This document discusses the assessment and treatment of bipolar disorder in children and adolescents. It notes that pediatric bipolar disorder often presents differently than the classic adult form, with symptoms of intense irritability and emotional dysregulation being more common. There is ongoing debate around the diagnosis of bipolar disorder in youth and whether the adult treatment literature can be applied. While mood stabilizers and atypical antipsychotics are used, polypharmacy is common and long-term safety is still being evaluated.
Bipolar disorder is a mood disorder characterized by periods of mania and depression. It can be diagnosed at any age but typically emerges in teens and early twenties. There are three main types: bipolar I, bipolar II, and mixed bipolar. Bipolar disorder in children tends to involve rapid cycling between mood states and behavioral issues like irritability and tantrums. The cause is unknown but believed to involve genetic and environmental factors. Treatment involves medication, therapy, and lifestyle changes. School accommodations for children with bipolar disorder may include preferential seating, scheduled breaks, and individualized scheduling.
Bipolar disorder was originally thought to primarily affect juveniles in the 1990s. It is estimated that 15-28% of cases begin before age 13 and 50-66% before age 19. Symptoms are often misdiagnosed as ADHD, and up to 1/3 of children diagnosed with ADHD may actually have juvenile bipolar disorder. A study following 263 children with bipolar disorder for 2 years found that 70% recovered from their first episode but relapsed an average of 3 times, showing the chronic nature of the disorder in youth.
This is a presentation I did for Pediatric Grand Rounds at Akron Children's Hospital in the summer of 2010 on the diagnosis and treatment of bipolar disorder in kids. The content is still very current in 2012...the term "Disruptive Mood Dysregulation Disorder" has been substituted for "Temper Dysregulation Disorder" in the debate on the DSM-V. Here's a link to the video:
https://www.akronchildrens.org/cms//b42450956e85aa39/index.html
Bipolar disorder is a mood disorder characterized by periods of mania and depression. During manic episodes, an individual may feel euphoric, irritable, and have increased energy and activity levels. Depressive episodes involve persistent sadness, loss of interest in activities, changes in appetite or sleep, feelings of worthlessness, and thoughts of death or suicide. Teachers should be aware of a student's medication schedule and side effects, communicate with parents, and provide classroom accommodations like allowing extra time to take medication or leave class. Having students do a research project on bipolar disorder can also help increase understanding of the condition.
The document discusses bipolar disorder in children and adolescents. It notes that the presentation of bipolar disorder can be different in children compared to adults, with symptoms often overlapping with other disorders like ADHD. Children may experience more mixed states and rapid cycling between moods. Treatment involves mood stabilizers and atypical antipsychotics, though their use requires monitoring side effects. The prognosis is often one of recovery from initial episodes but high rates of relapse.
C:\Documents And Settings\Anne Nuckolls\Desktop\Bipolar Disorderanuckolls
Bipolar disorder is a mood disorder characterized by periods of mania and depression. During manic phases, individuals experience elevated mood, hyperactivity, and reckless behavior. Depressed phases involve feelings of worthlessness, fatigue, and suicidal thoughts. Bipolar disorder is caused by biological and genetic factors and can be triggered by stress, with symptoms beginning most often between ages 15-25. Treatment involves medications like mood stabilizers and antipsychotics as well as psychotherapy and lifestyle changes.
The document discusses the controversy around diagnosing and treating pediatric bipolar disorder. It notes that powerful psychiatric drugs are being prescribed to very young children for bipolar disorder despite lack of evidence of their effectiveness for this use and serious potential side effects. Pharmaceutical companies have financially supported expanding the diagnosis and use of their drugs off-label in children. Critics argue this has led to overdiagnosis and overprescribing driven more by commercial and social factors than medical science.
This is characterized by recurrent episodes of mania and depression in the same patient.
Bipolar mood disorder is further classified into two according to DSM IV.
Bipolar I disorder
Bipolar II disorder
Bipolar disorder is a mood disorder characterized by periods of mania and depression. It can be diagnosed at any age but typically emerges in teens and early twenties. There are three main types: bipolar I, bipolar II, and mixed bipolar. Bipolar disorder in children tends to involve rapid cycling between mood states and behavioral issues like irritability and tantrums. The cause is unknown but believed to involve genetic and environmental factors. Treatment involves medication, therapy, and lifestyle changes. School accommodations for children with bipolar disorder may include preferential seating, scheduled breaks, and individualized scheduling.
