Assessing and Treating Pediatric Clients With Mood Disorders

Assessing and Treating Pediatric Clients With Mood Disorders Week 2: Therapy for Pediatric Clients With Mood Disorders

Psychopharmacological Approach to Treat Psychopathology

The incidence of , including pediatric depression, is increasing dramatically in the United States. This trend is associated with genetic factor, which significantly increases the risk of depression in various age brackets, including children (Shadrina et al., 2020). Therefore, the risk of becoming depressed is 4 times higher among children of depressed parents compared to healthy parents. Hence, mental health providers should focus on diagnosing MDD in children and developing the most appropriate pharmacological treatment to meet the healthcare needs of an individual patient. In the provided case study, the client is an African American 8yo male whose mother accompanies him to ER. He is portraying depressive symptoms. The client reports feeling “sad.” His mother reveals that the teacher’s report indicated withdrawing from his peers in class. The mother added that she had noticed decreased appetite and becoming irritated occasionally. The client was referred to a psychiatrist for further evaluation. Upon conducting a mental status exam, the Psychiatric Nurse Practitioner reported that the client is alert and oriented X 3. His speech is clear. He is coherent, spontaneous, and goal-directed. His self-reported mood is “sad” with a blunt affect. However, the client smiled appropriately during the clinical interview. He denies auditory or hallucinations. Additionally, the psychiatric nurse practitioner does not notice paranoid or delusional thought processes. The client appears to be age-appropriate with clear judgment and insight. He denies suicidal ideation or thoughts. Nonetheless, the client reports thinking about himself being dead and the feeling of being dead. Upon administering the Children’s Depression Rating Scale, the client’s score was 30, portraying significant depression. This paper presents three pharmacological interventions for managing and treating a client’s depressive symptoms, considering the patient’s pharmacokinetics and pharmacodynamics processes.

Mood disorders can impact every aspect of a child’s life, making it difficult for clients and their families to complete even the most basic tasks. This was Kara’s situation, a 13-year-old who was struggling at home and at school. Kara struggled with sleep problems, inappropriate behavior, impulsivity, temper tantrums, and other issues for over 8 years. If you work as a psychiatric mental health nurse practitioner with children, you must be able to determine whether their symptoms are the result of psychological, social, or underlying growth and development issues. You must then be able to suggest appropriate treatments.

This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with . You also consider ethical and legal implications of these therapies.

: Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

An African American Child Suffering From Depression

Also Check Out:

You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

RESOURCES

§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point OneSelect what you should do:

Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID

Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

According to the National Institution of Mental Health, approximately 9% of children and adolescents from age 12 years to age 17 years, are diagnosed with depression each year (Lamy & Erickson, 2018). Despite the negative impact of depression on the patient’s life, only a few individuals seek medical attention, which worsens the condition in the majority of the population. However, thanks to evidence-based practice for the current pharmacological and psychotherapeutic interventions available in the management of depressive disorders among children and adolescents (Bitsko et al., 2022). The purpose of this discussion is to illustrate the clinical decision-making on the most appropriate drug of choice for the treatment of an African American male patient with depression based on pharmacodynamic and pharmacokinetic factors.

Summary of the Case

The assigned case report illustrates an 8-year-old African American male with signs of depression. The patient reported to the ER accompanied by his mother with a chief complaint of feeling sad. Her mother reported that the patient is withdrawn from his peers in class. Additional reported symptoms include occasional periods of irritation and decreased appetite. The patient is however reported to have attained all the developmental landmarks appropriate for his age. He was referred to a PMHNP for psychiatric evaluation. A mental status exam was conducted which revealed a sad mood, and a history of suicidal ideation. No signs of visual or auditory hallucination, paranoia, or delusion were reported. The Children’s Depression Rating Scale (CDRS) was used for screening, where the patient recorded a score of 30 suggesting a diagnosis of major depressive disorder (MDD).

