Mood Disorders Flashcards
1
Q
Mood Disorders in Youth (4)
A
(1) Major depressive disorder (MDD)
(2) Persistent depressive disorder (PDD)
(3) Disruptive Mood Dysregulation Disorder (DMDD)
(4) Bipolar disorder (I & II)
2
Q
Core Features of Depression (3)
A
(1) Dysphoria
(2) Irritability
(3) Anhedonia
3
Q
Dysphoria def
A
Prolonged sadness
4
Q
Irritability def
A
Excessive sensitivity, hostility, and moodiness
=> In kids especially: CORE component of mood disorder
=> Unique to children and adolescents
5
Q
Theory: Why not irritability symptom in adulthood?
A
In adults, more cognitive (e.g. negative thoughts), younger kids might not have those cognitive abilities
=> Thus might present as irritability
6
Q
Anhedonia def
A
Loss of pleasure or interest in previously enjoyable activities
7
Q
Specifiers of MDD relevant to PDD
A
Anxious distress & Melancholic features
8
Q
Can you have MDD and PDD at the same time?
A
Yes -> double depression
9
Q
Disruptive Mood Dysregulation Disorder (DMDD)– Core feature
A
Irritability
=> Diff than diff mood disorders bc it has the CHRONIC IRRITABILITY (vs bipolar: ‘EPISODIC’ picture)
=> Very controversial addition to DSM-5
10
Q
Clear overlap between DMDD and __
A
ODD
11
Q
Why would the controversial diagnosis of DMDD be in the DSM-5 with so little proof?
A
Reduce the perceived over-diagnosed # of kids diagnosed with pediatric bipolar disorder
12
Q
DMDD is NOT diagnosed concurrently with:
A
(1) ODD
(2) BP
13
Q
How do I help managing kids? (4)
A
(1) What are the triggers? Rly important -> Wanna work with them on those triggers
(2) Find coping strategies if getting dysregulated (counting to 10, take a break, calm down area).
(3) Diff ways to explain to kids the ‘no’. Sometimes they need an explanation.
(4) Don’t be afraid to ask for help - those kids are hard to be with
14
Q
Axelson et al. 2013: Can we find DMDD in past samples?
- Research teams worked retrospectively by applying new criteria to data already collected
- Examined DMDD in a large sample of 6- to 12-year-olds seeking psychiatric services
Results?
A
(1) DMDD was NOT well-differentiated from CD or ODD
(2) NO difference between youth WITH and WITHOUT DMDD diagnosis in symptom severity or functional impairment
-> E.g. 100 kid with vs without DMDD; equally severe DMDD symptoms (Label is NOT helpful)
(3) DMDD diagnosis showed poor stability
15
Q
Copeland et al. 2013: Examined the DMDD criteria in three large community samples
A
(1) 3-month prevalence rates for meeting criteria for DMDD ranged from 0.8% to 3.3%, with the highest rate in preschoolers.
(2) If you ignore the duration criteria, more cases of DMDD → bc stability is bad over time
(3) Highest levels of co-occurrence were with depressive disorders and ODD
(4) Occurred with another disorder 62%–92% of the time
(5) Affected children displayed elevated rates of social impairments, school suspension, service use, and poverty.
16
Q
DMDD Diagnosis, main takeaways (3)
A
(1) Validity of this diagnosis is not firmly established
(2) Risk of over-diagnosis
(3) Irritability is a core feature of DMDD
17
Q
Depression Diagnoses: Problem with categorical classification
A
Suggestion that it’s more Dimensional:
=> Many children and adolescents will have subclinical depression and have quite a lot of symptoms + impairment
=> Greater risk for going on to develop depression as well as other disorders and difficulties (e.g., substance use)
18
Q
Preschool Depression: Is it common?
A
Very rare and important.
-> Real violation of expectations of what preschool-age kids should be (e.g. curious, excited to explore…).
-> But subset of very young kids w sadness/irritability underlying low mood.
