Bipolar+Disorder

1,144 views

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,144
On SlideShare
0
From Embeds
0
Number of Embeds
41
Actions
Shares
0
Downloads
15
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Bipolar+Disorder

  1. 1. Epidemiology, Educational Implications, and Interventions
  2. 3. DSM-IV-TR  <ul><li>Five types of episodes </li></ul><ul><li>Four subtypes </li></ul><ul><li>Four severity levels </li></ul><ul><li>Three course specifiers </li></ul> American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision. Washington, DC: Author.
  3. 4. Manic Episode <ul><li>Symptoms: </li></ul><ul><ul><li>Inflated self-esteem or grandiosity </li></ul></ul><ul><ul><li>Decreased need for sleep </li></ul></ul><ul><ul><li>Pressured speech or more talkative than usual </li></ul></ul><ul><ul><li>Flight of ideas or racing thoughts </li></ul></ul><ul><ul><li>Distractibility </li></ul></ul><ul><ul><li>Psychomotor agitation or increase in goal-directed activity </li></ul></ul><ul><ul><li>Hedonistic interests </li></ul></ul>
  4. 5. Hypomanic Episode <ul><li>Similarities with Manic Episode = </li></ul><ul><ul><li>Same symptoms </li></ul></ul><ul><li>Differences = </li></ul><ul><ul><li>Length of time </li></ul></ul><ul><ul><li>Impairment not as severe </li></ul></ul>
  5. 6. Major Depressive Episode <ul><li>Symptoms: </li></ul><ul><li>Depressed mood (in children can be irritable) </li></ul><ul><li>Diminished interest in activities </li></ul><ul><li>Significant weight loss or gain </li></ul><ul><li>Insomnia or hypersomnia </li></ul><ul><li>Psychomotor agitation or retardation </li></ul><ul><li>Fatigue/loss of energy </li></ul><ul><li>Feelings of worthlessness/inappropriate guilt </li></ul><ul><li>Diminished ability to think or concentrate/indecisiveness </li></ul><ul><li>Suicidal ideation or suicide attempt </li></ul>
  6. 7. Mixed Episode <ul><li>Both Manic and Major Depressive Episode criteria are met nearly every day for a least a one week period. </li></ul>
  7. 8. Subtypes <ul><li>Bipolar Disorder I = more classic form; clear episodes of depression & mania </li></ul><ul><li>Bipolar Disorder II = presents with less intense and often unrecognized manic phases </li></ul><ul><li>Cyclothymia = chronic moods of hypomania & depression, often evolves into a more serious type </li></ul><ul><li>Bipolar Disorder Not Otherwise Specified (NOS) = largest group of individuals </li></ul>
  8. 9. Children vs. Adults (or early vs. late onset ) <ul><li>Irritability </li></ul><ul><li>Depression </li></ul><ul><li>Lack of mood reactivity </li></ul><ul><li>Rejection sensitivity </li></ul><ul><li>Less evident are the “classic” symptoms of mania </li></ul>
  9. 11. Prevalence <ul><li>Estimated between 3-6% </li></ul><ul><li>Subsyndromal bipolar disorder </li></ul><ul><li>Equal distribution across gender variables </li></ul><ul><li>Average age @ onset = 20 years old </li></ul>
  10. 12. Course <ul><li>Initial cycle typically major depressive episode </li></ul><ul><li>Recovery </li></ul><ul><li>Relapse </li></ul><ul><li>Rapid Cycling </li></ul><ul><ul><li>Rapid cycling=4 episodes/year </li></ul></ul><ul><ul><li>Ultrarapid cycling=5-364 episodes/year </li></ul></ul><ul><ul><li>Ultradian cycling=>365 episodes/year </li></ul></ul>
  11. 13. Age at Onset <ul><li>Pediatric, prepubertal, or early adolescent (prior to age 12) </li></ul><ul><li>Adolescent (12 - 18 years) </li></ul><ul><li>Adult onset (+ 18 years) </li></ul>
  12. 15. Comorbidity <ul><li>Attention Deficit Hyperactivity Disorder (ADHD) </li></ul><ul><ul><li>Between 60-80% </li></ul></ul>
  13. 16. Criteria Comparison <ul><li>Bipolar Disorder (mania) </li></ul><ul><ul><li>More talkative than usual, or pressure to keep talking </li></ul></ul><ul><ul><li>Distractibility </li></ul></ul><ul><ul><li>Increase in goal directed activity or psychomotor agitation </li></ul></ul><ul><li>ADHD </li></ul><ul><ul><li>Often talks excessively </li></ul></ul><ul><ul><li>Is often easily distracted by extraneous stimuli </li></ul></ul><ul><ul><li>Is often “on the go” or often acts as if “driven by a motor” </li></ul></ul>Differentiation= elated mood, grandiosity, decreased need for sleep, hypersexuality, and irritable mood.
  14. 17. Comorbidity (cont.) <ul><li>Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD) </li></ul><ul><ul><li>70-75% </li></ul></ul><ul><li>Substance Abuse </li></ul><ul><ul><li>40-50% </li></ul></ul><ul><li>Anxiety Disorders </li></ul><ul><ul><li>35-40% </li></ul></ul>
  15. 18. Suicidal Behaviors <ul><li>Prevalence of suicide attempts </li></ul><ul><ul><li>40-45% </li></ul></ul><ul><li>Age of first attempt </li></ul><ul><li>Multiple attempts </li></ul><ul><li>Severity of attempts </li></ul><ul><li>Suicidal ideation </li></ul>