Other than the patient’s symptoms, CDRS scores of 30, and diagnosis of MDD, additional factors which might impact my decision making when deciding on which drugs to prescribe to the patient include his ethnicity as an African American race and his young age. For instance, symptomatic management of the patient will be based on selecting a drug that will be effective in alleviating the patient’s sad mood, loss of appetite, and withdrawal. The CDRS scores will be essential in monitoring the effectiveness of the medication, whereas the patient’s age and the race will be essential in determining the right choice of drug and dosage to promote safety and great tolerance.

Decision #1

Selected Decision and Rationale

            The selected decision is to initiate Zoloft 25mg once daily. This decision is supported by previous evidence which demonstrates great effectiveness in the use of selective serotonin reuptake inhibitors like Zoloft in the management of depression among children below the age of 18 years as reported by Mullen, (2018). The mode of action of this medication is through neuronal inhibition of serotonin (5HT) uptake in the central nervous system. The drug has a desirable safety profile, which led to its approval by the FDA for the management of depressive disorders among pediatric patients except for those with obsessive-compulsive disorder (Kupfer, 2022). However, due to the risks of suicidal ideation and suicidality among children, close monitoring of the patient and the use of low doses (25mg) are recommended (Baek et al., 2016). As stated by Lamy & Erickson, (2018) Zoloft undergoes first-pass metabolism in the liver, hence when administered in low doses, the patient will exhibit great tolerance and adherence with reduced risk of adverse effects.

Paxil could not be considered at this point, as studies show that the drug is associated with increased side effects and high risks of suicidality among children as compared to Zoloft (Hetrick et al., 2021). As such, the drug is only recommended when there is no other alternative for children above the age of 10 years (Fava & Papakostas, 2016). Wellbutrin is also not recommended for children below the age of 18 years due to its increased risk of seizure (Lamy & Erickson, 2018). As such, the drug is only recommended for use as send option, when the first drug is ineffective, or if the patient has depression with comorbid ADD (Seedat, 2014).

 

Expected Outcome

After 4 weeks of treatment therapy, the patient will exhibit more than 50% remission of depressive symptoms. His CDRS scores are expected to reduce to less than 20 (Mullen, 2018). He is also expected to be more joyful and engage with his peers appropriately within this time (Baek et al., 2016).

Ethical Consideration

            Since the patient is below the age of 18 years, her parents or caregivers have legal responsibilities for making decisions concerning his health (Hetrick et al., 2021). As such, the PMHNP must educate the patient’s parents on the diagnosis, and available treatment options before deciding on which drug to go with.

Question description

Link for the textbook below

Apa format. 3 academic references minimum but need 7 cited references total, no more than 5 years old

Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option) and why you did not choose the other options (I want you to defend your decision as if you were in open court). I would like 7 references cited with every assignment. I deduct 1 point per reference missing. Credible reference material only will be accepted. Sites such asWebMD and drugs.com (among others) will not be counted.

Examine Case Study: An African American Child Suffering From Depression from https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/02/mm/therapy_for_pediatric_clients_with_mood_disorders/index.html. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

• At each decision point stop to complete the following:
  • Decision #1
    • Which decision did you select? I chose Zoloft 25mg daily as the answer
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. (Remember, a total of 7 cited references is what I am looking for)

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The evaluation, diagnosis, and treatment of children with mood disorders can be extremely difficult. Adult patients with the same diseases may come with a distinct set of symptoms, but children’s bodies process drugs in a way that adults’ do not. Prescriptions for psychotropic drugs by psychiatric mental health nurse practitioners should be handled with caution because of this. This Assignment asks you to think about how you may assess and treat children with mood problems as you review this week’s Learning Resources.

There will be ten tasks based on interactive case studies with clients. You’ll have to make judgments about how to evaluate and treat clients for these jobs. Every action you take will have repercussions. Some of the ramifications will be inconsequential, while others could have a profound impact. The “correct” decision may not exist in every situation; in fact, it may not be possible to make one at all. However, you are expected to learn from each decision you make and display the capacity to assess risks and benefits in order to prescribe suitable therapies for your customers..

