Mood, Anxiety, & OCD

Major Depressive Disorder

• Episode of persistent feelings of sadness, emptiness, hopelessness, crankiness, or irritability

• Somatic and cognitive changes significantly affecting clients ability to function

• Without history of mania

• Must have 4 or more symptoms

  • Marked diminished interest/pleasure

  • Significant weight gain/loss or appetite

  • Difficulty/change in sleep habits

  • Excessive feelings of inappropriate guilt/worthlessness

  • Fatigue

  • Decreased ability to think/concentrate

  • Thoughts of death or SI

  • Observed feelings of restlessness or being in “slow motion”

Major Depressive Disorder Specifiers

• With Anxious Distress

  • 2 of 5 anxiety related symptoms present during a depressive episode (Higher anxiety = higher suicide risk, longer duration, poor treatment response)

• With Mixed Features

  • Manic episode and MD episode nearly every day for at least a week. 3 of 7 manic/hypomanic symptoms

• With Melancholic Features

  • 4 symptoms of a near-complete absence of capacity for pleasure are present.

• With Atypical Features

  • depressive episode improves in response to events and 2 of 4 symptoms are observed

• With Psychotic Features

  • Delusions &/ hallucinations

• With Catatonia

  • Neurogenic motor immobility & behavioral abnormality during most of Depressive Episode

• With Peripartum Onset

  • Major depressive episode occur during pregnancy or 4 weeks post delivery

• With Seasonal Pattern

  • Recurrent & regular episodes during a 2 year period over a particular time of year (fall/winter)

Persistent Depressive Disorder (PDD, previously Dysthymia)

• Depressed mood for most of the day for more days than not

• 2 of 6 symptoms

• Can be over years

• No thoughts of death, SI, or attempts

Premenstrual Dysphoric Disorder (PMDD)

Time and onset – 1 week prior to onset of menses

Assessment for Depression

• Children's Depression Inventory (CDI) (7-17)

• PHQ9 (ages 11+)

• RCADS (grades 3-12)

Treatment for Depression

• CBT

• Play Therapy

• Interpersonal Psychotherapy (IPT)

• Attachment-Based Family Therapy (ABFT)

Separation Anxiety Disorder

• present for at least 4 weeks in children 6 mo in adults,

  significant impairment and functioning

• Persistent and excessive fear or anxiety in response to separation from a person who is a major attachment figure (parent)

Selective mutism

failure to speak in specific social situations in which there is an expectation for speaking

Social Anxiety Disorder - Social Phobia

fear or anxiety in social situations in which they might be scrutinized

Agoraphobia

• fear of 2 or more types of situations

  • Public transportation

  • Open spaces

  • Enclosed spaces

  • Standing in line or crowd

  • Being outside of home alone

Specific Phobia

• excessive or marked fear regarding a specific object or situation

• Demonstrated by crying, tantrums, freezing, or clinging

• Fear or avoidance causes functional impairment in social, occupational, other areas

• Specifiers

  • Animal

  • Natural Environment

  • Blood-injection-injury

  • Situational

Panic Disorder

• recurrent & unexpected panic attacks accompanied by at least 4

  symptoms. Followed by 1 month or more of worry about future attacks.

  • Accelerated heart rate

  • Sweating

  • Trembling

  • Feeling short of breath

  • Feeling of choking, chest pain, nausea, dizziness, chilled/overheated, numbness

  • Feeling detached or losing control.

Generalized Anxiety Disorder

• excessive and numerous worries occurring most days

  within a 6 month or longer period

  • Restlessness

  • Being easily tired

  • Difficulty concentrating

  • Irritability

  • Muscle tension

  • Sleep disturbance

Anxiety Assessment Measures

• Multidimensional Anxiety Scale for Children (8-19 year old)

• RCADS (grades 3-12)

Anxiety Treatment

• CBT

• Play Therapy

• Parent Child Interventions

• Medication

OCD

• Obsessions of unwanted recurrent and persistent thoughts, urges, or images that continually intrude into consciousness causing anxiety & stress

• Compulsions behaviors or mental acts compelled to perform repeatedly in a stereotypical fashion

Body Dysmorphic Disorder

intrusive or unwanted, time consuming preoccupation with a perceived defect or flaw in physical appearance that others do not perceive.

Hoarding Disorder

excessive acquisition of and persistent difficulty discarding or parting with possessions, congested and cluttered active living areas, marked functional impairment.

Trichotillomania (hair pulling)

recurrent pulling out of one’s own hair, repeated attempts to reduce or stop hair pulling, significant impairment/distress

Excoriation (skin picking)

recurrent skin picking resulting in skin lesions, repeated attempts to reduce or stop, significant impairment/distress

Assessment Measures for OCD

• CY-BOCS or C-FOCI (11-17)

• FAS (Family accommodation scale)

• RCADS (grades 3-12)

• Observations

Treatment for OCD

• CBT

• Family Focused Therapy

• Medication