Week 5: Mood and Anxiety Disorders in Children and Adolescents
School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping.
—Madison, age 16
Mood and anxiety disorders can be particularly challenging to address in childhood and adolescence for many reasons. Children may not be able to fully express or understand their feelings and behaviors. Parents may misattribute or not recognize signs and symptoms. The symptoms of disorders also vary when present in children as opposed to adults. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies with both individual and family therapy to optimize treatment outcomes.
Learning Objectives
Students will:
Explain signs and symptoms of mood and anxiety disorders in children and adolescents
Explain the pathophysiology of mood and anxiety disorders in children and adolescents
Explain diagnosis and treatment methods for mood and anxiety disorders in children and adolescents
Develop patient education materials for mood and anxiety disorders in children and adolescents
Learning Resources
Required Readings (click to expand/reduce)
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
Chapter 3, “Common Clinical Concerns”
Chapter 7, “A Brief Version of DSM-5″
Chapter 8, “A stepwise approach to Differential Diagnosis”
Chapter 10, “Selected DSM-5 Assessment Measures”
Chapter 11, “Rating Scales and Alternative Diagnostic Systems”
Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). The patient education materials assessment tool (PEMAT) and user’s guide. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
Chapter 60, “Anxiety Disorders”
Chapter 61, “Obsessive Compulsive Disorder”
Chapter 62, “Bipolar Disorder in Childhood”
Chapter 63, “Depressive Disorders in Childhood and Adolescence”
Required Media (click to expand/reduce)
Center for Rural Health. (2020, May 18). Disruptive mood dysregulation disorder & childhood bipolar disorder [Video]. YouTube. https://youtu.be/tSfYXkst1vM
Mood Disorders Association of BC. (2014, November 20). Children in depression [Video]. YouTube. https://youtu.be/Qg-BBKB1nJc
Psych Hub Education. (2020, January 7). LGBTQ youth: Learning to listen. [Video]. YouTube. https://www.youtube.com/watch?v=Wn4AVjMMYX4
Medication Review
Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.
Bipolar depression Bipolar disorder
lurasidone (age 10–17)
olanzapine-fluoxetine combination (age 10–17) aripiprazole (age 10–17)
asenapine (for mania or mixed episodes, age 10–17)
lithium (for mania, age 12–17)
olanzapine (age 13–17)
quetiapine (age 10–17)
risperidone (age 10–17)
Generalized anxiety disorder Depression
duloxetine (age 7–17) escitalopram (age 12–17)
fluoxetine (age 8–17)
Obsessive-compulsive disorder
clomipramine (age 10–17)
fluoxetine (age 7–17)
fluvoxamine (age 8–17)
sertraline (age 6–17)
Assignment: Patient Education for Children and Adolescents
Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.
Photo Credit: Getty Images
For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers.
To Prepare
By Day 1, your Instructor will assign a mood or anxiety disorder diagnosis for you to use for this Assignment.
Research signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
The Assignment
In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
Although you are not required to respond to colleagues, collegial discussion is welcome.
By Day 7 of Week 5
Submit your Assignment.
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Patient Education for Children and Adolescents
Student’s Name
Institutional Affiliation
Course
Professor’s Name
Date
Patient Education for Children and Adolescents
Symptoms of DMDD
Disruptive Mood Dysregulation Disorder (DMDD) is a childhood condition characterized by severe anger, persistent irritability, and frequent temper outbursts. The symptoms include frequent verbal and behavioral temper, such as a minimum of three times a week (Bruno et al., 2019). Children can experience outbursts for a minimum of 12 months and an angry mood every day. Patients with DMDD have trouble performing daily activities at school, at home, and with peers (Bruno et al., 2019). Healthcare workers diagnose the condition by reviewing the past behavior of a child.
Pharmacological Treatments
Psychiatrists may prescribe antipsychotics, stimulants, antidepressants, and mood stabilizers to treat the disease. Antidepressants are effective in treating irritability conditions such as DMDD (Benarous et al., 2020). Risperidone is one of the Food and Drug Administration-approved drugs used in the treatment of the condition. In some cases, practitioners may avoid prescribing antidepressants or stimulants for fear that they will trigger mania symptoms (Benarous et al., 2020). Practitioners may avoid stimulants for individuals with heart conditions.
Nonpharmacological Treatments
Practitioners can use nonpharmacological treatments such as behavioral therapy to help patients learn to control their emotions. Cognitive behavior therapy is effective psychotherapy that is effective in teaching children how to deal with feelings and emotions (Benarous et al., 2020). The therapy helps the children to increase tolerance to frustration or anger. CBT helps the children to learn how to cope and alter perceptions that lead to outbursts.
Parent training is effective since it helps the parents learn how to interact with children to reduce the chances of aggression (Vidal‐Ribas et al., 2018). It helps parents to anticipate behavior or activities that may lead to outbursts. Anticipating the situations helps them to prevent or cope with the outbursts when they occur.
Evidence-based practice shows that computer-based training effectively alters a child’s behavior with DMDD (Vidal‐Ribas et al., 2018). The program changes the behavior of a child with severe irritability.
Community Resources
Medication guides are available to help parents to decide the form of treatment for their ailing children. Bullying awareness and outreach community programs are intended to empower the community or peers to avoid triggering other children’s aggression (Bruno et al., 2019). Children with DMDD may require support groups to share experiences and regulate behavior.
Referrals
Referrals are essential in the treatment of DMDD since the provision of care is diverse. A psychiatrist can refer a patient to a counselor for psychotherapy. Healthcare workers can refer a child to a mental healthcare professional in a hospital setting or school environment (Vidal‐Ribas et al., 2018). Social workers who interact with children can be essential referrals in the healthcare provision team.
Referrals
Benarous, X., Renaud, J., Breton, J. J., Cohen, D., Labelle, R., & Guilé, J. M. (2020). Are youths with disruptive mood dysregulation disorder different from youths with major depressive disorder or persistent depressive disorder?. Journal of Affective Disorders, 265, 207-215.
Bruno, A., Celebre, L., Torre, G., Pandolfo, G., Mento, C., Cedro, C., … & Muscatello, M. R. A. (2019). Focus on Disruptive Mood Dysregulation Disorder: A review of the literature. Psychiatry Research, 279, 323-330.
Vidal‐Ribas, P., Brotman, M. A., Salum, G. A., Kaiser, A., Meffert, L., Pine, D. S., … & Stringaris, A. (2018). Deficits in emotion recognition are associated with depressive symptoms in youth with disruptive mood dysregulation disorder. Depression and Anxiety, 35(12), 1207-1217.
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