BD GL based on 2005 workgroup and 2007 AACAP GL

Question 1

most common type of BAD?

Answer 1

NOS

subthreshold

Question 2

discuss pediatric BD as a diagnosis

Answer 2

validity not clear
use 2 week diary prior to eval
older adol with full criteria tend to persist
younger with partial criteria tend to have personality disorders later
epidemiologically there is a problem cuz child and lifetime prevalence are the same 1% and this does not make sense
only 0.1% had mania

Question 3

BAD acute medication?

Answer 3

both GL say: Li, epival or AA
2005 says if psychotic features, give AA as part of a combo
(differs from adult, would not do this)
2005 chooses wt neutral 1st
2007 says epival most studied
depends on sx and SE
better to go with FDA, most studied: Li
Li also studied in SUD -good
clozapine is option
ECT for adol

Question 4

BAD therapy

Answer 4

CBT and IPT work for youth with unipolar dep

Milkowitz adapted famliy therapy and family focused CBT: good
as well as adult rec: psycho ed IPSRT…

Question 5

genetic risk if 1st degree relative has BD?

Answer 5

5 times

also have other things:mood, anxiety, ADHDH

Question 6

rate of BAD later in youth with MDE

Answer 6

20%

Question 7

factors predicting BAD in a depressed youth

Answer 7

family Hx of mood DO especially BAD
Hx of switch on meds
Depression with PMR, rapid onset, psychotic features

Question 8

BAD mainenance

Answer 8

stay on what stabilized youth
even if combo
high chance of relapse if simplify back to mono
hard to reat
if stable for 2 yrs after 1 episode consider stopping if ptn wants
90% chance of relapse
vs 40% on meds

Question 9

BAD and ADHD

Answer 9

most with BAD have ADHD
opposite not true
can treat with stimulants safely
Strattera has a switch risk
they respond as well as ADHD lone