• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Illinois Doc Assist Bipolar Depression Presentation
 

Illinois Doc Assist Bipolar Depression Presentation

on

  • 1,881 views

Distinguishing Pediatric Bipolar Disorder from Depression in the Primary Care Setting

Distinguishing Pediatric Bipolar Disorder from Depression in the Primary Care Setting

Toya Clay, MD

Statistics

Views

Total Views
1,881
Views on SlideShare
1,762
Embed Views
119

Actions

Likes
0
Downloads
21
Comments
2

3 Embeds 119

http://www.psych.uic.edu 115
file:// 2
http://www.carolsim.com 2

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel

12 of 2 previous next

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
  • helpful website that may help others. This website has practice exams for various nursing classes as well as videos, presentations, notes, nclex help, and many other tools that already are helping me. Hope they help


    http://www.rnpedia.com/
    Are you sure you want to
    Your message goes here
    Processing…
  • excellent information. for those of you who needs more detailed info, checkout http://NurseReview.Org
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Illinois Doc Assist Bipolar Depression Presentation Illinois Doc Assist Bipolar Depression Presentation Presentation Transcript

    • Illinois DocAssist Program Distinguishing Pediatric Bipolar Disorder from Depression in the Primary Care Setting Toya Clay, MD
    • Our Partners and Services • Illinois DocAssist is a collaborative program of the Illinois Department of Healthcare and Family Services; the Department of Human Services/Division of Mental Health; the University of Illinois at Chicago Department of Psychiatry and the Illinois Children's Mental Health Partnership. • Services: – Problem-based consultation to guide the mental health and substance use assessment of children & youth and provide evidence-based treatment options, including medication management strategies – Education and technical assistance – Referral services to identify local community resource options Illinois DocAssist * 866-986-ASST (2778) 2 www.psych.uic.edu/docassist
    • Disclosure Information • Illinois DocAssist presenters have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services in this presentation. • Illinois DocAssist presenters do not intend to discuss commercial products, services or unapproved/investigative uses of a commercial product/device in this presentation. Illinois DocAssist * 866-986-ASST (2778) 3 www.psych.uic.edu/docassist
    • Outline • Role of the Primary Care Provider • Learning Objectives • Depressive Disorders: Criteria • Child and Adolescent Depression Facts and Special Considerations • Bipolar Disorders: Criteria • Pediatric Bipolar Disorder Facts and Special Considerations • Key Symptoms and Co-morbidities • Diagnostic Process for Mood Disorders in Children and Adolescents • Treatment Planning in Primary Care • Resources Illinois DocAssist * 866-986-ASST (2778) 4 www.psych.uic.edu/docassist
    • Role of the Primary Care Provider • Primary Care Providers (PCPs) as the major source of mental health care • PCPs are frequently asked by parents and teachers to evaluate a child for depression and other mood disorders • Not uncommon for the PCP to be first person who has opportunity to diagnose a mood disorder • Early recognition, assessment, and management, can realign the educational and psychosocial development of most children with a mood disorder • Many patients will go undiagnosed and untreated if their clinicians are not prepared to consider the diagnosis of a mood disorder Illinois DocAssist * 866-986-ASST (2778) 5 www.psych.uic.edu/docassist
    • Learning Objectives • Define child and adolescent depression • Define pediatric Bipolar Disorder and differences in how it is conceptualized • Describe how different sources of information contribute to the diagnostic process (screening tools, parent reports, school reports, etc.) • Discuss the key symptoms and co-morbidities for both disorders • Understand the importance of course of illness, severity, and level of impairment in distinguishing the two disorders and determining a treatment plan (management in PC setting vs. consultation/ co-managing with mental health professional) Illinois DocAssist * 866-986-ASST (2778) 6 www.psych.uic.edu/docassist
    • Major Depression DSM-IV symptom criteria • Depressed mood or irritable in children/adolescents • Diminished interest or pleasure • Decreased or increased appetite • Insomnia or hypersomnia • Recurrent thoughts of death • Psychomotor agitation or retardation • Fatigue or loss of energy • Feelings of worthlessness or guilt • Inability to think or concentrate Illinois DocAssist * 866-986-ASST (2778) 7 www.psych.uic.edu/docassist
