Bipolar 2nd half

Question 1

Common Comorbidities

Answer 1

Anxiety Disorders (Panic Attacks, Social

• Anxiety Disorder/Social Phobia, Specific Phobia)
• ADHD
• Oppositional Defiant Disorder
• Conduct Disorder
• Substance Use Disorder

Question 2

Assessment Considerations

Answer 2

Assessment is extremely important before beginning any treatment for bipolar disorder, as this disorder has a high treatment threshold

Difficult to diagnose in youth:

• Symptoms confused with other conditions such as ODD, ADHD, anxiety disorders
• If psychotic symptoms present, it can be misdiagnosed as schizophrenia

Multi-method, multi-source

• Need collateral informants as discrepancies between parent, youth, teacher can be common
• Parents are best raters of BPD (Youngstrom et al., 2006)

Purpose of assessment: assess risk, prognosis, severity, develop case conceptualization, and develop treatment plans

Family history of bipolar disorder (genetics & family environmental processes)

Ongoing assessment of mood & energy and relapse prevention

Question 3

Assessment Tools

Answer 3

Interview & Records Review

• Obtain history for child & family to assess risk, develop a case conceptualization & develop treatment
• Mental health history of parents
• Physical health of child
• Previous mental health services
• Description of symptom presentation
• Family strengths and weaknesses

Challenges to obtaining information

• Parent availability, reporter accuracy, & disclosure
• Parent mental health or family disruptions

Behavior Rating Checklists / Scales

• Screening, monitoring outcome, & may help to disentangle which behaviors are attributable to mood disorder vs. other contributing factors
• Parent report aids in differential diagnosis

Specific measures examples

• Child Behavior Checklist (CBCL)
• General Behavior Inventory (GBI)
• Mood Disorder Questionnaire (MDQ)
• BDI (Beck Depression Inventory)
• Young Mania Rating Scale (YMRS)

Diagnostic interviews

• Often used by clinicians to assess Bipolar Disorder
• Depends on validity of structured interviews
• Depends on training level of evaluator
• Administration time (1.5 - 6 hours)

Examples
K-SADS
Children’s Interview for Psychiatric Syndromes

Question 4

Empirically Supported Treatments

Answer 4

Psychoeducational Treatments

Cognitive-Behavioral Therapy

Interpersonal Therapy- like AA meetings all share same problem

Medication- effective when a biological etiology

Question 5

Family Focused Treatment (FFT)

Answer 5

For adolescents with bipolar disorder, adapted from FFT adults
Used as an adjunct to pharmacotherapy
Focused on the family
Improve caregiver’s ability to understand & cope with their child’s illness
Decreased caregiver’s levels of expressed emotion
Goals:
Increase adherence to meds to delay reoccurrence of manic episodes
Enhance adolescent’s knowledge of BPD, communication & coping skills
Minimize psychosocial impairment
3 components (approximately 20 sessions)
Psycho-education
Communication enhancement training
Problem solving skills training

Question 6

RAINBOW Program

Answer 6

Child & family focused; CBT; Adapted from FFT model for children (8-12 yrs)

12 sessions protocol, sessions with parents alone, child alone, child and parents together, and parents with siblings

R (routine),
A (Affect Regulation),
I (I can Do it!),
N (No Negative thoughts & live in the now)
B (be a good friend & balanced lifestyle for friends),
O (Oh, How can we solve the problem)
W (Ways to get support)

Question 7

Multi-Family Education Groups

Answer 7

Consists of 8 - 90 minute sessions for parents with concurrent sessions for children with another therapist

Psycho-educational in nature
Information on course, prognosis, & treatments

Designed for children with bipolar disorder or a diagnosis of depressive disorder

Allows parents to get support from other parents

Similar components to FFT & RAINBOW

Question 8

Cognitive Behavioral Therapy

Answer 8

Focuses on identifying & altering negative thought patterns, beliefs, & actions that contribute to the maintenance of depressive disorders

Change mood through cognitive restructuring to help client focus on the learning & practicing of new or more effective coping skills

Question 9

Interpersonal Therapy (IPT)

Answer 9

Designed to allow depressed individuals an opportunity to:
Focus on resolving areas of grief
Improve interpersonal relationships by reducing conflict
Identify & rectify personal difficulties

Key areas include
Role transitions
Role disputes
Interpersonal skill deficits
Grief resolution

Question 10

Medication Treatment

Answer 10

Medication treatment guidelines: Child Psychiatric Workgroup on Bipolar Disorder (Kowatch et al., 2005)
Mood Stabilizers: Lithuim, Depocote, Tegretal
Used commonly to treat Acute mania in adults
Side-effects: thirst, tremors, weight gain
No methodologically sound research studies for lithium with adolescents
Comorbidity with personality disorders associated with decreased responsiveness
Neuropleptics
Combined with lithium
Side-effects - Increased rate of tardive dysknesia
Anti-convulsants
Carbamazepine and valpoiric acid
Benzodiazepines
Used for acute management of agitation & insomnia in mania
Not as successful as with adults
More research needed