Learning Objectives

Students will:

• Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Reading

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter 6, “Mood Disorders”
• Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Review the following medications:

• amitriptyline
• bupropion
• citalopram
• clomipramine
• desipramine
• desvenlafaxine
• doxepin
• duloxetine
• escitalopram
• fluoxetine
• fluvoxamine

• imipramine
• ketamine
• mirtazapine
• nortriptyline
• paroxetine
• selegiline
• sertraline
• trazodone
• venlafaxine
• vilazodone
• vortioxetine

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171
Note: Retrieved from Walden Library databases.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655

Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497

Cases from Stephen Stahl’s suite- Discussions

This week’s assignment is a Decision Tree

To prepare for this Assignment:

• Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

At each decision point stop to complete the following:

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from peers in class
• Mother notes decreased appetite and occasional periods of irritation
• Client reached all developmental landmarks at appropriate ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation
• Client seen by Psychiatric Nurse Practitioner

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

RESOURCES: Assessing and Treating Pediatric Clients With Mood Disorders

• Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One

Select what the PMHNP should do:

Decision Point One

Select what the PMHNP should do:

• Begin Zoloft 25 mg orally daily
• Begin Paxil 10 mg orally daily
• Begin Wellbutrin 75 mg orally BID

Client returns to clinic in four weeks

No change in depressive symptoms at all

If Zoloft 25mg orally daily is chosen as decision one

Please include the reasons why not using the two medications as my decision one

Decision Point Two

Select what the PMHNP should do next:

• Increase dose to 37.5 mg orally daily
• Increase dose to 50 mg orally daily
• Change to Prozac 10 mg orally daily

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Depressive symptoms decrease by 20%. Client reports feeling a little bit better

Please include the reasons why not using the two medications as my decision one

Decision Point Three

Select what the PMHNP should do next:

• Maintain current dose
• Increase to 50 mg orally daily
• Change to a different SSRI
• Maintain current dose

Guidance to Student

At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a

significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.

Please include the reasons why not using the two medications as my decision one

Assessing and Treating Pediatric Clients With Mood Disorders Require readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 6, “Mood Disorders”

Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Note: Retrieved from Walden Library databases.

Assessing and Treating Pediatric Clients With Mood Disorders Required Media

Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.

Optional Resources

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655

Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497.

Depression in the elderly affects patients, families, and groups as a whole. Familiarity with inclining and hastening variables can aid in identifying patients who require screening with instruments such as the Geriatric Depression Scale (American Psychiatric Association, 2013). Following analysis, consistent development and dynamic drug administration are required to supplement treatment and reduce risk. The selection of a stimulant solution should be based on the best reaction profile and the lowest risk of medication interaction. If abatement is not achieved, additional medications, including different medications and psychotherapy, may be considered (Flint & Rifat, 2013). Electroconvulsive therapy is used in cases of severe, insane, or recalcitrant depression in the elderly. This paper examines the treatment options for a 31-year-old Hispanic man suffering from severe depression. To gain a better understanding of geriatric depression therapy, treatment decisions are evaluated and outcomes are compared.

Zoloft is a highly effective medication for the treatment of severe depression in adults. When the PMHNP administered the MADRS, the patient received a score of 51, indicating severe depression. Given the available antidepressants in this case, phenelzine is recommended for use in cases where other medications have failed (Stahl, 2014b). Effexor XL, on the other hand, can be used but has a number of potential side effects depending on the patient’s history and lifestyle. As a result, Zoloft is the best option.

Expected Outcomes

The action of Zoloft should be noticeable within the first two weeks, as this is the pharmaceutical expectation based on the drug’s experiments. When the patient returns for his two-week checkup, he should be able to sleep at night. When this drug is administered, the level of concentration should increase as well (Liu, Anderson, Mittmann, Axcell & Shear, 2015). It is also expected that the patient will be motivated to participate in normal activities and will interact well with others. The patient’s sense of being an outsider as a result of previous treatment should begin to fade.