    • Diagnosing Depression: Mnemonic C – concentration problems S – sleep disturbance A – appetite changes I – interest reduced P – psychomotor changes G – guilt & self-blame S – suicidal thoughts E – energy loss & fatigue Illinois DocAssist * 866-986-ASST (2778) 8 www.psych.uic.edu/docassist
    • Major Depression DSM-IV additional criteria • Major Depressive Episode (MDE): – 5 or more symptoms needed with at least one being depressed mood or loss of interest (anhedonia) – Symptoms present for 2 week period – Clear change from previous functioning – Significant “(D)istress and/or (D)ysfunction” in social, school, etc. – Not due to a drug; not due to a medical condition – Not better accounted for by bereavement – Not a Mixed (Bipolar) episode Illinois DocAssist * 866-986-ASST (2778) 9 www.psych.uic.edu/docassist
    • Other Depressive Disorders • Major Depressive Disorder (MDD) – 2 MDEs separated by at least 2 months – Not better accounted for by a Psychotic Disorder – No hx of a Bipolar Episode (Mixed, Manic, Hypomanic) • Dysthymic Disorder – In youth, depressed/ irritable mood for 1 year – Other symptoms similar to MDE except absence of recurrent thoughts of death and loss of interest – During the year, not a 2 month period without symptoms Illinois DocAssist * 866-986-ASST (2778) 10 www.psych.uic.edu/docassist
    • Adolescent Depression Facts • About 1 in 20 teens suffer from Depression (JAMA, 2004) • 1/3 of US teens with Depression receive treatment (King, 1991) • Up to 75% of youth with a Major Depressive Episode will experience a recurrence within 5 years (Birmaher, et al 1996) Illinois DocAssist * 866-986-ASST (2778) 11 www.psych.uic.edu/docassist
    • Diagnosing Depression in Children and Adolescents • Pre-pubertal children vs. older adolescents • Common adolescent symptoms: – Frequent Atypical Features: • Low self esteem and rejection sensitivity • Psychomotor depression /hypersomnia – Apathy, boredom – Increased irritability: anger, hostility, yelling – Substance use – Change in weight, sleep or grades – Aggression/antisocial behavior – Social withdrawal Illinois DocAssist * 866-986-ASST (2778) 12 www.psych.uic.edu/docassist
    • Bipolar/ Mania DSM-IV Symptom Criteria A. Mood: distinct period of at least 1 week of elevated, expansive or irritable mood B. Associated symptoms: 3/7 or 4/7 (if irritable mood) 1. Inflated self-esteem/grandiosity 2. Decreased need for sleep 3. Flight of ideas/racing thoughts 4. Poor judgment or hypersexuality 5. Distractibility 6. Goal-directed activity 7. Talkative/pressured speech Illinois DocAssist * 866-986-ASST (2778) 13 www.psych.uic.edu/docassist
    • Bipolar/ Mania DSM-IV Additional Criteria • Bipolar Mania – Clear change from previous functioning – Significant “(D)istress and/or (D)ysfunction” in social, school etc., or necessitates hospitalization, or psychotic features are present – Not do to a drug; Not due to a medical condition – Not a Mixed (Bipolar) episode Illinois DocAssist * 866-986-ASST (2778) 14 www.psych.uic.edu/docassist
    • Other Bipolar Disorders • Mixed Episode • Hypomanic Episode • Bipolar I • Bipolar II • Bipolar NOS • Cyclothymic Disorder Illinois DocAssist * 866-986-ASST (2778) 15 www.psych.uic.edu/docassist
    • Pediatric Bipolar Facts • BD occurs in at least l-2% of the adolescent and adult population, with bipolar spectrum disorders (such as recurrent depression) believed to occur in 5-7% • No studies have measured prevalence in younger children, but the number of children diagnosed is rising as doctors begin to recognize signs of the disorder in children • 59% of adults with BD surveyed by the National Depressive and Manic-Depressive Association in 1993 reported that symptoms of their illness appeared during or before adolescence • Time between onset of symptoms and diagnosis is 8- 10 years, longer for pediatric cases • Symptoms of BD resemble symptoms of ADHD with some important distinctions Illinois DocAssist * 866-986-ASST (2778) 16 www.psych.uic.edu/docassist
    • Diagnosing Bipolar Disorder in Children and Adolescents Strict DSM-IV Mania Broadly applied; “Severe mood dysregulation” Frequency Rare Most common type Mood type Euphoria Irritability, agitation (can be irritable) Episodicity Lasting 4-7 days Several changes within a day +/- chronic irritability Developmental Labile, changeable mood same common in school-age kids; considerations verbal skills underdeveloped; energy level high Symptom overlap Few but pretty clear Many syndrome Illinois DocAssist * 866-986-ASST (2778) 17 www.psych.uic.edu/docassist
