treatment of BD licensed in both the UK and USA for patients with a diagnosis of BD above 12 years of age. A limited number of double-blind randomized controlled trials have been carried out to assess the efficacy of lithium as a treatment for BD in children and adolescents. Most of these studies are however limited by small sample sizes and variability in diagnostic criteria. Despite these limitations, lithium remains the most widely investigated treatment for BD in this age group. Clinical research has shown that lithium has a number of significant adverse effects, for which patients should be monitored closely. These include tremor, weight gain and dehydration. It also has a relatively narrow therapeutic index and therefore precise dosing is required, alongside monitoring of blood lithium levels. NICE recommends that lithi Therapy for Pediatric Clients With Mood Disorders Essay Paper

The treatment and management of bipolar disorder are complicated. Hence, most children and adolescents with this diagnosis require referral to a psychiatrist specializing in their age group. In general, a team approach is used in the clinical setting because several factors need to be addressed, including medication, family issues, social and school functioning, and, when present, substance abuse.

In general, the treatment of bipolar disorder may be thought of as a 4-phase process: (1) evaluation and diagnosis of presenting symptoms, (2) acute care and crisis stabilization for psychosis or suicidal or homicidal ideas or acts, (3) movement toward full recovery from a depressed or manic state, and (4) attainment and maintenance of euthymia.

um should be used as a second-line agent in the long-term treatment of children and adolescents, whereas AACAP and the CABF guidelines suggest lithium as one of the possible first-line agents.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Bipolar disorder (BD), previously known as manic depression, is a complex psychiatric illness characterized by alternating episodes of mania and depression. Manic symptoms commonly include racing thoughts, delusions of self-grandeur, partaking in risky behaviors and reduced need for sleep. In contrast, during depressive periods, patients commonly experience reduced mood, changes in appetite, irritability and anhedonia. BD is considered to be one of the most disabling psychiatric disorders, associated with a suicide rate approximately 20–30 times that of the general population [1]. Overall lifetime prevalence is thought to be around 4% [2], with typical onset occurring during late adolescence or early adulthood. Prevalence of BD in children and adolescents alone is thought to be around 2% [3,4]; however there is controversy surrounding the diagnosis of BD in this patient population. Although there is no clear consensus as to how many types of BD exist even in adult patients, current classification systems acknowledge the existence of two BD subtypes [5]. BD type I is characterized by the presence of one or more manic episodes, whilst depressive or hypomanic episodes occur frequently but are not required for diagnosis. In BD type II there are no manic episodes, but one or more hypomanic episodes and one or more major depressive episodes. Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are not associated with psychotic features).Therapy for Pediatric Clients With Mood Disorders Essay Paper

The first controversial issue is about diagnostic criteria, as not all professionals agree on the usefulness of the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) [5]. Specifically, it has been suggested that symptoms of mania presenting in childhood are not easily distinguishable from those of attention deficit hyperactivity disorder (ADHD) and other neuropsychiatric disorders [6]. With regard to BD subtypes, there is reasonable agreement surrounding the diagnosis of BD type I in children and adolescents, however there is doubt concerning the validity of a broad diagnosis of bipolar spectrum disorder. In the United Kingdom (UK), the National Institute for Health and Care Excellence (NICE) [7] suggested that a broader bipolar diagnosis could be unreliable and therefore not useful. This is somewhat in contrast with the prevalent view in the United States, where other BD diagnoses, such as BD type II and BD-not otherwise specified, are widely accepted and in recent years there has seen a 40-fold increase [8]. The exact reason for this phenomenon is yet unknown; possible explanations include the wider application of the diagnostic criteria to children and adolescents, and previous under-diagnosis of the condition [9]. In the absence of accepted diagnostic criteria specific to children and adolescents, in pediatric practice BD is generally diagnosed based on adult criteria. In DSM-5, bipolar and related disorders are given a chapter on their own (between depressive disorders and schizophrenia spectrum disorders), where bipolar-like phenomena that do not fulfill the diagnostic criteria for BD type I, II or cyclothymic disorder (i.e., short-duration hypomanic episodes and major depressive episodes, hypomanic episodes with insufficient symptoms and major depressive episodes, hypomanic episode without prior major depressive episode, and short-duration cyclothymia) are summarized under the label “other specified bipolar and related disorders”. In this new edition of the DSM, the symptoms which have to be present to fulfill the formal criteria for a hypomanic or manic episode have been specified: While in the past only a distinct period of abnormally and persistently elevated, expansive or irritable mood was necessary, these symptoms now have to be present in association with persistently increased (goal-directed) activity or energy [10].Therapy for Pediatric Clients With Mood Disorders Essay Paper

Early-onset BD tends to be clinically more severe than later-onset forms and patients tend to have more frequent episodes [11]. Furthermore, mood swings and episodes of mixed mania and depression appear to be more frequent in younger patients [12]. Importantly, risk of suicide is also higher in early-onset BD [11]. Differences in BD phenomenology between children/adolescents and adult patients should therefore reflect in separate management guidelines for these two patient groups. Management of BC includes integrated behavioral and pharmacological treatment. The most commonly used behavioral therapies include targeted psychotherapy, family therapy, interpersonal and social rhythm therapy and group co-education, which have been shown to be effective, especially as an adjunct to pharmacological therapy [7,8]. This review will focus specifically on currently available guidelines for long-term pharmacological therapy of BD in children and adolescents.Therapy for Pediatric Clients With Mood Disorders Essay Paper

2. Pharmacological Therapies for BD in Children and Adolescent: Overview

There are four main classes of medications indicated for the management of BD in children and adolescents. These include mood stabilizers (primarily lithium), atypical antipsychotics, anticonvulsant drugs and antidepressants. The mechanisms of action along with guidelines for their use in children and adolescents will be reviewed separately for each class of medication. The treatment guidelines which will be discussed here include those published by the National Institute for Health and Care Excellence (NICE) [7], the American Academy for Child and Adolescent Psychiatry (AACAP) [3], and the Child and Adolescent Bipolar Foundation (CABF) [14] (Table 1). A further set of guidelines for the diagnosis and treatment of BD in adults have been compiled by the British Association of Psychopharmacology (BAP) [8]. However, although these guidelines contain information about the diagnosis of BD in children and adolescents, they do not make any specific recommendations regarding treatment of the disorder in this patient population, and therefore will not be discussed in this review.

