Bipolar Disorder in Children and Adolescents Flashcards
Bipolar, General
One of the leading causes of disability
One of the leading causes of suicide
Increased substance abuse
Biologically-based
Unusual shifts in a person’s mood & energy
Impairs ability to function
Dramatic mood swings – from overly high and/or irritable, to sad and hopeless, and then back again
Mood related changes are accompanied by severe changes in energy and behavior
*In older adolescents and adults there are often periods of normal mood in between
Child/Adolescent Bipolar Disorder [onset / temperament]
Symptoms can emerge in early childhood
Some evidence that children diagnosed with early onset bipolar disorder were:
- difficult to soothe
- slept erratically
- seemed extraordinarily clingy
- from a very young age often displayed uncontrollable seizure-like tantrums or rages – out of proportion to any event
Severe tantrums often appear to be without provocation
Conflict in the field – what are the true symptoms of mania? e.g. sexual promiscuity, elevated mood, grandiosity
[If only rages = DMDD]
Bipolar I vs. Bipolar II dx
Bipolar I:
Recurrent episodes of both mania and depression – although Bipolar I can be diagnosed if mania is present without depression
* usually results in hospitalization
Bipolar II: more common in children
Milder episodes of hypomania that alternate with depression
Some people experience multiple episodes within a single week, or within a single day – rapid cycling
Bipolar Disorder: Mixed States
Symptoms of mania and depression may occur together in what is called a mixed state
Suicide is more likely, due to increase in energy
*sad, hopeless mood while feeling extremely energized
Agitation
Trouble sleeping
Significant change in appetite
Psychosis
Suicidal thinking
Mania versus Hypomania
Duration:
Manic Episode:
1 week OR any duration if hospitalization is necessary
Hypomanic Episode:
At least 4 days but less than 1 week
Clearly different from non-depressed mood
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Impairment/Features:
Manic: severe enough to cause marked impairment in occupational function or an usual social activities – may require hospitalization to prevent harm to self or others, or if there are psychotic features
Hypomanic: definite change in level of functioning, but not so severe to cause marked impairment that would necessitate hospitalization – *NO psychotic features**
Bipolar I
Presence of at least one manic or mixed episode
With OR Without depressive episodes
Symptoms significantly interfere with psychosocial functioning and must last at least a week or require hospitalization
Bipolar II
Presence of one or more major depressive episodes
Presence or history of at least one hypomanic episode
No prior history of a manic or mixed episode (=bipolar I)
Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning
Cyclothymia
For at least 1 year, presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for major depressive episode
During this 1 year period, person has not been without symptoms more than 2 months at a time
Exclusionary:
No major depressive episode, manic episode, or mixed episode has been present during the first year of the disturbance
*Dr. Ohr: keep in mind that it’s difficult to get the full picture for diagnosis since most information is based on parental report
Controversies in Child Criteria
Rages – different opinions in the operational definition
Chronic irritability versus cycling, what are the rates of cycling
Role of irritability as a diagnostic symptom
Elation & Grandiosity in child presentation of mania: is it truly grandiosity or simply imagination?
e.g. Does the child really believe that he can fly?
Epidemiology
Children and Adolescents
Bipolar I: 0.06-0.10%
Bipolar II Cyclothymia: 0.85%
Bipolar spectrum: 5-10%
Pre-pubescence
boys/girls 3.85 : 1
Bipolar disorder occurs equally in males and females in late adolescence and adulthood
Incidence is greater after puberty
Bipolar II and Cyclothymia may be 5x more common
Biological Causes of Bipolar Disorder
Genetic factors:
*5x risk when clear BP in one parent
- 2.5x risk when BP in extended family
- Even if not diagnosed with BP, children of parents with BP 2.7x more likely to have mental health diagnosis and 4x more likely to have a mood disorder
Physiological Factors {theorized}:
- a low or high level of a specific neurotransmitter, e.g. serotonin, norepinephrine and dopamine, or the imbalance of NT’s
- change in the sensitivity of receptors may be the issue
Environmental Factors
Genetic predisposition is not a guarantee
MZ Twin Studies, only 65% chance when 1 twin has BD
Suggests that environmental factors play significant role
Overlapping Diagnoses
ADHD
CD
ODD
Sexual abuse
Specific language disorders
Schizophrenia/schizoaffective disorder
Substance abuse
Anxiety
ADHD and Bipolar Disorder Similarities
Impulsivity
Hyperactivity
Emotional/behavioral lability
Comorbidity of CD and ODD
Sleep problems
ADHD and Bipolar Disorder Differences
Destructiveness
ADHD: non-angry
BP: angry, destructive
Duration and intensity of tantrums
Trigger for tantrum
ADHD: sensory and affective overstimulation (transitions, insults)
BP: limit-setting, conflict
Children with ADHD do not generally show dysphoria
Conflict with peers
ADHD: stumble into a fight
BP: looks for a fight and enjoys power struggle
Psychotic symptoms
BP
*Child exhibits gross distortions in perceiving reality or interpreting affective (emotional) events
*They may even exhibit paranoid-like thinking or openly sadistic impulses.