Disparities between Expected and Actual Results

When the patient returned after four weeks, he reported a 25% reduction in symptoms. This is in line with the expectations. However, another unexpected outcome occurred: the patient was suffering from erectile dysfunction (Gaboda, Lucas, Siegel, Kalay & Crystal, 2014). This is a drug side effect that was not anticipated when the treatment plan was developed. Erectile dysfunction is one of the possible side effects of Zoloft, though it is not very common. The rest of the results followed the expected trend, despite the fact that the rate was slightly lower than expected.

Motive for Selection

The client’s depression symptoms had improved after taking Zoloft, but the same medication had caused erectile dysfunction. It is a good idea to continue taking Zoloft for depression relief and to combine it with another antidepressant that can treat erectile dysfunction. Wellbutrin is an antidepressant that can be used to help patients maintain normal erection function while receiving depression treatment (Flint & Rifat, 2013). In this case, the focus is not on treating Zoloft side effects, as this is not recommended, but on introducing an antidepressant and gradually withdrawing Zoloft, thereby correcting erectile dysfunction.

Expected Outcomes

When Wellbutrin is used as an augmentation agent, the patient’s symptoms should be significantly reduced. Because both Zoloft and Wellbutrin work to alleviate depression, the combined effect should be greater (Flint & Rifat, 2013). Furthermore, as a result of Wellbutrin’s action, the patient should experience normal erections. This should even improve and motivate the patient.

Disparities between Expected and Actual Results

After four weeks, the patient returned and stated that his depressive symptoms had improved even more. He also stated that the erection dysfunction was resolved. As the therapy was being administered, these two outcomes were expected. However, different than expected outcomes occurred (Gaboda, Lucas, Siegel, Kalay & Crystal, 2014). The patient was nervous and jittery. Both Zoloft and Wellbutrin, which are known to cause anxiety in some people, could have an effect on this. The type of dosage of the two drugs can sometimes cause jitteriness.

Motive for Selection

The only issue with the current therapy is jitteriness in the patient. Because the medication’s effect is as intended, it is not appropriate to change just because of a side effect. The immediate release of Wellbutrin may cause jitteriness. Changing the way Wellbutrin is administered may be the answer to jitteriness. Wellbutrin in its extended release form can help to alleviate depression and jitteriness. It is not appropriate to introduce a new drug to treat the side effects of another before attempting to modify the original drug’s dosage.

Expected Outcomes

Administration If the problem is the immediate release of Wellbutrin, the extended release form is expected to treat jitteriness. It is also expected that the patient’s depression reduction rate will continue to improve (Liu, Anderson, Mittmann, Axcell & Shear, 2015). The absence of jitteriness should give the patient confidence in the therapy and motivation to continue taking the medication. The patient’s ability to concentrate should improve dramatically. The patient should also have no trouble sleeping at night.

Disparities between Expected and Actual Results

The decision appears to be consistent with the standard approach to dealing with side effects of a patient’s therapy (Laureate Education, 2016g). It was suggested that rather than introducing another drug to treat the side effect, a drug’s administration method be modified in an attempt to handle the side effects (Liu, Anderson, Mittmann, Axcell & Shear, 2015). Because every drug has side effects, treating one may be just as effective as introducing another.

Adult antidepressant therapy is fraught with complications, as is any medication regimen. It entails taking risks because the drugs used in this therapy have numerous side effects. Some medications cause suicidal thoughts in patients (Flint, 2012). Some drugs may not be included in the therapy of certain patients based on the doctor’s evaluation of the patient. Some drugs may not be used in this case, particularly those that induce suicidal tendencies, because this patient is not interacting with people, which makes it risky.

