Day 22 - Bipolar Disorder

Question 1

WHat are the diagnostic criteria for a manic episode?

Answer 1

A. period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization needed)
B. 3+ sx (4+ if only mood is irritable) of:
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative than usual
- flight of ideas
- distractibility
- increase in goal-directed activity
- excessive involvement in pleasurable activities w high potential for painful consequences

Question 2

What is a hypomanic episode?

Answer 2

• less extreme manic episode
• lasts at least 4 days
• change in functioning BUT no marked impairment in social or occupational functioning

Question 3

Distinguish Bipolar 1, Bipolar 2, and Cyclothymia

Answer 3

• Bipolar 1: manic episodes, maybe depression
• Bipolar 2: major dep episodes and hypomanic episodes (never full manic episode)
• Cyclothymia: 1y for youth, 2y for adults, when there were numerous hypomanic and depressive sx that do not meet full criteria for hypomanic, manic, or major depressive episode

Question 4

What are 2 key diagnostic challenges of pediatric bipolar disorder?

Answer 4

• irritability (vs euphoria) can be predominant mood state (which overlaps w lots of other disorders so lacks specificity)
• children may not show discrete episodes (changes in mood even within same day)

Question 5

Rates of bipolar rise around what age?

Answer 5

adolescence

Question 6

About __% of ppl w bipolar experience their first episode in adolescence

Answer 6

60%

Question 7

NCS-A estimates lifetime prevalence of Bipolar1/2 at __%

Answer 7

2.9%

Question 8

How is recovery defined for bipolar disorder?

Answer 8

• 8 consecutive weeks not meeting criteria for manic/hypomanic/depressive/mixed episode

Question 9

__-__% of youth w bipolar will recover within a year.
__-__% of the children who recover will show recurrence within a year

Answer 9

40-100%
60-70%

Question 10

__% of children and __% of adolescents w bipolar meet criteria for ADHD

Answer 10

60-90% of children and 30% of adolescents w bipolar meet criteria for ADHD

Question 11

__% of children w bipolar meet criteria for conduct disorder

Answer 11

20%

Question 12

WHat role do genetics play in bipolar?

Answer 12

• play bigger role in early onset cases
• research suggests its highly heritable not not entirely
• multiple genes involved

Question 13

We see a ___ gene-environment correlation in bipolar

Answer 13

passive (combo of genetic risk and stressors)

Question 14

What 3 types of medications are used to treat bipolar?

Answer 14

• mood stabilizers (lithium, approved for kids, serious side-effects)
• atypical antipsychotics (RCTs have found them effective)
• anti-depressants (research is mixed)

Question 15

What is the typical recommended treatment for mania in youth?

Answer 15

• start w one atypical antipsychotic
• if doesn’t work, stop and try another
• if doesn’t respond to 2/3, try lithium
• if partially responds to antipsychotic, add lithium

Question 16

What is the first line of treatment for bipolar disorder?

Answer 16

medication!

Question 17

What 2 family treatments for bipolar are supported by RCTs?

Answer 17

• multifamily psychoeducational psychotherapy
• family-focused therapy

Question 18

What does the RAINBOW acronym in Child and Family focused CBT (CFF-CBT) stand for?

Answer 18

Routine
Affect regulation
I can do it (increase self-efficacy)
No negative thoughts (re-train cognitive distortions)
Be a food friend and Balanced lifestyle
Oh, how can we solve this problem? (problem-solve together)
Ways to support

Question 19

What do we know about efficacy of CFF-CBT for pediatric bipolar disorder?

Answer 19

• lower mania vs tx as usual
• 88% below cutoff for manic sx post-treatment (vs 21%)
• similar pattern for parent-reported depression but NOT clinician-reported depression