Bipolar disorder was originally thought to primarily affect juveniles in the 1990s. It is estimated that 15-28% of cases begin before age 13 and 50-66% before age 19. Symptoms are often misdiagnosed as ADHD, and up to 1/3 of children diagnosed with ADHD may actually have juvenile bipolar disorder. A study following 263 children with bipolar disorder for 2 years found that 70% recovered from their first episode but relapsed an average of 3 times, showing the chronic nature of the disorder in youth.
This is a presentation I did for Pediatric Grand Rounds at Akron Children's Hospital in the summer of 2010 on the diagnosis and treatment of bipolar disorder in kids. The content is still very current in 2012...the term "Disruptive Mood Dysregulation Disorder" has been substituted for "Temper Dysregulation Disorder" in the debate on the DSM-V. Here's a link to the video:
https://www.akronchildrens.org/cms//b42450956e85aa39/index.html
Bipolar disorder is a mood disorder characterized by periods of mania and depression. During manic episodes, an individual may feel euphoric, irritable, and have increased energy and activity levels. Depressive episodes involve persistent sadness, loss of interest in activities, changes in appetite or sleep, feelings of worthlessness, and thoughts of death or suicide. Teachers should be aware of a student's medication schedule and side effects, communicate with parents, and provide classroom accommodations like allowing extra time to take medication or leave class. Having students do a research project on bipolar disorder can also help increase understanding of the condition.
The document discusses bipolar disorder in children and adolescents. It notes that the presentation of bipolar disorder can be different in children compared to adults, with symptoms often overlapping with other disorders like ADHD. Children may experience more mixed states and rapid cycling between moods. Treatment involves mood stabilizers and atypical antipsychotics, though their use requires monitoring side effects. The prognosis is often one of recovery from initial episodes but high rates of relapse.
C:\Documents And Settings\Anne Nuckolls\Desktop\Bipolar Disorderanuckolls
Bipolar disorder is a mood disorder characterized by periods of mania and depression. During manic phases, individuals experience elevated mood, hyperactivity, and reckless behavior. Depressed phases involve feelings of worthlessness, fatigue, and suicidal thoughts. Bipolar disorder is caused by biological and genetic factors and can be triggered by stress, with symptoms beginning most often between ages 15-25. Treatment involves medications like mood stabilizers and antipsychotics as well as psychotherapy and lifestyle changes.
The document discusses the controversy around diagnosing and treating pediatric bipolar disorder. It notes that powerful psychiatric drugs are being prescribed to very young children for bipolar disorder despite lack of evidence of their effectiveness for this use and serious potential side effects. Pharmaceutical companies have financially supported expanding the diagnosis and use of their drugs off-label in children. Critics argue this has led to overdiagnosis and overprescribing driven more by commercial and social factors than medical science.
This is characterized by recurrent episodes of mania and depression in the same patient.
Bipolar mood disorder is further classified into two according to DSM IV.
Bipolar I disorder
Bipolar II disorder
This document provides information about depression and bipolar disorder from the Depression and Bipolar Support Alliance (DBSA). It defines depression and bipolar disorder, describes their symptoms, types, causes, and prevalence. The guide aims to educate people about these illnesses and help those suffering from them seek treatment. It emphasizes that depression and bipolar disorder are treatable medical conditions, not character flaws or signs of weakness.
Diagnosis And Treatment Of Attention Defect Hyperactivity Disorder (ADHD)Arwa H. Al-Onayzan
ADHD is diagnosed through clinical history, examination, and sometimes investigations. It is characterized by inattention, hyperactivity, and impulsivity. Treatment includes non-pharmacological options like behavior management as well as pharmacological options like stimulant medications which are the first-line treatment.
The document discusses bipolar disorder, including its symptoms and potential biological causes. Bipolar disorder causes extreme shifts in mood from depression to mania. Studies show it can affect both adults and children. Possible biological causes include abnormal neurotransmitter levels and brain structure differences. Genetics also plays a role, as identical twins have a higher likelihood of both having the disorder. Effective treatment requires a combination of medication, typically lithium or antipsychotics, alongside psychotherapy. More research is still needed on therapy and determining the exact causes of bipolar disorder.
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
Bipolar disorder is a brain disorder that causes unusual shifts in mood and energy levels. It is characterized by periods of mania and depression. There are four main types of bipolar disorder defined by the severity and length of manic or depressive episodes. Bipolar disorder is caused by imbalances in brain chemistry and genetics, and often develops in late teens to early adulthood. Treatment involves mood stabilizing medications, antipsychotics, antidepressants, psychotherapy, and sometimes electroconvulsive therapy.