  16. 19. Cognitive Deficits <ul><li>Executive Functions </li></ul><ul><li>Attention </li></ul><ul><li>Memory </li></ul><ul><li>Sensory-Motor Integration </li></ul><ul><li>Nonverbal Problem-Solving </li></ul><ul><li>Academic Deficits </li></ul><ul><ul><li>Mathematics </li></ul></ul>
  17. 20. Psychosocial Deficits <ul><li>Relationships </li></ul><ul><ul><li>Peers </li></ul></ul><ul><ul><li>Family members </li></ul></ul><ul><li>Recognition and Regulation of Emotion </li></ul><ul><li>Social Problem-Solving </li></ul><ul><li>Self-Esteem </li></ul><ul><li>Impulse Control </li></ul>
  18. 22. Psychopharmacological <ul><li>DEPRESSION </li></ul><ul><ul><li>Mood Stabilizers </li></ul></ul><ul><ul><ul><li>Lamictal </li></ul></ul></ul><ul><ul><li>Anti-Obsessional </li></ul></ul><ul><ul><ul><li>Paxil </li></ul></ul></ul><ul><ul><li>Anti-Depressant </li></ul></ul><ul><ul><ul><li>Wellbutrin </li></ul></ul></ul><ul><ul><li>Atypical Antipsychotics </li></ul></ul><ul><ul><ul><li>Zyprexa </li></ul></ul></ul><ul><li>MANIA </li></ul><ul><ul><li>Mood Stabillizers </li></ul></ul><ul><ul><ul><li>Lithium, Depakote, Depacon, Tegretol </li></ul></ul></ul><ul><ul><li>Aypical Antipsychotics </li></ul></ul><ul><ul><ul><li>Zyprexa, Seroquel, Risperdal, Geodon, Abilify </li></ul></ul></ul><ul><ul><li>Anti-Anxiety </li></ul></ul><ul><ul><ul><li>Benzodiazepines </li></ul></ul></ul><ul><ul><ul><ul><li>Klonopin, Ativan </li></ul></ul></ul></ul>
  19. 23. Therapy <ul><li>Psychoeducation </li></ul><ul><li>Family Interventions </li></ul><ul><li>Cognitive-Behavioral Therapy </li></ul><ul><li>RAINBOW Program </li></ul><ul><li>Interpersonal and Social Rhythm Therapy </li></ul><ul><li>Schema-focused Therapy </li></ul>
  20. 24. EDUCATIONAL IMPLICATIONS
  21. 25. IDEA Classification <ul><li>Emotional Disturbance (ED) vs. Other Health Impaired (OHI) </li></ul>
  22. 26. Considerations <ul><li>Rapidly changing moods of depression, irritability, grandiosity, pressured speech, racing thoughts, etc. </li></ul><ul><li>Need for movement </li></ul><ul><li>Poor relationships </li></ul><ul><li>Difficulties with concentration and focus </li></ul><ul><li>Difficulties with task completion </li></ul><ul><li>Impaired judgment and imulsivity </li></ul><ul><li>Disorganization </li></ul><ul><li>Becoming overwhelmed with stressful situations </li></ul>
  23. 27. Possible Accommodations/Modifications <ul><li>Provide student with a safe place and person to go to when feeling overwhelmed or stressed </li></ul><ul><li>Shortened day (permit late start as needed) </li></ul><ul><li>Prior notice of transitions </li></ul><ul><li>Consistent schedule </li></ul><ul><li>Scheduling the student’s most challenging tasks at a time of day when the child is best able to perform </li></ul><ul><li>Modified or shortened assignments </li></ul><ul><li>Plan for unstructured times of the day </li></ul><ul><li>Adjust for medication needs, dispensing, as well as plans for addressing side effects (e.g., sedation) </li></ul>
  24. 28. Other Considerations <ul><li>Educating staff </li></ul><ul><li>Communication </li></ul><ul><li>Hospitalization </li></ul>
  25. 29. RESOURCES <ul><li>BOOKS/BOOKLETS: </li></ul><ul><ul><li>Mondimore, F. (1999). Bipolar disorder: A guide for patients and families . City: Johns Hopkins Press. </li></ul></ul><ul><ul><li>Geller, B., & DelBello, M. P. (Eds.). (2003). Bipolar disorder in childhood and early adolescence . New York: Guilford Press. </li></ul></ul><ul><ul><li>Educating the child with bipolar disorder. Available from: www.bpkids.org </li></ul></ul><ul><ul><li>Anderson, M., Kubisak, J.B., Field, R., & Vogelstein, S. (2003). Understanding and educating children and adolescents with bipolar disorder: A guide for educators . </li></ul></ul>
  26. 30. RESOURCES <ul><li>WEBSITES: </li></ul><ul><ul><li>The Child and Adolescent Bipolar Foundation </li></ul></ul><ul><ul><ul><li>www.bpkids.org </li></ul></ul></ul><ul><ul><li>Depression and Bipolar Support Alliance </li></ul></ul><ul><ul><ul><li>www.dbsalliance.org </li></ul></ul></ul><ul><ul><li>The Bipolar Child </li></ul></ul><ul><ul><ul><li>www.bipolarchild.com </li></ul></ul></ul><ul><ul><li>Parents of Bipolar Children </li></ul></ul><ul><ul><ul><li>www.bpparent.org </li></ul></ul></ul><ul><ul><li>The Gray Center for Social Learning and Understanding </li></ul></ul><ul><ul><ul><li>www.thegraycenter.org/Social_Stories.htm </li></ul></ul></ul><ul><ul><li>National Institute of Mental Health (NIMH) </li></ul></ul><ul><ul><ul><li>www.nimh.org </li></ul></ul></ul>

×