Mood Disorders (Bipolar Disorder) Flashcards
Importance of Emil Kraeplin’s findings regarding onset and mixed states
Illness most frequently set on between 15 and 20 years of age. Onset prior to 10 years of age was rare and mild.
Children lack higher cognitive structures required for a diagnosis of BP
Nearly 60% of BP adults recall having symptoms prior to age 19. Up to 20% prior to age 10.
Mixed states appear to happen more commonly in c/a with BP than adults. Mixed emotional presentations are more common in c/a than adults even in the absence of psychopathology and that elevated and mixed emotions alone are not diagnostic.
DSM 5 criteria
Distinct period of elevated, expansive or irritable mood for more than 1 week (or any duration if hospitalization is required)
Symptoms (irritable mood ONLY): Decreased need for sleep Increased risk-taking Pressured speech Grandiosity or inflated self-esteem Extreme Distractibility Flight of ideas, racing thoughts Increase in goal-directed behavior 3/7 symptoms= euphoric mood; 4/7= irritable mood 1 week= BP 1 4 days= BP II Psychosis of hospitalization= BP I
Mood Cycles
Normal mood–> drops to depression–> rises to mania–> drops a little to hypomania–> splits between mixed episode
a. Hypomania- 4 days—BP 2
b. Dysthmia- 1 year
c. Mania- 1 week—BP 1
d. Depression- 2 weeks
Pediatric BP Disorder Diagnostic Dilemnas
Centrality of Irritability–absence of grandiosity, elation, and episodicity.
Absence of Pure BP disorder- always comorbid
Episode Length
Most salient characteristics thought to separate BP in children from other psychiatric conditions
a. Grandiosity
b. Decreased need for sleep
c. Hypersexuality
d. Flight of ideas
Ubiquity of irritability in child psychiatric disorders and common comorbidities
ADHD PTSD ODD CD MDD Anxiety ASD SUDS Psychotic d/o
Comorbidities (70-90%)
ADHD (10-75%) Psychosis (16-60%) ODD (46-75%) CD (6-37%) Anxiety Disorder (13-56%) Substance Abuse (0-40%)
Increase in comorbidities in earlier onset of BP Disorder
Depression Anxiety Disorder Alcohol Use Drug use ADHD Suicide Attempt
ADHD vs. BP Symptoms (Mania)
MANIA ADHD
elevated/expansive mood NO
irritability COMMON
grandiosity NO
decreased need for sleep MILD (RESTLESS)
more talkative CRITERIA
FOI/racing thoughts NO
hyperactivity/goal-directed CRITERIA
high risk activities COMMON
distractibility CRITERIA
Atypical presentation of Child BP
Predominant mood often irritable
Irritability may be persistent, severe, and violent
Complex Cycling (>80% are rapid cycling)
Ultrarapid/ Ultraradian (not considered an episode/ hypomania/depression)
Recall that unstable and labile moods are typical of children <10 yo
Comobidity and family history of BP are common
Poor Treatment response and recurrence
Recognize the increase in prevalence in hospital discharge diagnoses and outpatient diagnoses but no increase in large scale epidemiological studies
a. Number stays the same with a proper diagnostic screening tool
b. Number of kids have gone way up but we don’t really have any proof of BP in a detailed study of symptoms.