Follow-up appointments initially occur weekly, during the period of time when symptoms are most intense and medication adjustments are being made. These appointments are then usually reduced to monthly visits and may eventually occur once every three months.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Medication for Major Depressive Disorder

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are the most common medications used to treat people with depression. They work by increasing the amount of a chemical messenger called serotonin in the brain.

Serotonin relays signals between the brain’s nerve cells, or neurons, to regulate mood, appetite, and sleep. Raising the level of serotonin helps neurons pass messages from one nerve cell to another. This may contribute to improved mood and reduced anxiety.

Several different SSRIs are available, and our child and adolescent psychiatrists select the most appropriate one for your child. The length of time a child takes a medication after his or her symptoms have resolved depends on many factors, including whether the child has had a previous episode of depression. Medication may be prescribed along with psychotherapy.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Medication for Persistent Depressive Disorder

As with major depressive disorder, treatment for persistent depressive disorder may involve medication, psychotherapy, or both. SSRIs and other types of antidepressant medication may be used in conjunction with evidence-based psychotherapy, such as cognitive behavioral therapy.

Medication for Bipolar Disorder

For children and teens with bipolar disorder, doctors may prescribe one of a variety of mood-stabilizing medications, including lithium, anticonvulsants, or antipsychotics. These medications help to balance the brain chemicals that regulate emotions. Occasionally, antianxiety medications may also be prescribed. The medications used are carefully tailored to your child’s symptoms.

Bipolar disorder affecting children and adolescents usually requires long-term management with medication, sometimes for life.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Medication for Disruptive Mood Dysregulation Disorder

Children with disruptive mood dysregulation disorder may be prescribed an antidepressant medication, as well as a combination of other classes of medications, including stimulants. These treatments can reduce impulsivity and temper outbursts and improve your child’s ability to focus, work, and learn.

extreme changes in mood, energy levels and behavior.

Symptoms can begin in early childhood but usually emerge in adolescence or adulthood. Until recently, young people were rarely diagnosed with this disorder. Yet up to one-third of the 3.4 million children and teens with depression in the United States may actually be experiencing the early onset of bipolar disorder, according to the American Academy of Child and Adolescent Psychiatry. Doctors now recognize and treat the disorder in young people, but it is still an under-recognized illness.Therapy for Pediatric Clients With Mood Disorders Essay Paper

Children with bipolar disorder usually alternate rapidly between extremely high moods (mania) and low moods (depression). These mood shifts can produce irritability with periods of wellness between episodes, or the young person may feel both extremes at the same time. Parents who have children with the disorder often describe them as unpredictable, alternating between aggressive or silly and withdrawn. Children with bipolar disorder are at a greater risk for anxiety disorders and attention-deficit hyperactivity disorder. These "co-occurring" disorders complicate diagnosis of bipolar disorder and contribute to the lack of recognition of the illness in children.

Bipolar disorder is a serious brain illness. It is also called manic-depressive illness or manic depression. Children with bipolar disorder go through unusual mood changes. Sometimes they feel very happy or “up,” and are much more energetic and active than usual, or than other kids their age. This is called a manic episode. Sometimes children with bipolar disorder feel very sad and “down,” and are much less active than usual. This is called depression or a depressive episode.The mainstay of treatment for bipolar disorder in children and adolescents is pharmacotherapy [1]. In addition, adjunctive psychotherapy is generally regarded as essential [2].Therapy for Pediatric Clients With Mood Disorders Essay Paper

Fewer studies have been conducted in pediatric bipolar patients than adult patients; thus, treatment is often based upon adult studies [3,4]. However, response to specific medications may differ between youth and adults.

Although pharmacotherapy is indicated for nearly all youth with bipolar disorder, approximately one-third of patients do not receive medications [5]. As an example, an eight-year prospective observational study enrolled youth with mania who were treated in the community (n = 115), and found that antimanic medications (antipsychotics, lithium, or anticonvulsants) were never prescribed to 37 percent [6].Therapy for Pediatric Clients With Mood Disorders Essay Paper

In addition, the wrong medication regimen is frequently administered to children and adolescents with bipolar disorder. A retrospective study found that among bipolar patients who were treated for mania with or without mixed features (n = 282), antidepressant monotherapy was prescribed for 24 percent [5].

This topic reviews the choice of treatment for pediatric bipolar disorder. Other aspects of pediatric bipolar disorder are discussed separately, including the general principles of using pharmacotherapy; efficacy, administration, and side effects of second-generation antipsychotics for mania; efficacy and core elements of adjunctive psychotherapy; assessment and diagnosis; and the epidemiology, clinical features, and course of illness:

Bipolar disorder is not the same as the normal ups and downs every kid goes through. Bipolar symptoms are more powerful than that. The mood swings are more extreme and are accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms are so strong, they can make it hard for a child to do well in school or get along with friends and family members. The illness can also be dangerous. Some young people with bipolar disorder try to hurt themselves or attempt suicide. Therapy for Pediatric Clients With Mood Disorders Essay Paper

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