19
Q
Earlier onset of depression (preschool) associated with: …
A
Higher risk for more severe & chronic of depression later on
20
Q
Luby et al (2014):
Study of ~250 preschoolers (high in depression) followed through school-age
Results? (2)
A
(1) 2.7X more likely to be depressed at school age
(2) Higher rates of anxiety and ADHD
-> Risk factor for depression + other disorders
21
Q
Gaffrey et al (2011): Does the diagnostic criteria fit kids that are THIS young?
Results (2)
A
(1) 2-week MDE (major depressive episode) DURATION criterion not as relevant for preschoolers
(2) MDD in preschool associated with increased likelihood of having MDD 2 years later REGARDLESS of whether MDE duration criterion met at baseline if other sx were present
22
Q
Gaffrey et al 2013:
Depressed 4-6 year olds & Brain activity
Results
A
Altered brain activity (e.g., + amygdala activity) when viewing EMOTIONAL faces vs non-depressed kids
***You also see this in adults
23
Q
Is disrupted amygdala functioning a consequence of depression throughout lifespan or a biomarker/precursor?
A
We don’t rly know
=> All we know is that it’s associated (not necessarily causal at this point)
24
Q
Mood disorders: Latine vs White kids
A
Latine youth more likely than White youth to meet diagnostic criteria for a mood disorder
25
Mood disorders: Black vs White kids
Evidence that Black youth experience greater levels of mood disorders than White youth
26
Treatment: White vs Latine vs Black youth
White youth more likely than both Latine and Black youth to have received treatment for a mood disorder
27
Why differences in # of kids treated (white vs minorities)? (3)
(1) Overrepresentation of minorities in low SES groups
(2) Discrimination (interpersonal, systemic, cultural), etc.
(3) Differential access to resources: Leads to increased minority rates of mood disorders + less treatment for them
28
Gender differences in MDD
(1) No difference in childhood -- becomes pronounced in adolescence
(2) Girls much more likely to have clinical levels of depression in adolescence
29
Possible Explanations for Gender Gap in MDD (6)
(1) Girls are more likely to seek help
(2) Biological factors
(3) Stress
(4) Interpersonal Stress
(5) Cognition
(6) Coping
30
Possible Explanations for Gender Gap in MDD:
Girls are more likely to seek help?
=> Yes or No? (2)
Not rly conclusive
(1) NCS-A: No gender difference in use of services for depression
(2) But... gender difference is found in community samples: adolescent girls more likely to seek treatment
31
Possible Explanations for Gender Gap in MDD:
Biological factors
=> Yes or No? (4)
Yes.
(1) Onset of elevated rates of depression in girls coincides with puberty
(2) More mature pubertal status is linked to depression in girls, but not boys, and is a stronger predictor than age
(3) Early onset puberty is a risk factor for depression (+ delinquent behavior, risky sexual behaviors, SUD…)
(4) Puberty may sensitize girls to the impact of stressors => hormonal diathesis?
32
Possible Explanations for Gender Gap in MDD:
Stress
=> Yes or No? (2)
Yes.
(1) Puberty may create more stressors for girls (vs boys): Changes in physical appearance and sex-role identification
=> e.g. Sexualization, unwanted attention = new added stressors
(2) In general, robust link between stress and depression
33
Possible Explanations for Gender Gap in MDD:
Interpersonal Stress
=> Yes or No? (4)
(1) Conflict with friends, rejection by peers
(2) Girls are more likely to generate interpersonal stress than boys: Gender socialization → importance of social relationships rated as higher in girls (vs boys); might lead to interpersonal stress
(3) Stronger association between interpersonal stress and depression for girls than for boys
(4) Girls are more invested in interpersonal relationships
34
Possible Explanations for Gender Gap in MDD:
Cognition
=> Yes or No?
Not really.
Depression is associated with attributions about stressful events that are likely to amplify negative affect
BUT => this bias is across girls and boys
35
Possible Explanations for Gender Gap in MDD:
Coping
=> Yes or No?
Yes.
