7/6/2011
Riding the Rollercoaster: Mood Disorders 101
Suzanne Zinck, MD, FRCPC IWK Health Centre Dalhousie Department of Psychiatry
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Objectives Understand the basic causes and treatment of mood disorders Learn to recognize the signs of a mood disorder in your students and how you can help. Learn about how mood disorders can affect performance and some strategies to assist students with their learning as they recover from a mood disorder
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Major Depressive Episode DSM-IV-TR (2000)criteria requires 5 out of 9 signs or symptoms for a two week period Sadness or Irritability Decreased Interest Increased Guilt and/or Low Self-Esteem Self Esteem Decreased Energy Poor Concentration Low or high appetite with possible weight change Psychomotor (movement)changes Poor or increased need for Sleep Self-harm/suicide Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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SIGECAPSS SIG prescribe E energy CAPSS capsules
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Sleep Interest Guilt Energy Concentration Appetite Psychomotor changes Sad mood Suicide & self-harm Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Rates of Depression in Children General population: Pre-schoolers
0.3-0.9%*
School age
1.5-3% (boys > girls)
Adolescence Early teens For all syndromes Late teens Males Females
1-6% (girls > boys) 10% (girls>boys) 12% 21-24%
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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Duration of Depressive Disorders Mean durations: Major depressive episode (MDE): 8-13 months Dysthymia: 3 years Adjustment disorder (<6 months by definition)
69% will have MDE within 5 years of diagnosis with dysthymia 30-72% children with MDE will relapse within 5 years. Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
DSM-IV Mood Disorders Major Depression Dysthymia Adjustment disorder with depressed mood Bipolar I and II disorder Depression due to a general medical condition Substance-induced mood disorder Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Double Trouble: Comorbidity is Common 50% depressed will have another mental disorder Anxiety disorders – 34% (> in girls) Conduct disorder (law breaking) – 40% (> in boys) Oppositional defiant disorder (rule-breaking) Eating disorders Substance use ADHD ‘Bad’ or ‘Sad’? Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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Etiology: Causes Aplenty Interaction likely among genetic risk (heredity), inborn temperament, learned cognitive style, learned behaviours and various forms of stress. Likely multiple contributors as no single biological f t found factor f d in i all ll subgroups b off depressed d d adults d lt or youth Problems assessing causes versus consequences Which comes first? Detailed time course can tell.
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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Signs of Depressed Mood in the Classroom Decreased grades Sad face/tearfulness Appears tired Appears overwhelmed P Poor attendance d or lleaving i early l Cranky; giving attitude Late assignments Change in quality of work Social isolation: drops friends and activities Visible scars of self-harm Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Downward Spiral Depression affects thinking, action and self concept. Problems at school can lead to decreased self-esteem and conflict with parents. Theyy can withdraw from activities and p see friends less or lose friends. They can become targets of bullying due to sad or reserved behaviour. They may not know what is happening and become hopeless. This may lead to suicidal thoughts and acts of self-harm. Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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Risks of Untreated Depression Safety: self-harm or suicide Failing a grade Lose social supports Drug abuse Damage to family relationships Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Self-Harm and Suicide Rare event in the population but not among depressed youth. 50% of mood disordered youth have ideas/plans Up to 15% lifetime completion risk depending on co morbidity. co-morbidity Youth who talk about it still at risk Cutting/burning never simply a â&#x20AC;&#x153;gestureâ&#x20AC;? Asking decreases risk not increases it. Call parent or GC right away if suspect suicidal.
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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I Think Sheâ&#x20AC;&#x2122;s Depressed. What Now? Ask student, confidentially, caring. Explain limits of confidentiality. Expect stigma and irritability: donâ&#x20AC;&#x2122;t give up. Speak p to gguidance counselor/Teen Health Let student know about next steps Call parent: check-in; provide referral info. Invite parent to school meeting if needed Consider & discuss adaptations in class Encourage activities with adaptations Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Getting Teens to Further Help Public & private options: depends on ability to pay or insurance coverage: IWK Central Referral (902) 464-4110 MHMCT (Mobile Crisis Team) (902) 429-8167 Local Mental Health clinics outside HRM Parent can refer to private psychologist or social worker. Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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Treatment Alone or in combination: Skills-based psychotherapy Medication (antidepressants) Parent and teen education Liaison with teachers, GC and VP of school School meetings Increase or resume positive activities Level of treatment by severity & risk Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
Assisting in the School Ensure confidentiality Longer time for assignments and projects Deferred or alternate exams Encouragement g Matter-of-fact acceptance Classroom education independent of event Call parents as needed about attendance, performance. Let therapist or psychiatrist know if permitted Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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QUESTIONS
“CHILDREN DO WELL IF THEY CAN. IF THEY CAN’T, WE AS ADULTS NEED TO FIGURE OUT HOW WE CAN HELP” (Ross Greene)
Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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