Week 9: Bipolar Basics Flashcards
Pediatric Bipolar Disorder
Different manifestations of the same underlying problem we see in adults
Fundamental debate in child psychology: How do we ensure that symptoms
are developmentally appropriate
-CD/ODD
-Depression
Definition
Manic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms
have persisted (four if the mood is only irritable) and have been present to a
significant degree:
-inflated self-esteem or grandiosity
-decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
-more talkative than usual or pressure to keep talking
-flight of ideas or subjective experience that thoughts are racing
-distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
-increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
-Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., sexual behavior, shopping, gambling)
Hypomanic Episode
Same as manic episode except:
- Lasting at least four consecutive days
- Represents a change in functioning for the person
- But no marked impairment in social or occupational functioning
Depressive Episode
Meets criteria for a major depressive episode
Bipolar 1
Manic episode
-May or may not show depression (note that textbook is mistaken)
-Specifier – with mixed features
-Person is experiencing episodes that include symptoms of both mania and
depression (e.g., a manic episode in which some symptoms of depression are
present)
Bipolar 2
Major depressive episodes and hypomanic episodes
- Has not ever had a full manic episode
- Specifier – with mixed features
Cyclothymia
Period lasting at least 1 year (in children and adolescents, 2 years for adults) when there numerous hypomanic and depressive symptoms that do not meet full criteria for either a hypomanic, manic, or major depressive episode
Bipolar Disorder in Children
Between 1990 and 2000 diagnoses of bipolar disorder in children quadrupled
1999 saw the publication of a book entitled the Bipolar Child by a New York psychiatrist
Argued that bipolar disorder in children was overlooked
Provided a vague and general list of behaviors
- 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
NOT SPECIFIC
Could be normal or another condition
Bipolar Definition
2001 field decided that bipolar disorder could be diagnosed in children
Noted that there can be differences in presentation of bipolar in children and adults
Adults typically have discrete episodes
In children, may see changes in mood even within the same day
Tend to have long episodes like this (1 to 4 years)
Narrow/broad
Narrow phenotype
“Classic” adult symptoms
-Mania, grandiosity
Some children/adolescents meet the full diagnostic criteria meant for adults
Broader phenotype
-Irritability, mood lability
Irritability is much more common than mania
However, irritability is not a specific symptom for bipolar
Occurs in other disorders as well
- Depression
- ODD
Is this actually bipolar disorder?
Diagnostic Challenges
Irritability, rather than euphoria, can be the predominant mood
state
Differential diagnosis
Depression, ODD, CD, ADHD
Due to this overlap, some authors have argued that to be diagnosed with bipolar disorder, children must show core features of
mania, which has higher specificity
Grandiosity, elevated mood
These features do occur in a significant number of youth who have been identified as having bipolar disorder
Children may not show discrete episodes:
Children often show rapid mood changes (between depression and
mania on the same day)
Also see youth with chronic mania
Practice Parameters of the American Academy of Child and Adolescent Psychiatry
DSM criteria for adults should be applied to children and
adolescents
Mania, which may include irritability, present as a marked change in the individual’s state
Illness represents a departure from baseline functioning
Note that many children do not meet the duration criteria for a full manic episode, which is required for bipolar I, so bipolar 2
and cyclothymia are more common diagnoses
Diagnostic validity of bipolar disorder in preschool children has yet to be established
AS OF NOW YOU MUST USE DSM-5 ADULT CRITERIA
DSM-5 DMDD BS
Inclusion of new disorder
Disruptive Mood Dysregulation Disorder (DMDD)
Very controversial
No published data using these criteria
DMDD
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward
people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers)
E. Symptoms are present for 12 months or more
F. Not diagnosed before age 6 or after age 18
G. Age at onset of the outbursts and irritable mood is before age 10
H. Child has never met criteria (except duration) for a manic or a hypomanic episode (even lasting one day)
Is not diagnosed concurrently with:
ODD
DMDD is more severe
Bipolar disorder
Research on DMDD
Research on this disorder is very limited
More research has focused on related on construct – severe mood dysregulation (SMD)
Also includes symptoms of hyperarousal (e.g., flight of ideas, agitation, insomnia)
Work has been done primarily on one sample