Dysthymia, or persistent depressive disorder, is a chronic form of depression that lasts for at least two years in adults and one year in children. Common symptoms include feelings of negativity, low self-esteem, and changes in appetite and sleep patterns. Approximately 3-6% of Americans experience dysthymia at some point. Women and African Americans have higher rates than other groups. Causes may include genetic, biological, environmental, and psychological factors. Treatment options include yoga therapy, which can help regulate mood and reduce stress through gentle stretching, breathing, and meditation exercises.
Common psycological cases in clinical practiceWafa sheikh
The document discusses common psychological cases seen in clinical practice such as depression among adolescents, adults, and the elderly as well as generalized anxiety disorder and panic attacks. It presents a case study of a 15-year-old adolescent named Faisal experiencing severe depression and anxiety and recommends a treatment plan of cognitive behavioral therapy and the antidepressant fluoxetine to address his conditions. Guidelines for diagnosing and treating adolescent depression are provided, including the effectiveness of cognitive behavioral therapy and SSRIs like fluoxetine, either alone or in combination.
Mood disorders in preschool and primary school childrenCatina Feresin
This document discusses mood disorders in preschool and primary school children. It proposes two new research studies: 1) including a teacher in Parent-Child Interaction Therapy when the caregiver shows affective disorders, to help the caregiver participate effectively in treatment; and 2) a three-step early prevention program in primary schools involving screening, diagnosis, and teacher-clinician collaboration on treatment to identify and treat mood disorders early. It also proposes using fMRI to study brain activity in depressed preschoolers undergoing therapy with and without teacher involvement. The goal is to validate approaches to better identify and treat mood disorders in young children to prevent psychiatric problems later in life.
Epilepsy is a disorder characterized by recurring seizures caused by abnormal electrical activity in the brain. A seizure is a brief, temporary disturbance in brain activity. While the specific cause is unknown in many cases, common causes include head trauma, brain infections, tumors, strokes, and genetic factors. Epilepsy is diagnosed based on the patient's medical history, symptoms, and tests like EEGs, CT scans, MRIs. Treatment involves medications, surgery, dietary changes, and lifestyle modifications to control seizures and allow patients to live normal lives.
Bipolar disorder is a brain disorder that causes shifts in mood and ability to function. People with bipolar disorder experience extreme episodes of mania and depression. It is a lifelong illness that typically develops in late adolescence or early adulthood. Bipolar disorder is caused by an imbalance of neurotransmitters in the brain and can be triggered by stress, though the underlying causes are unknown. Treatment involves mood stabilizing medications, psychotherapy, and lifestyle management.
The document discusses World Health Organization's 2017 World Mental Health Day campaign on depression. The campaign's goals were to educate the public about depression, its causes and consequences like suicide, and available prevention and treatment options. It provides global statistics on depression's prevalence, burden and lack of resources. The document outlines diagnostic criteria, screening methods, at-risk groups, contributing factors, impacts of untreated depression, and current policies and programs to promote mental health worldwide and in India. Prevention strategies include healthy lifestyle habits while treatment involves counseling, medication or a combination.
Identification of psychiatric disorders in primary care settingsSujit Kumar Kar
This document provides an overview of psychiatric disorders and their identification in primary care settings. It discusses common psychiatric conditions like mood disorders, schizophrenia, anxiety disorders, and substance use disorders. It outlines factors like biological, psychological, and socio-cultural elements that can contribute to developing a psychiatric disorder. The importance of early diagnosis and treatment in primary care is highlighted. Symptoms of psychiatric disorders that can present in primary care are described. Two case vignettes of patients presenting with obsessive-compulsive disorder and depression are then summarized. Key issues from each case are discussed.
Mood disorders are disturbances of emotions that affect many aspects of life. The three main types are depression, dysthymia, and bipolar disorder. Depression involves feeling sad for at least two weeks with symptoms like fatigue and guilt. Dysthymia is a chronic, milder form of depression lasting two years. Bipolar disorder causes alternating episodes of depression and mania, an elevated mood with increased energy. Treatment involves medication and psychotherapy, as finding an effective drug combination can take years due to side effects.