(1) Girls are more likely to cope by ruminating, either alone or with a friend
-> Co-ruminating = increase relationship closeness and warmth
BUT exacerbates symptoms
=> Hard cycle to get out of (cuz it’s reinforcing)
36
Co/ruminating def
Thinking about a problem constantly, but not moving to active problem-solving
-> E.g. Why do I feel like this? Why is this happening to me? What’s going to happen to me? I’ll never get better. I’ll never feel good again. This is so unfair.
37
Etiology and Maintenance of Depression - main domains (3)
- Biological Factors
- Cognitive Factors
- Interpersonal Factors
38
Etiology and Maintenance of Depression: Biological factors
Heritable component to depressive disorders
(1) Children of depressed parents are more likely to be depressed
(2) Children with a parent who was depressed as a child are 14x more likely to become depressed before age 13
(3) Stress reactivity: Early exposure to stress which may sensitize a person to later stress (emotion regulation problems) -> E.g. if i experience a lot of stress when i’m 10, dysregulation of stress response, might modulate my reaction to stress when i’m 15 → 25 (…)
39
Prenatal depression & Depression in kids (3)
(1) Depression in moms is associated with increased levels of cortisol -> affect fetus
(2) Number of months a woman is depressed during pregnancy predicts elevated levels of cortisol when children are 6-7 years of age
(3) Elevated cortisol associated with internalizing problems
40
Postnatal (postpartum) depression & Depression in kids (3)
(1) Higher cortisol levels in moms with postpartum depression leads to more cortisol/hormone signaling for cortisol production in breastmilk → Then impact kid
(2) Higher level of maternal cortisol predicting greater fearfulness in kids but ONLY for kids that were breastfed
(3) Higher level of cortisol in breastmilk associated with negative affectivity at 3 months
-> Other research: breastmilk>> → might be a bit negative if depressed mom
41
Parenting & Depression in kids
(1) Maternal depression is associated with parenting behaviors that may be problematic for children’s development: Less responsiveness, frustration tolerance, emotion regulation
=> May contribute to dysregulation of stress responses in infants
- Infants cannot regulate their own emotion → they rly rely on parents
- Decreased responsiveness might be an issue: impede on how infant regulate their emotions
(2) Pple that are depressed might have fewer resources to devote towards other things
42
Reminder: Social-Cognitive Processing
Encoding
Interpretation**
Response Search**
Response Decision**
Enactment
43
Study: Ask about interpretation scenarios
“You and your friend are supposed to go to the movies but you can’t find a time that is good for both of you”
Results?
Depression associated with a tendency to select negative interpretations
=> Negative attributional bias
44
Response Search & Depression
Identify fewer assertive strategies
(Assertive vs Aggressive)
45
Response Decision & Depression (2)
(1) Report themselves less able to carry out assertive strategies
(2) Evaluate avoidant strategies as more likely to result in positive outcomes and assertive strategies as less likely to result in positive outcomes (bit similar with anxiety -> prefer avoidance)
46
Interpersonal Theories of Depression
Children and adolescents may be responding to challenging interpersonal situations in problematic/unhelpful ways:
E.g. avoiding vs assertive solution -> more likely to be victimized
-> BUT: being treated poorly = more aggressive = more depression = fewer strategies to prevent bullying
47
2 competing theories of Interpersonal theory of depression
Stress Exposure vs. Stress Generation
48
Stress reactivity def
Capacity or tendency to respond to a stressor
=> Disposition that underlies individual differences in responses to stressors and is assumed to be a vulnerability factor for the development of diseases.