    • Overlapping Signs and Symptoms 1 Depression Mania/ Mixed ADHD ODD PTSD Irritability Often present Often Present Often present, low Loses temper, Often present, frustration tolerance angry, argues Outbursts of anger Sleep Changes Insomnia Decreased need Insomnia common Difficulty falling or staying Hypersomnia for sleep, asleep insomnia Impulsivity Impulsive poor Present judgment Talkativeness Present, Present Anxious verbosity Pressured speech Aggression Often present Often present Verbal aggression, Outburst of anger/ occasional (impulsive or (impulsive or reactive) occasional impulsive aggression, reactive) provocative Re-enactments physical aggression Hyperactivity/ Psychomotor Present, Present Can be present, “nervous energy,” Restlessness agitation driven/ goal- Provokes and anxious restlessness, agitation directed behavior annoys others Concentration- Impaired Flight of ideas, Inattentive, Hypervigilance, related concentration Racing thoughts, distractible, Flashbacks, and memory; distractibility Forgetful, Intrusive memories preoccupation careless with mood Sexually Often present Occasionally present Occasionally Often Present inappropriate (impulsive) present behavior (provocative) Illinois DocAssist * 866-986-ASST (2778) 18 www.psych.uic.edu/docassist
    • Overlapping signs and symptoms 2: Mania/ Mixed vs ADHD +ODD Mania/ Mixed ADHD ODD Irritability Often Present Often present, low Loses temper, angry, frustration tolerance argues Sleep Changes Decreased need for Insomnia common sleep, insomnia Impulsivity Impulsive poor judgment Present Talkativeness Present, Present Pressured speech Aggression Often present Often present Verbal aggression, (impulsive or reactive) (impulsive or reactive) occasional provocative physical aggression Hyperactivity/ Present, Present Can be present, Restlessness driven/ goal-directed Provokes and annoys behavior others Inattentive, distractible, Concentration-related Flight of ideas, Forgetful, Racing thoughts, careless distractibility Sexually inappropriate Often present Occasionally present Occasionally present behavior (impulsive) (provocative) Illinois DocAssist * 866-986-ASST (2778) 19 www.psych.uic.edu/docassist
    • Diagnostic Process for Mood Disorders in Children and Adolescents Illinois DocAssist * 866-986-ASST (2778) 20 www.psych.uic.edu/docassist
    • Diagnostic Process for Mood Disorders in Children and Adolescents • Interviews – Parent, Child, and Teacher – Discrepancies common; must understand discrepancy – Family psychiatric history important; kids with BD parents at increased risk but still more likely to have Depression than BD • Screening tools can help – Young Mania Rating Scale (YMRS); parent version – Mood Disorder Questionnaire (MDQ) – Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) Illinois DocAssist * 866-986-ASST (2778) 21 www.psych.uic.edu/docassist
    • Diagnostic Process for Mood Disorders in Children and Adolescents • Careful assessment for other co-morbid or mimicking disorders – Use developmental knowledge – Note: diagnostic validity of BD in preschool children has yet to be established • Suicide Assessment • Medical Work-up • Severity and Impairment (“Distress and Dysfunction”) Assessment – Psychotic features, suicidality, severe aggression: • Prompt emergent assessment by psychiatrist – School failure, moderate aggression, substance abuse, risky behavior: • Consultation with psychiatrist/ referral for psychiatric evaluation • Consider psychopharm RX in consultation with psychiatrist Illinois DocAssist * 866-986-ASST (2778) 22 www.psych.uic.edu/docassist
    • Acknowledgments Illinois Department of Healthcare and Family • Services Illinois Department of Human Services/Division of • Mental Health Julie A. Carbray PhD, APN, BC and Mani • Pavuluri, M.D., Directors Pediatric Mood Disorders Clinic Institute for Juvenile Research University of Illinois at Chicago Illinois DocAssist * 866-986-ASST (2778) 23 www.psych.uic.edu/docassist
    • Resources Articles: 1)Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder. J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY. 46:1, Jan 2007 Websites/Guides: 1) UIC Pediatric Mood Disorders Clinic www.psych.uic/pmdc 2) Child and Adolescent Bipolar Foundation www.cabf.org 3) Depression and Bipolar Support Alliance www.dbsalliance.org -online story for kids: The Storm in My Brain Illinois DocAssist * 866-986-ASST (2778) 24 www.psych.uic.edu/docassist
    • Illinois DocAssist Program The mission of the Illinois DocAssist Program is to improve the ability of primary care providers to screen, diagnose and treat the mental health and substance use problems of children and youth (ages 21 and under). For more information about DocAssist call 866-986-ASST (2778) or visit our website at: www.psych.uic.edu/DOCASSIST Illinois DocAssist * 866-986-ASST (2778) 25 www.psych.uic.edu/docassist
    • Thank You