Conclusion

Depression in the elderly is a noteworthy, normal, and developing issue that requires treatment. It has genuine ramifications for the patient, family, and group. Recognizable proof took after by a careful evaluation can help manage the determination of a proper upper prescription. There are a few variables to consider when choosing, altering, and changing antidepressants in the elderly. Together, these techniques can help advance the sheltered utilization of antidepressants in the elderly (Flint & Rifat, 2013). Other than medicines, different treatments for wretchedness that may be considered incorporate different types of psychotherapy and neurostimulation, with electroconvulsive treatment as yet being the highest quality level for extreme or crazy discouragement

Mood Disorders in Children and Adolescents” was presented at the Minnesota Psychological Association Friday Forum series on November 6, 2015. Dr. Leffler’s research focused on three main areas: improving diagnostic skills for diagnosing mood disorders in children and adolescents, implementing assessment strategies for identifying mood disorders in children and adolescents, and implementing treatment methods for children and adolescents with mood disorders.

Depression and bipolar spectrum disorder are two of the more severe forms of pediatric mood disorders. People with these illnesses suffer from difficulties in a wide range of areas, including relationships with others, communication patterns, academic and professional performance, involvement in families, and even suicidal ideation.

Increasing the ability to diagnose mental problems in children and adolescents. Correct identification of mood problems in children and adolescents is essential to guiding the most effective treatments.” When diagnosing mental disorder in children, comorbidity might make it more difficult to make an accurate diagnosis (Caron & Rutter, 1991). Mood disorders in children and teenagers are more difficult to diagnose because of the wide range of symptoms and stages of development that they might take (Mash & Barkley, 2007). All of the systems in which the person is embedded must be included in the evaluation process when evaluating how well they function and how they display symptoms over the course of their development (Leffler, Riebel, & Hughes, 2014).

Identification of mood disorders in children and adolescents using assessment strategies. There is enough time in diagnostic appointments for structured and semi-structured clinical interviews to be incorporated (Leffler et al., 2014). Information from these interviews, as well as limited or broad-band diagnostic assessments, can help clarify the diagnosis. A biopsychosocial history can be used in conjunction with the results of these procedures to better understand the client. According to an example of bipolar disorder, a client’s family history of bipolar disorder and their scores on a parent checklist might provide significant information about the risk for the disorder in this particular situation (Youngstrom & Youngstrom, 2005). When making a differential diagnosis of mania in children and adolescents, always consider the account of the parents as an informant and as a score on a rating scale. The Achenbach Child Behavior Checklist (CBCL) teacher report was found not to offer further information about bipolar diagnoses, and low scores on the CBCL can be definitive in most contexts for ruling out bipolar in most cases (Youngstrom & Youngstrom, 2005). In contrast, high scores on the CBCL Externalizing scale should prompt a more extensive evaluation.

Examples of narrow band measures for depression that were reviewed include the Children’s Depression Inventory (ages 7-17), the Reynolds Child Depression Scale (ages 8-12), the Reynolds Adolescent Depression Scale (ages 13-18), the Center for Epidemiological Studies Depression Scale for Children (ages 12-18), the Center for Epidemiological Studies Depression Scale (ages 14 and older), and the PHQ-9M (ages 11-17).  Narrow band measures of mania included the General Behavior Inventory (ages 11-17), the Parent General Behavior Inventory (ages 5-17), the Parent Young Mania Rating Scale (ages 11-17), and the Mood Disorder Questionnaire (ages 12-17).  Non-proprietary measures are also available and include those listed on the American Psychiatric Association Diagnostic and Statistical Manual fifth edition (DSM 5) assessment webpage ().  These include the PROMIS Emotional Distress—Depression—Parent Item Bank,

The Affective Reactivity Index (ARI) and adaptations of the Altman Self-Rating Mania Scale (ASRM). Versions for youth and parents are available.  Broad-band measures that were reviewed include the Behavior Assessment System for Children (BASC-2), the Child Behavior Checklist (CBCL), the Conner’s Comprehensive Rating Scales (CBRS), the Conner’s Rating Scales –Revised (CRS-R), and the Devereux Scales of Mental Disorders.

