Week 9: Bipolar Development/Prognosis Flashcards
Prevalence of Pediatric Bipolar
Disorder
Bipolar disorder very rare prior to puberty
Rates rises in adolescence
NCS-A estimates lifetime prevalence of Bipolar I/Bipolar II at 2.9%
Course of Bipolar Disorder
About 60% of people with bipolar disorder experience their first episode in adolescence (i.e., prior to 19-years-of-age)
Peak age of onset between 15 and 19
Most people report first episode was major depression
Mania in adolescence associated with psychosis, mixed episodes
(mania/depression), extreme mood lability
Recovery
8 consecutive weeks in which an individual does not meet the DSM criteria for manic episode, hypomanic episode, depressive episode, or
mixed episode
40% to 100% of children and adolescents with bipolar disorder will recover within a year
60% to 70% of the children who recover will show recurrence within a year
Children with pre-pubertal onset bipolar disorder are two times less likely to recover than those with adolescent onset
Rate of mania in adults who had Bipolar I as a child are 13 to 44 times higher than population prevalence
Suggests homotypic continuity
Taken together, the evidence suggests a chronic course
Comorbidity
ADHD
60% to 90% of children, 30% of adolescents with bipolar meet criteria for ADHD
Note similarity in symptoms
This is a challenging and critical differential diagnosis
Possible that stimulant medications may exacerbate bipolar symptoms
Disruptive behavior disorders
20% of children with bipolar disorder meet criteria for conduct disorder
Again, note overlap in symptoms
Conduct symptoms may be a consequence of bipolar presentation
Risk-taking activities associated with mania
Clinical Correlates
Marked social impairment
Peers
- Poor social skills (easily set off)
- Frequently teased and victimized by peers (becasue easily set off)
- Few friends
Families
- Poor relationships with siblings
- Frequent hostility and conflict with parents
Etiology and Maintenance of
Bipolar Disorder
Work with adults suggests that bipolar is highly heritable
If one or both parents have bipolar, chances are 5 x greater that child will develop bipolar or another mood disorder (e.g.,
depression)
However, twin studies suggest that variability is not entirely due to genetics
If one identical twin has bipolar disorder, 65% chance that the other
twin will have it as well (so not only genes or 100%)
Genetics appear to play a bigger role in early onset cases
Environmental factors likely play a role
Diathesis-stress model
Genetic risk and environmental stressor
Problematic family interactions
Hostility, conflict
Contributes to expression of bipolar symptoms
Multiple gene problem
Summary
Bipolar disorder is chronic
Comorbid with ADHD and CD
Social impairment
Highly heritable
Stress may contribute to development of symptoms