*Can look at it via cortisol
49
Stress Exposure Models of Depression (2)
- Depression results from exposure to stressful events
- Very important to know (supported by research)
50
Stress Generation Models
Depression may lead individuals to generate stressful life events
51
Study:
4 groups:
- Depressed only
- Externalizing only
- Both (comorbid)
- Neither (clinic control)
Assessed experience of life stress: subjective vs objective stress
Stressful episodes rated by researchers along several dimensions: severity + extent to which child contributed to the event (independent vs dependent)
Results? (3)
(1) Depression was associated with DEPENDENT, INTERPERSONAL stress
(2) Depression was NOT associated with independent stressors at all (neither w externalizing disorders)
(3) Children with comorbidity experienced the highest levels of BOTH interpersonal and non-interpersonal DEPENDENT stress
=> Supports stress generation hypothesis
→ Takeaway: Youth with depression more likely to generate problematic interpersonal circumstances
-> Similar patterns for life hassles/victimization
52
Study: Meta-analysis and stress-generation studies (Rnic et al., 2023)
- 95 longitudinal studies (~38k participants of all ages)
Results?
Strong support for stress generation hypothesis
(1) Stress generation effect of dependent stressors was stronger in YOUNGER samples
(2) DEPENDENT stress is MORE predictive of psychopathology than independent stressors (in general!!)
53
Friends & Depression (2)
(1) Friends = protective factor for loneliness, depression, victimization...
(2) May be more difficult to maintain healthy, close friendships in context of depression (double directionality, also friends can make depression worse)
54
Study: Observed children with depression interacting with their friends
Results? (2)
(1) Friends’ becoming more negative over the course of the interaction
(2) Why? → Corumination & Reassurance seeking
55
Co-rumination
Tendency to dwell on problems and not solve them (with someone else)
=> Co-rumination at one time point predicts later increases in friendship quality and internalizing symptoms (Rose, 2002)
56
Rose et al. 2014: Looks at effects of co-rumination
(1) Dwelling on negative affect w/ friend → more depressive and anxious symptoms, but not associated with friendship quality
(2) (a) Discussing the problem repeatedly (rehashing), and (b) SPECULATING about what might happen → increased friendship quality and closeness, but not associated w/ greater depressive or anxious symptoms
57
Reassurance Seeking
Depressed pple: Person thinks they don’t mean it, and seeks more reassurance
=> Very BRIEF sense of relief
-> Pple get trapped in this increasing asking of reassurance
-> Overtime, this becomes irritating and/or invalidating
=> Eventually, the child will be rejected, unstable relationships
58
Contagion of depressive symptoms
Depression of one friend predicts increase in depression in other friend over time!
59
Friend 1's Depression symptom -> Friend 2's Depression symptom
Mediating pathway?
Co-rumination
60
Treatment of Depression: Overview (2
- Cognitive behavioral therapy (CBT)
- Antidepressant medications
61
CBT main areas of intervention (3)
(1) Depression maintained by negative cognitive and behavioral processes
(2) Cognitive processes targeted: depressogenic thinking: thinking patterns conducing to more depression (depressive thought patterns)
(3) Behavioural processes targeted: Low reinforcement and negative life events + Skill deficits
62
Emotional Spirals
Depression may begin, or deepen, as part of a downward emotional spiral: Moody -> Sad -> Worse -> cries all the time -> Depression
-> But, moods do not have to just go down. We also experience UPWARD EMOTIONAL SPIRALS.
63
Cognitive Techniques (7)
(1) Goal of CBT is NOT to convince the person that something bad is good, rather it is to bring reaction IN LINE with the event
(3) Help youths learn how to observe their thoughts, feelings, and behavior
(4) Consider alternative explanation
(5) Solve problems and make rational decisions
(6) Therapy as observation and experiment
(7) Match developmental level
64
Behavioral Techniques in CBT (4)
(1) Keep track of mood and activity (mood tracker): how do you feel/what are you doing
-> Maybe across time, we find that some situations are always associated with low mood, others with higher mood (maximize high mood, minimize low)
(2) Develop list of rewarding activities
(3) Change habits: Address environmental obstacles, skill deficit
(4) Monitor impact and refine plan
65
Study: Meta-analysis
31 CBT trials – 4335 participants – all children and adolescents
Results?
(1) Sub-clinical at baseline → 63% lower risk depression at follow-up/post-intervention (vs controls)
(2) Clinical depression at baseline → ~45% lower risk post-treatment (vs control)
***Moderated by baseline status of clinical depression
(Good study, but… WEIRD countries.)