Anxiety definition, symptoms and risk factors include
Personality - Sensitive nature
Childhood history of anxiety
Female gender
Abuse of alcohol
Traumatic experience
Difficult childhood
Family history of anxiety disorders
Separation and divorce
Intoxication with alcohol, sedatives etc
Illness and medical conditions
. Generalized Anxiety Disorder and Separation Anxiety Disorder. treatment and therapy include- medication, cognitive behavioural therapy, exposure therapy, Mindfulness based cognitive therapy and certain lifestyle changes are also helpful in treating mild anxiety.
Bipolar disorder is a mental illness characterized by extreme mood swings from mania to depression. It affects about 0.6-0.9% of the population. While the exact cause is unknown, it is believed to involve genetic and environmental factors. Symptoms include changes in mood and behavior during manic, depressive, hypomanic or mixed episodes. There are several types of bipolar disorder that are diagnosed based on the severity and length of episodes. Treatment involves medications, psychotherapy, and in some cases electroconvulsive therapy, with the goals of managing mood swings and preventing relapse. Proper long-term treatment can help people with bipolar disorder lead productive lives.
This slide contains information regarding mood disorder and depression. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
Mental Health Nursing
Psychiatric Nursing
Dr. Rahul Sharma
Associate Professor
H.O.D. of Mental Health Nursing
Ph. D Coordinator
Seedling School of Nursing,
Jaipur National University, Jaipur
Bipolar disorder consists of three subsets: Bipolar I, Bipolar II, and Cyclothymia. Bipolar I involves severe mood swings that significantly impair functioning, while Bipolar II is a milder form with less severe episodes. Cyclothymia is the mildest form with milder highs and lows. The causes of bipolar disorder are believed to include biological, neurochemical, genetic, and environmental factors. Treatments include psychotherapy, medication, and sometimes hospitalization. Common medications are mood stabilizers, anticonvulsants, antidepressants, and antipsychotics.
This document provides information about bipolar disorder, including its symptoms, types, causes, effects, myths, and treatment. Bipolar disorder involves periods of elevated or irritable mood alternating with periods of depression. It is a serious mental illness caused by genetic and environmental factors that affect neurotransmitters in the brain. Bipolar disorder can impair individuals' relationships and job performance, and increase risks of suicide. Treatment involves medication, psychotherapy, lifestyle management, education, and social support.
This document describes the author's experience with bi-polar disorder and depression. It discusses how depression is experienced mentally rather than physically, with no clear locus or understanding of how to describe the pain. The author resorts to dramatic projects or substance abuse to dull the pain of depression. Physical pain is contrasted with the amorphous nature of depression which has no clear locus or understanding of when it will end. The author was recently diagnosed with bi-polar II disorder after experiencing depression for 45 years, and is learning this diagnosis could have helped them lead a more productive life if identified earlier.
Bipolar disorders involve extreme shifts in mood between mania and depression. During manic episodes, people may feel euphoric or irritable and display symptoms like inflated self-esteem, decreased need for sleep, racing thoughts, and involvement in risky behaviors. Bipolar disorders are thought to have biological and genetic causes, and episodes can be triggered by psychosocial stressors. They are diagnosed based on the duration and severity of mood episodes as outlined in the DSM-IV criteria. Bipolar disorder can emerge at any age and often involves comorbid conditions that complicate diagnosis and treatment.
This document provides information about depression and bipolar disorder from the Depression and Bipolar Support Alliance (DBSA). It defines depression and bipolar disorder, describes their symptoms, types, causes, and prevalence. The guide aims to educate people about these illnesses and help those suffering from them seek treatment. It emphasizes that depression and bipolar disorder are treatable medical conditions, not character flaws or signs of weakness.
Diagnosis And Treatment Of Attention Defect Hyperactivity Disorder (ADHD)Arwa H. Al-Onayzan
ADHD is diagnosed through clinical history, examination, and sometimes investigations. It is characterized by inattention, hyperactivity, and impulsivity. Treatment includes non-pharmacological options like behavior management as well as pharmacological options like stimulant medications which are the first-line treatment.
The document discusses bipolar disorder, including its symptoms and potential biological causes. Bipolar disorder causes extreme shifts in mood from depression to mania. Studies show it can affect both adults and children. Possible biological causes include abnormal neurotransmitter levels and brain structure differences. Genetics also plays a role, as identical twins have a higher likelihood of both having the disorder. Effective treatment requires a combination of medication, typically lithium or antipsychotics, alongside psychotherapy. More research is still needed on therapy and determining the exact causes of bipolar disorder.