Applying treatment techniques for youth with mood disorders. Treatment interventions that are well-established and probably efficacious were reviewed for depression and bipolar disorder.  Well–established therapies for depression in children include cognitive behavioral therapy (CBT) provided in individual or group settings along with parent involvement.  Treatments for adolescents with depression include CBT offered in a group therapy format, and interpersonal psychotherapy (IPT) provided in an individual format.  Additionally, CBT with adolescents and parents and IPT- adolescents (IPT-A) are probably efficacious interventions (David-Ferndon, & Kaslow, 2008).  Probably efficacious treatments for child and adolescents with bipolar disorder include Family psychoeducation plus skill building (i.e., Multi-Family Psychoeducational Psychotherapy, Family-Focused Treatment) and cognitive-behavioral therapy (CBT; Fristad, MacPherson, 2014). Overall treatment approaches for depression and bipolar include cognitive behavioral therapy, interpersonal psychotherapy, and family based strategies.   Additionally, mindfulness and health and wellness techniques were reviewed.  A two-week integrated partial hospitalization program (PHP) for youth with mood disorders and their families was discussed.  Mayo Clinic’s Child and Adolescent Integrated Mood Program (CAIMP) integrates a family-based approach to treating complex mood disorders in a PHP setting.  Preliminary results of CAIMP suggest decreased inpatient psychiatric readmission for patients, decreased levels of youth depression, and improved functioning.

Jarrod M. Leffler, Ph.D., L.P., ABPP, is a diplomate of the American Board of Professional Psychology in the specialty of Clinical Child and Adolescent Psychology (ABCCAP).  He is the director of the Child and Adolescent Integrated Mood Program (CAIMP), the co-director of the Pediatric Mood Disorder Program, and director of the Pediatric Transitions Program (PTP). He is an Associate Professor, and faculty member of the Mayo Clinic Clinical Child Psychology Fellowship (Department of Psychiatry and Psychology) and Mayo Clinic Graduate School (Rochester, MN).  His research program focuses on the assessment and treatment of mood disorders in children and adolescents; clinical program development, implementation and evaluation; biological mechanisms of identifying mood disorders; and training of mental health professionals.  Dr. Leffler received his Doctorate in Psychology from Saint Louis University and completed his internship at Harvard Medical School and Children’s Hospital Boston before completing his Post-Doctoral Fellowship at The Ohio State University in Child and Adolescent Mood Disorders.

References

Caron C., & Rutter, M. (1991). Comorbidity in child psychopathology: concepts, issues and research strategies. Journal of Child Psychology and Psychiatry, 32(7): 1063-80.

David-Ferndon, C., & Kaslow, N.J., (2008).  Evidence-based psychosocial treatments for child and adolescent depression. Journal of Clinical Child Adolescent Psychology, 37(1): 62-104.

Fristad, M.A., & MacPherson, H.A. (2014). Evidence-based psychosocial treatments for child and adolescent bipolar spectrum disorders. Journal of Clinical Child and Adolescent Psychology, 43(3): 339-55.

Leffler, J.M., Riebel, J., & Hughes, H.M. (2014). A Review of Child and Adolescent Diagnostic Interviews for Clinical Practitioners. Assessment, 22(6): 690-703.

Mash, E.J., & Barkley, R. (2007).  Assessment of Childhood Disorders, Fourth Edition Eric J. Mash, Russell Barkley Editors. The Guilford Press: New York, NY.

Youngstrom, E.A., & Youngstrom, J.K. (2005). Evidence-based assessment of pediatric bipolar disorder, Part II: Incorporating information from behavior checklists. Journal of the American Academy Child Adolescent Psychiatry, 44(8): 823-8.