Mood disorders in children can include depressive disorders like major depressive disorder and persistent depressive disorder, as well as bipolar disorders. Depressive disorders are characterized by depressed mood and loss of interest, while bipolar disorder involves periods of mania or hypomania alternating with depression. Left untreated, childhood mood disorders can lead to risks like suicide, substance abuse, academic problems, and poor relationships. Treatment involves psychotherapy like CBT or medication like SSRIs and mood stabilizers, with close monitoring for side effects.

1. CHILDHOOD DEPRESSION AND BIPOLAR
DISORDER
By – Dr. Aftab Ahmad
Mod –Dr. V. R. Anand

2. QUESTIONS
1. Childhood Depression (2006) 10.

3. INTRODUCTION
Mood disorders are interrelated sets of psychiatric symptoms
characterized by a core deficit in emotional self-regulation.
Mood disorders have been divided into
1- depressive disorders
2- bipolar disorders

4. DEPRESSIVE DISORDERS
Depressive disorders are subdivided in-
1- Major depressive
2- Persistent depressive
3- Disruptive mood dysregulation disorder
4- Premenstrual dysphoric
5- Substance/medication induced disorder
6- Depressive disorder caused by another medical condition.

5. Major depressive disorder (MDD)
MDD is characterized by period of at least 2 wk in which
A) depressed or irritable mood
B) loss of interest or pleasure in almost all activities
That is present for most of the day, nearly every day

6. MDD
Major depression is associated with characteristic vegetative and
cognitive symptoms
A) disturbances in appetite, sleep, energy, and activity level.
B) impaired concentration
C) thoughts of worthlessness or guilt
D) suicidal thoughts or actions.

8. Persistent depressive disorder
(dysthymia)
It is characterized by depressed or irritable mood for at least 1 yr.
Associated with vegetative and cognitive symptoms but the cognitive
symptoms are less severe.
e.g low self-esteem rather than worthlessness
hopelessness rather than suicidality

10. Disruptive mood dysregulation disorder
(DMDD)
In this severe & persistent irritability or angry mood evident for at
least 12 mo in multiple settings (at home, at school, with peers)
This irritability is characterized by frequent and severe temper
outbursts(verbal or physical)

12. SEQUELAE
Approx. 60% of youths with MDD report thinking about suicide, and
30% actually attempt suicide.
Have high risk of
1- Substance abuse
2- Impaired family
3- Educational and occupational underachievement
4- Poor adjustment to life stressors

13. ETIOLOGY
Genetic studies shows that depressive disorders are hereditary
disease
The exact nature of genetic expression remains unclear.
Cerebral variations in structure and function (particularly
serotonergic) is responsible

14. RISK FACTORS
A) physical/sexual abuse,
B) neglect
C) chronic illness
D) school difficulties (bullying, academic failure)
E) social isolation
F) family or marital disharmony
G) divorce/separation
H) domestic violence

15. PROTECTIVE FACTORS
A) positive relationship with parents,
B) better family function,
C) closer parental supervision ,monitoring
D) a prosocial peer group,
E) higher IQ
F) greater educational aspirations.

16. MANAGEMENT
High risk children- First assessed by a pediatric practitioner for severity of
the symptoms, and functional impairment.
Mild symptoms (i.e with no suicidal tendency, psychosis, and drug abuse )
Guided self help - Provision of educational materials (e.g., pamphlets,
books, internet sites) and advice to parents about strengthening the parent-
child relationship.
Modifying adverse environment (e.g., taking action against bullying,
increasing opportunities for social interaction/support, protecting the child
from exposure to marital discord).

17. MANAGEMENT
For youth who do not respond in 4-8 wk of supportive psychotherapy,
or who exhibit moderate to severe, comorbid, or recurrent depression
or suicidality - assessment and treatment by a mental health clinician.
1. Specific manualized psychotherapies
(a) Cognitive Behaviour therapy (CBT)
(b) Interpersonal therapy
2. Pharmacotherapy

18. MANAGEMENT
Cognitive-behavioral therapy (CBT)- identifying and correcting
cognitive distortions that may lead to depressed mood & teaches
problem-solving, behavior activation, social communication, and
emotional regulation skills.
 Interpersonal therapy- enhancing interpersonal problem solving and
social communication to decrease interpersonal conflicts.
Each of these therapies typically involves approximately 8-12 weekly
visits.

19. MANAGEMENT
 Pharmacotherapy-
First line-SSRIs- fluoxetine and escitalopram, are approved by FDA for
the treatment of depression, and fluoxetine alone is approved for
preadolescents.
Alternative SSRI-sertraline or citalopram.

20. Evidence of treatment efficacy
Based on a large meta-analysis of RCTs, approx. 60% of youths with depression
respond to antidepressants (vs. 50% for placebo), yielding a number needed to
treat of 10, but only around 30% of medicated depressed youth experience
symptom remission.
Fluoxetine has greater efficacy, with a number needed to treat of 6.
Studies of other classes of antidepressant medications have not demonstrated
clear superiority over placebo.
The absolute risk for suicidal thoughts in youth with major depression
approximates 3% with antidepressant versus 2% with placebo.

21. BIPOLAR DISORDER
It includes
A) Bipolar I
B) Bipolar II
C) Cyclothymic
D) Specified/unspecified bipolar

23. MANIC EPISODE
A manic episode is characterized by_
1) a period of at least 1 wk in which there is an abnormally and
persistently elevated mood
2) abnormally and persistently increased goal-directed activity or
energy that is present for most of the day, nearly every day

24. HYPOMANIC EPISODE
A hypomanic episode is similar to a manic episode
1) But is briefer – at least 4 days
2) Less severe – causes less impairment in functioning,
- is not associated with psychosis
- and would not require hospitalization

25. BIPOLAR-I
The criteria must be met for at least 1 manic episode, and the
episode must not be better explained by a psychotic disorder.
The manic episode may have been preceded by and may be followed
by hypomanic or major depressive episodes.

26. BIPOLAR-II
Criteria must be met for at least 1 hypomanic episode and at least 1
major depressive episode.

27. CYCLOTHYMIC DISORDER
It is characterized by
1) Period of at least 1 yr
2) In which there are numerous periods with hypomanic and
depressive symptoms
3) Do not meet criteria for a hypomanic episode or a major
depressive episode

28. OTHER SPECIFIED/UNSPECIFIED BIPOLAR
DISORDERS
In these disorder
1) symptoms characteristic of a bipolar and related disorder are
present
2) cause distress or functional impairment,
3) but do not meet the full criteria for any of the disorders in this
diagnostic class.

29. SEQUELAE
a) Suicidal risk is 15 times that of the general population.
b) Substance abuse
c) Antisocial behaviour
d) Impaired academic performance
e) Impaired family and peer relationships
f) Poor adjustment to life stressors

30. TREATMENT
FDA approved drugs for the treatment of bipolar disorder
1- Lithium – age > 12 yr
2- Aripiprazole – age > 10 yr
3- Risperidone – age > 10 yr
4- Quetiapine – age > 10 yr, and
5- Olanzapine – age > 13 yr

31. MONITORING
1- Care should be taken to avoid unnecessary polypharmacy
2- Watch for side effects of the medications
3- Acute overdose of Litheum (level > 1.5 mEq/L) manifests with
A) neurologic symptoms (tremor, ataxia, nystagmus, hyperreflexia,
myoclonus, slurred speech, delirium, coma, seizures)
B) altered renal function

32. THANK YOU