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
Bipolar disorder is a brain disorder that causes unusual shifts in mood and energy levels. It is characterized by periods of mania and depression. There are four main types of bipolar disorder defined by the severity and length of manic or depressive episodes. Bipolar disorder is caused by imbalances in brain chemistry and genetics, and often develops in late teens to early adulthood. Treatment involves mood stabilizing medications, antipsychotics, antidepressants, psychotherapy, and sometimes electroconvulsive therapy.
Dysthymia, or persistent depressive disorder, is a chronic form of depression that lasts for at least two years in adults and one year in children. Common symptoms include feelings of negativity, low self-esteem, and changes in appetite and sleep patterns. Approximately 3-6% of Americans experience dysthymia at some point. Women and African Americans have higher rates than other groups. Causes may include genetic, biological, environmental, and psychological factors. Treatment options include yoga therapy, which can help regulate mood and reduce stress through gentle stretching, breathing, and meditation exercises.
Common psycological cases in clinical practiceWafa sheikh
The document discusses common psychological cases seen in clinical practice such as depression among adolescents, adults, and the elderly as well as generalized anxiety disorder and panic attacks. It presents a case study of a 15-year-old adolescent named Faisal experiencing severe depression and anxiety and recommends a treatment plan of cognitive behavioral therapy and the antidepressant fluoxetine to address his conditions. Guidelines for diagnosing and treating adolescent depression are provided, including the effectiveness of cognitive behavioral therapy and SSRIs like fluoxetine, either alone or in combination.
Mood disorders in preschool and primary school childrenCatina Feresin
This document discusses mood disorders in preschool and primary school children. It proposes two new research studies: 1) including a teacher in Parent-Child Interaction Therapy when the caregiver shows affective disorders, to help the caregiver participate effectively in treatment; and 2) a three-step early prevention program in primary schools involving screening, diagnosis, and teacher-clinician collaboration on treatment to identify and treat mood disorders early. It also proposes using fMRI to study brain activity in depressed preschoolers undergoing therapy with and without teacher involvement. The goal is to validate approaches to better identify and treat mood disorders in young children to prevent psychiatric problems later in life.
Epilepsy is a disorder characterized by recurring seizures caused by abnormal electrical activity in the brain. A seizure is a brief, temporary disturbance in brain activity. While the specific cause is unknown in many cases, common causes include head trauma, brain infections, tumors, strokes, and genetic factors. Epilepsy is diagnosed based on the patient's medical history, symptoms, and tests like EEGs, CT scans, MRIs. Treatment involves medications, surgery, dietary changes, and lifestyle modifications to control seizures and allow patients to live normal lives.
Bipolar disorder is a brain disorder that causes shifts in mood and ability to function. People with bipolar disorder experience extreme episodes of mania and depression. It is a lifelong illness that typically develops in late adolescence or early adulthood. Bipolar disorder is caused by an imbalance of neurotransmitters in the brain and can be triggered by stress, though the underlying causes are unknown. Treatment involves mood stabilizing medications, psychotherapy, and lifestyle management.
The document discusses World Health Organization's 2017 World Mental Health Day campaign on depression. The campaign's goals were to educate the public about depression, its causes and consequences like suicide, and available prevention and treatment options. It provides global statistics on depression's prevalence, burden and lack of resources. The document outlines diagnostic criteria, screening methods, at-risk groups, contributing factors, impacts of untreated depression, and current policies and programs to promote mental health worldwide and in India. Prevention strategies include healthy lifestyle habits while treatment involves counseling, medication or a combination.
Identification of psychiatric disorders in primary care settingsSujit Kumar Kar
This document provides an overview of psychiatric disorders and their identification in primary care settings. It discusses common psychiatric conditions like mood disorders, schizophrenia, anxiety disorders, and substance use disorders. It outlines factors like biological, psychological, and socio-cultural elements that can contribute to developing a psychiatric disorder. The importance of early diagnosis and treatment in primary care is highlighted. Symptoms of psychiatric disorders that can present in primary care are described. Two case vignettes of patients presenting with obsessive-compulsive disorder and depression are then summarized. Key issues from each case are discussed.
Mood disorders are disturbances of emotions that affect many aspects of life. The three main types are depression, dysthymia, and bipolar disorder. Depression involves feeling sad for at least two weeks with symptoms like fatigue and guilt. Dysthymia is a chronic, milder form of depression lasting two years. Bipolar disorder causes alternating episodes of depression and mania, an elevated mood with increased energy. Treatment involves medication and psychotherapy, as finding an effective drug combination can take years due to side effects.
