Integrating Treatment and Education for Mood Disorders: An Adolescent Case Report

Abstract

This case study illustrates one successful outcome of an intensive, outpatient, treatment project for adolescents with mood disorders. An 18-year-old female with symptoms across several DSM-IV Axis I classifications, including a depressive disorder, and her parents participated in a year-long, multimodal intervention that included mood-focused psychoeducation and coaching designed to impact on her, her family, school, and community systems. Self-report, clinician-driven, and ecologically valid measures were used to assess treatment effects on psychiatric symptoms and psychosocial functioning. Results on the Child and Adolescent Functional Assessment Scale demonstrated considerable gains in the following areas: Home, school/work, social behavior, self-harm, thinking/communication, and substance use. During the intervention, she went from failing several of her classes to graduating from high school. In addition, she made the Honours’ List in her first semester at a local community college. A discussion of intervention pluses and pitfalls specific to the case highlight the necessity to influence the various spheres of the young person’s life.

Keywords

adolescence mood disorder multimodal approach outpatient treatment

Get full access to this article

View all access options for this article.

References

Beck, A. T. , Steer, R. A. , & Brown, G. K. (1996). Beck Depression Inventory (2nd ed.). San Antonio, TX: Psychological Corporation .

Bernstein, D. P. , & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report (CTQ). San Antonio, TX: Psychological Corporation .

Blair-West, G. W. , Cantor, C. H. , Mellsop, G. W. , & Eyeson-Annan, M. L. (1999). Lifetime suicide risk in major depression: Sex and age determinants . Journal of Affective Disorders, 55(2-3), 171-178 .

Cuijpers, P. (1998). A psychoeducational approach to the treatment of depression: A meta-analysis of Lewinsohn’s ‘Coping with Depression’ course . Behavior Therapy, 29(3), 521-533 .

de Wilde, E. J. , Kienhorst, I. , & Diekstra, R. (2001). Suicidal behaviour in adolescents. In I. M. Goodyer (Ed.), The depressed child and adolescent (pp. 267-291). New York: Cambridge University Press .

Dishion, T. J. , & Kavanagh, K. (2003). Intervening in adolescent problem behavior. New York: Guilford Press .

Epstein, M. H. , Kutash, K. , & Duchnowski, A. (1998). Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices. Austin, TX: PRO-ED .

Evans, M. E. , Armstrong, M. I. , & Kuppinger, A. D. (1996). Family-centered intensive case management: A step toward understanding individualized care . Journal of Child and Family Studies, 5(1), 55-65 .

Flisher, A. J. (1999). Mood disorder in suicidal children and adolescents: Recent developments . Journal of Child Psychology and Psychiatry and Allied Disciplines, 40(3), 315-324 .

10.

Greenfield, B. , Larson, C. , Hechtman, L. , Rousseau, C. , & Platt, R. (2002). A rapid-response outpatient model for reducing hospitalization rates among suicidal adolescents . Psychiatric Services, 53(12), 1574-1579 .

11.

Grundle, T. J. (2002). Wraparound care. In D. T. Marsh & M. A. Fristad (Eds.), Handbook of serious emotional disturbance in children and adolescents (pp. 323-333). New York: Wiley .

12.

Guy, W. (1976/2000). Clinical Global Impressions Scale [CGI]. In American Psychiatric Association Task Force for the Handbook of Psychiatric Measures (Ed.), Handbook of psychiatric measures (pp. 100-102). Washington, DC: American Psychiatric Association .

13.

Henggeler, S. W. , Rowland, M. D. , Pickrel, S. G. , Miller, S. L. , Cunningham, P. B. , Santos, A. B. , Schoenwald, S. K. , et al. (1997). Investigating family-based alternatives to institution-based mental health services for youth: Lessons learned from the pilot study of a randomized field trial . Journal of Clinical Child Psychology, 26(3), 226-233 .

14.

Henggeler, S. W. , Schoenwald, S. K. , Rowland, M. D. , & Cunningham, P. B. (2002). Serious emotional disturbance in children and adolescents: Multisystemic therapy. New York: Guilford Press .

15.

Hodges, K. (1994). Child and Adolescent Functional Assessment Scale. Ypsilanti, MI: Eastern Michigan University, Department of Psychology .

16.

Kaufman, J. , Birmaher, B. , Brent, D. , Rao, U. , Flynn, C. , Moreci, P. , Williamson, D. , & Ryan, N. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data . Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980-988 .

17.

Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press .

18.

Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder. New York: Guilford Press .

19.

Manzano, J. , & Salvador, A. (1993). Antecedents of severe affective (mood) disorders: Patients examined as children or adolescents and as adults . European Journal of Child and Adolescent Psychiatry: Acta Paedopsychiatrica, 56(1), 11-18 .

20.

March, J. S. (1997). Multidimensional Anxiety Scale for Children (MASC). Tonawanda Falls, NY: Multi Health Systems .

21.

National Institute of Mental Health [NIMH] . (1985). CGI (Clinical Global Impressions) Scale . Psychopharmacology Bullettin, 21, 839-843 .

22.

Overall, J. E. , & Pfefferbaum, B. (1982). The brief psychiatric rating scale for children . Psychopharmacology Bullettin, 18(2), 10-16 .

23.

Reynolds, W. M. (1987). Suicidal ideation questionnaire. Odessa, FL: Psychological Assessment Resources .

24.

Rothschild, L. , & Zimmerman, M. (2002). Personality disorders and the duration of depressive episode: A retrospective study . Journal of Personality Disorders, 16(4), 293-303 .

25.

Rushton, J. L. , Forcier, M. , & Schectman, R. M. (2002). Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health . Journal of the American Academy of Child and Adolescent Psychiatry, 41(2), 199-205 .

26.

Sorgi, P. , Ratey, J. J. , Knoedler, D. W. , & Markert, R. J. (1991). Rating aggression in the clinical setting: A retrospective adaptation of the Overt Aggression Scale - Preliminary results . Journal of Neuropsychiatry and Clinical Neurosciences, 3(2), S52-S56 .

27.

Spielberger, C. D. (1999). State-Trait Anger Expression Inventory - 2. Lutz, FL: Psychological Assessment Resources Inc.

28.

Tarter, R. E. , Mezzich, A. C. , Hsieh, Y. , & Parks, S. M. (1995). Cognitive capacity in female adolescent substance abusers . Drug and Alcohol Dependence, 39(1), 15-21 .

29.

U. S. Public Health Service . (2000). Report of the Surgeon General’s conference on children’s mental health: A national action agenda. Washington, DC: Department of Health and Human Services .

30.

Woodcock, R. W. , McGrew, K. S. , & Mather, N. (2001). Woodcock Johnson - III tests of cognitive abilities. Itasca, IL: Riverside Publishing .

31.

Young, R. C. , Biggs, J. T. , Ziegler, V. E. , & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity . British Journal of Psychiatry, 133, 429-435 .