66
Predictors of positive outcomes for treatment (2)
(1) Combination of behavioral activation + thought challenging
(2) Involving parents in intervention
67
Study:
Meta-analysis CBT with adolescents in low and middle income countries (LMIC)
4 Groups:
- Micro-finance interventions: If we give pple that have no access to services more money, what’s happening
- Interpersonal therapy: focused on interpersonal relationships
- CBT
- Integrated (CBT + other techniques)
Results? (4)
(1) CBT = strongest reduction
(2) Micro-finance = not quite as strong as CBT, but still reduction
(3) Interpersonal = not much improvement (quite same as finance)
(4) Integrated = seems to be working, though less studies (little diamond)
68
Antidepressant Medication Effects: Developmental differences
Many efficacious medications for adults do NOT work at all in children
-> Most do not work as well in adolescents
-> May be due to differences in brain development or metabolism
69
Types of Antidepressant Medication (4)
(1) Tricyclic antidepressants
(2) Monoamine oxidase inhibitors (MAOIs)
(3) Selective serotonin reuptake inhibitors (SSRIs)
(4) Selective norepinephrine reuptake inhibitors (SNRI’s)
70
Tricyclic antidepressants: Mechanism & efficacy
Prevent the reuptake of norepinephrine and serotonin in the synapses or by increasing the responsiveness of receptors to these neurotransmitters
=> No evidence of efficacy in youth
71
Monoamine oxidase inhibitors (MAOIs): Mechanism & efficacy
MAO is an enzyme that breaks down some neurotransmitters
-> MAO inhibitors STOP this enzyme thus increasing the level of neurotransmitters in the synapse
=> Some mixed evidence of efficacy in teens
-> Potentially LETHAL side effects: Interact with foods that are rly rich in tyramine (don't take those foods - lethal increase in blood pressure)
72
Selective serotonin reuptake inhibitors (SSRIs): Mechanism
Inhibit the reuptake of serotonin so that more is available in the synapse -Similar to tricyclics, but more specifically focused on serotonin
=> Good evidence for fluoxetine (Prozac) in teens
=> Tend NOT to be fatal in overdose
-> Side effects: agitation, jitteriness, anger, hostility, nausea, stomach cramps
73
SNRIs
Like SSRIs, but also block norepinephrine, Used in depression and anxiety
-> Similar side effects to SSRIs
-> Examples: Venlafaxine, duloxetine, desvenlafaxine, milnacipran, levomilnacipran
74
SSRIs & SNRIs vs Stimulants (3)
(1) Work very differently than stimulant medication (instant, acute effect - increases dopamine - increase focus in short term).
(2) Stimulants help EVERYONE focus
(3) SSRIs SNRIs don’t have acute effects, you need to take them during a certain period for the impact to be noticeable
75
SSRIs and risks (FDA)
Suggestion of increased risk of suicide for kids who start taking SSRIs
-> Black-box warning by the FDA, Most serious warning the FDA gives
76
Black-Box Warning (FDA): Evidence AGAINST medication (2)
(1) Began with concern about one drug (Paxil)
(2) FDA requested data from all RCTs involving antidepressants: Found higher levels of suicidality (attempts) in patients treated with antidepressants compared to placebos
77
Black-Box Warning (FDA): Evidence FOR medication (2)
(1) Epidemiological data: Indicates that as use of antidepressants goes up, suicidality goes down
(2) Adolescent suicide rates in the US increased for the first time in 2004, after many years of decrease (in part due to adolescents not being treated for depression)
78
Gibbons et al. 2012:
Obtained complete longitudinal data from RCTs for Prozac (fluoxetine) + the Treatment for Adolescents with Depression (TADS) study
-> Examined association between treatment group and clinician ratings of suicidal ideation
Results?
Did not find higher rates of suicidal ideation in youth treated with Prozac compared to placebo
79
Lu et al., 2014: Traking things Before and After black box labels (publicity)
~
Investigated whether warnings and media coverage were associated with decreased use of anti-depressants and increased suicides
3 groups:
- People who were prescribed an antidepressant
- Suicide attempts
- Completed suicides
Results?
