Bipolar Disorder

Question 1

Bipolar prevalence change

Answer 1

In early 2000s, 40-fold increase in diagnoses of pediatric bipolar disorder in US, not other countries

Question 2

BPD hallmarks

Answer 2

Manic and hypomanic episodes

Question 3

Criteria for Manic Episode A

Answer 3

• Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week and present most of the day nearly every day- or any duration if hospitalization is necessary

Question 4

Criteria for Manic Episode B

Answer 4

During period of mood disturbance and increased energy or activity, 3 or more of the following symptoms- 4 if the mood is only irritable- are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual/pressure to keep talking
- Flight of ideas/subjective experience that thoughts are racing
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences

Question 5

Manic Episode other criteria

Answer 5

Mood disturbance is sufficiently severe to cause marked impairment in functioning or necessitate hospitalization
Not attributable to a substance or another medical condition

Question 6

Mood-congruent psychotic features

Answer 6

Added if manic episode includes hallucinations or delusions

Question 7

Hypomanic episode

Answer 7

Milder symptoms
Same criteria except: not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization but is still an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic and observable by others
Shorter duration- 4 days
No psychotic features

Question 8

DSM Bipolar I Disorder

Answer 8

Must have had one or more manic episodes

Question 9

DSM Bipolar II Disorder

Answer 9

Must have had one hypomanic episode and one major depressive episode

Question 10

Difference between BP1 and 2

Answer 10

BP1- more impairment related to up moods
BP2- more impairment related to down moods, more frequency depressive episodes, more severe depressive symptoms, more residual episodes of depression between mood episodes

Question 11

BP episodes time/order

Answer 11

Rarely straight from manic/hypomanic straight to depressive etc, more often interspersed w euthymia- long periods of stable moods that are neither depressive nor manic/hypomanic

Question 12

Pediatric bipolar diagnosed based on

Answer 12

Narrow phenotype- child clearly meets DSM criteria for BP1 or 2
Broader phenotype: children still struggling, challenging to parents

Question 13

Narrow phenotype BPD

Answer 13

Can begin in childhood but average age on onset is adolescence
Gradual onset
May be marked by years of subtle mood problems that never reach diagnostic criteria
First episode usually depressive

Question 14

Broad phenotype BPD

Answer 14

Irritability, anger, aggressiveness
Severe temper tantrums
Agitation, explosiveness
Moody, labile, affective storms
Symptoms characterize typical behavior not episodic
ADHD like symptoms
Tends to be diagnosed in early to mid childhood

Question 15

Considerations for BPD diagnosis

Answer 15

Severe, recurrent lifelong disorder w no cure
Different presenting problems have different prognoses and treatments, need to make sure working w real prblem
Primary treatment is psychotropic meds

Question 16

Primary meds for BPD

Answer 16

Stabilize moods
Lithium- salt, first line treatment
Anticonvulsants
Antipsychotics
FDA doesn’t endorse under 12-13 but used anyway- use for under 5 doubled in recent years, primarily for disruptive behavior

Question 17

Nonspecific effects

Answer 17

May be effective at improving behavior and affect regulation for people who don’t have the disorder they’re intended to treat, efficacy not proof of diagnosis

Question 18

Antipsychotic side effects

Answer 18

Severe- obesity, diabetes, high cholesterol, high blood pressure- about 1/3 kids
Takes 11 weeks for normal weight child to show changes
Need to balance need and impairment w accuracy

Question 19

What is the issue of diagnosing BPD in kids

Answer 19

Irritability criterion

Question 20

DSM 5 response to BPD concerns

Answer 20

Completely new diagnosis designed to tap individuals given BPD diagnosis but may not be
W severe irritability- careful to only diagnosis BPD in those who have had a clear episode of mania or hypomania

Question 21

Disruptive Mood Regulation Disorder Criteria A

Answer 21

Severe recurrent temper outbursts manifested verbally or behaviorally that are grossly out of proportion in intensity or duration to the situation

Question 22

DMDD other criteria

Answer 22

Temper outbursts inconsistent w developmental level
Occur on average 3+ times a week
Mood between outbursts is persistently irritable or angry most of the day nearly every day, observable by others
Symptoms present 12+ months, no period lasting 3+ months without all the symptoms
Present in at least 2 of 3 settings and severe in at least one
Diagnosis not first made before age 6 or after age 19
Age at onset is before 10 years
There has never been a distinct period lasting more than 1 day during which the full symptom criteria for a manic or hypomanic episode have been met

Question 23

What does last qualifier mean for DMDD

Answer 23

Can’t coexist w ODD, BPD, etc, can’t happen if ever experienced a manic or hypomanic episode
confused ngl

Question 24

DSM DMDD v BPD

Answer 24

Suggests they are entirely different
Emphasizes DMDD as a disorder w relatively constant symptomatology v episodic like BPD
DMDD classified as depressive

Question 25

Why is DMDD classified as depressive

Answer 25

Defining feature is dysregulation of negative mood, BPD is dysregulation of positive mood
Persistent irritability and agitation are signs of childhood depression
Young children w severe temper outbursts and irritability are more likely to display MDD later in childhood, not BPD

Question 26

DMDD and ODD

Answer 26

Hard to differentiate
Virtually all youth w DMDD meet criteria for ODD
Not true reverse, can’t be comorbid- relatively few youth w ODD fit DMDD diagnosis