(1) Before black box warning: Antidepressant use increasing
(2) After it came out: Use went down
(3) Drug poisoning: Post black box - attempts went up (SUPPOSED TO GO DOWN)
=> Seen in young adults but not adults (no change in attempted suicides even though decreased use)
(4) Media coverage might also impact behaviors youth are engaging in
80
Evidence on whether the SSRIs increase suicidal ideation in children is characterized as ...
mixed
Balancing risk and benefit
=> Possible increase of suicidal ideation due to taking SSRI
=> Risk of suicidal ideation if depression is left untreated
Evidence that some SSRIs (e.g., Prozac) may confer acceptable benefit-to-risk ratio for adolescents
81
Treating Depression in Preschoolers (3)
(1) Not much is known about effective treatments
=> In general, very limited data on use of psychiatric drugs with preschoolers
(2) Developed a version of parent-management training that focuses on helping parents learn to manage their children’s moods (promising!)
(3) Therapy is recommended as the first approach - if too severe, Prozac (best risk/benefit ratio)
82
Study: 1000 U.S. preschoolers treated with psychiatric meds in the 1990s
Results?
Most common prescriptions are for stimulants
83
Can you be diagnosed with Bipolar II and cyclothymia at the same time?
No
84
(BP): What happened between 1990 and 2000?
Diagnoses of bipolar disorder in children quadrupled -> big public health concern
=> Book written by a New York psychiatrist:
- Argued that we aren’t effectively identifying kids that have bipolar
- Provided a vague and general list of behaviors: not very good markers (not good validity) — but public became concern that child might have bipolar
85
Examples of the types of behaviors the book "Bipolar Child" depicted (problematic ones): ...
- Poor handwriting
- Complains of being bored
- Is very intuitive or very creative
- Excessively distressed when separated from family
- Has difficulty arising in the A.M
- Elated or silly, giddy mood states
- Curses viciously in anger
- Intolerant of delays
86
Adult vs Child presentation of BP
(1) Adults typically have discrete episodes (of mania/hypomania): clear end and start
(2) In children, may see changes in mood even within the same day: Not always clear where the start or the end of (hypo)manic symptoms are -> quick fluctuations
87
Narrow vs Broader phenotype of BP
Narrow =
- “Classic” adult symptoms
- Mania, grandiosity
- Some children/adolescents meet the full diagnostic criteria meant for adults!
Broader =
- Irritability, mood lability
- Irritability much more common than mania (even though not specific to BP)
88
Mood lability
Mood fluctuation
-> How much your mood goes up and down
89
In children, ..., rather than euphoria, can be the predominant mood state
Irritability
-> Differential diagnosis problem: Depression, ODD, CD, ADHD
=> Conclusion, narrow phenotype preferred (grandiosity, elevated mood)
90
BP: Prevalence
Bipolar disorder very rare prior to puberty
-> Rates rises in adolescence
=> About 60% of people with bipolar disorder experience their first episode in adolescence (i.e., prior to 19-years-of-age)
91
Most pple report that their onset of BP (in adolesence) was actually a ...
Major depressive episode
=> We often see subclinical hypomanic/depressive symptoms before the onset of a first major depressive episode/manic episode
92
Mania in adolescence associated with ...
Psychosis, mixed episodes (mania + depression at the same time), extreme mood lability (=fluctuations)
93
Recovery of Bipolar Disorder def
8 consecutive weeks (2 months period) without criteria for manic episode, hypomanic episode, depressive episode, or mixed episode
94
Often, ... of children and adolescents with bipolar disorder will recover within a year
40% to 100%
BUT: Recurrence pretty common as well: 60% to 70% of the children who recover will show recurrence within a year
95
Recovery rates differ based on ...
age of onset
=> Children with pre-pubertal onset: 2 times less likely to recover (vs adolescent-onset)
96
BP has a ... continuity
Homotypic continuity - more chronic course
=> Pediatric BP might predict onset of other disorders later in time
=> BUT, much higher risk of BP in adulthood if manic/hypo/depression episodes in childhood
-> Rate of mania in adults who had BP 1 as children are 13 to 44 times higher than the rates of mania in the general population → huge increase in risk of mania, continuity and stability across time
97
Clinical Correlates of BP
(1) Peer issues: lower social skills, few friends, family conflict (bc of mood liability)...
(2) Family: Poor relationships with siblings, frequent hostility and conflict with parents
98
Medication for BP (3)
- Mood stabilizers
- Antipsychotics
- Anti-depressants
99
Mood Stabilizers: Mechanism
E.g. Lithium *Reduce MANIA, not depression
-> Common treatment for adult bipolar disorder
-> Approved for use in children aged 12 and older
100
Lithium: Side effects
If toxic level in bloodstream, kidney/thyroid problems
=> Weight gain might decrease compliance to lithium
-> Compliance with instructions VERY important
101
Amerio et al., 2018 - Meta-analysis
Study of youth treated with Lithium
Results?
In youth (in this study), fairly minimal side effects
-> Although not good research on long-term outcomes
=> Mild side effects & help to reduce mania in 50% of kids
102
Atypical Antipsychotics
*Reduce mania, not depression
Wide-ranging class of antipsychotics
=> General examples: Asenapine Maleate, Clozapine, Iloperidone, Lurasidone, Olanzapine
103
Are Atypical Antipsychotics effective to treat BP?
10+ RCTs have demonstrated that these medications are effective for treatment of bipolar disorder in youth
104
Anti-Depressants for BP
In case of frequent depressive episodes
=> Mood stabilizer/antipsychotics may not help that
=> BUT: Taking antidepressants can lead to increased risk of mania!
-> Mixed research
105
First line treatment for BP
Medication
=> Althouth many youth with bipolar will not receive medication
-> Many may be treated with the wrong medication (e.g., an antidepressant by itself — cuz major depressive episode at first)
106
Recommendation for treating mania in youth: (4)
(1) Begin with one atypical antipsychotic
(2) If patient does not respond, or cannot tolerate the drug, taper, and then try a second atypical antipsychotic
(3) If patient does not respond to two or three atypical antipsychotics, switch to lithium
(4) If patient partly responded to antipsychotic, add lithium
107
Major source of relapse in BP
Poor compliance to medication
108
What can supplement medication in BP
Family Education
- Understanding disorder and symptoms
- Reducing conflict in the family
- Medication management
109
Brickman et al., 2022:
Groups:
- Family-focused treatment for adolescents
- Family-focused CBT
- Psychoeducational psychotherapy
Results?
Work to teach skills to increase # positive family interactions – all very similar
→ Improving family outcomes = good for psychopathology
110
Child- and Family-Focused CBT - Mechanism
RAINBOW acronym
- Routine
- Affect regulation (help kids monitor their emotions)
- I can do it (self-efficacy)
- No negative thoughts (recognize cog distortions)
- Be a good friend + Balanced life (social deficits to address)
- Oh, how can i solve this problem?
- Ways to get supports (for parents)
111
West et al., 2014: 69 children (aged 7 to 13 years) diagnosed with bipolar disorder stabilized on medication
2 Groups:
- CFF-CBT (individual therapy)
- TAU in same clinic
Outcome: parent vs clinician report of mania/depression
Results? (2)
(1) At post-treatment, youth in CBT group had lower mania symptoms than youth in control group
(2) 88% of youth in CBT group were BELOW the clinical cutoff for manic symptoms at post-treatment, compared to 21% in the control group
-> Similar pattern for parent-reported depression
BUT no difference for clinician-reported depression
112
West et al., 2014: Why difference between parent vs clinical-reported depression?
Clinicians might not be seeing SIGNIFICANT decreases in depression in one group compared to the other, but if parents are reporting it, maybe it can serve as a proxy for other things
-> Maybe kid is doing better at home, fewer arguments… Increase family functioning → less depression