Anxiety definition, symptoms and risk factors include
Personality - Sensitive nature
Childhood history of anxiety
Female gender
Abuse of alcohol
Traumatic experience
Difficult childhood
Family history of anxiety disorders
Separation and divorce
Intoxication with alcohol, sedatives etc
Illness and medical conditions
. Generalized Anxiety Disorder and Separation Anxiety Disorder. treatment and therapy include- medication, cognitive behavioural therapy, exposure therapy, Mindfulness based cognitive therapy and certain lifestyle changes are also helpful in treating mild anxiety.
Bipolar disorder is a mental illness characterized by extreme mood swings from mania to depression. It affects about 0.6-0.9% of the population. While the exact cause is unknown, it is believed to involve genetic and environmental factors. Symptoms include changes in mood and behavior during manic, depressive, hypomanic or mixed episodes. There are several types of bipolar disorder that are diagnosed based on the severity and length of episodes. Treatment involves medications, psychotherapy, and in some cases electroconvulsive therapy, with the goals of managing mood swings and preventing relapse. Proper long-term treatment can help people with bipolar disorder lead productive lives.
This slide contains information regarding mood disorder and depression. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
Mental Health Nursing
Psychiatric Nursing
Dr. Rahul Sharma
Associate Professor
H.O.D. of Mental Health Nursing
Ph. D Coordinator
Seedling School of Nursing,
Jaipur National University, Jaipur
Bipolar disorder consists of three subsets: Bipolar I, Bipolar II, and Cyclothymia. Bipolar I involves severe mood swings that significantly impair functioning, while Bipolar II is a milder form with less severe episodes. Cyclothymia is the mildest form with milder highs and lows. The causes of bipolar disorder are believed to include biological, neurochemical, genetic, and environmental factors. Treatments include psychotherapy, medication, and sometimes hospitalization. Common medications are mood stabilizers, anticonvulsants, antidepressants, and antipsychotics.
This document provides information about bipolar disorder, including its symptoms, types, causes, effects, myths, and treatment. Bipolar disorder involves periods of elevated or irritable mood alternating with periods of depression. It is a serious mental illness caused by genetic and environmental factors that affect neurotransmitters in the brain. Bipolar disorder can impair individuals' relationships and job performance, and increase risks of suicide. Treatment involves medication, psychotherapy, lifestyle management, education, and social support.
This document describes the author's experience with bi-polar disorder and depression. It discusses how depression is experienced mentally rather than physically, with no clear locus or understanding of how to describe the pain. The author resorts to dramatic projects or substance abuse to dull the pain of depression. Physical pain is contrasted with the amorphous nature of depression which has no clear locus or understanding of when it will end. The author was recently diagnosed with bi-polar II disorder after experiencing depression for 45 years, and is learning this diagnosis could have helped them lead a more productive life if identified earlier.
Bipolar disorders involve extreme shifts in mood between mania and depression. During manic episodes, people may feel euphoric or irritable and display symptoms like inflated self-esteem, decreased need for sleep, racing thoughts, and involvement in risky behaviors. Bipolar disorders are thought to have biological and genetic causes, and episodes can be triggered by psychosocial stressors. They are diagnosed based on the duration and severity of mood episodes as outlined in the DSM-IV criteria. Bipolar disorder can emerge at any age and often involves comorbid conditions that complicate diagnosis and treatment.
Bipolar disorder is a mood disorder characterized by periods of depression and periods of mania or hypomania. During manic or hypomanic periods, people experience hyperactivity, impulsivity, and overly optimistic or irritable moods. Depressive periods involve symptoms of major depression like difficulty concentrating and suicidal thoughts. Bipolar disorder can be difficult to diagnose and treatment often involves medication and therapy to help manage mood swings and related issues like anxiety or substance abuse. Living with bipolar disorder is challenging but possible to do successfully with proper treatment and lifestyle habits.
Quick Powerpoint depicting bipolar disorder, and my experience with it. Pictures included.
This a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
The document discusses mood and behavior management for patients with bipolar disorder in skilled nursing facilities. It notes that those in skilled nursing often face isolation, health issues, and sleep disturbances that can trigger bipolar episodes. Effective management includes maintaining regular routines, treating underlying symptoms, using behavioral chain analysis to address triggers, and helping staff regulate their own emotions to avoid exacerbating patients' conditions.
The document reviews evidence on the relationship between creativity and bipolar disorder. It finds that rates of bipolar disorder are higher among famous artists, writers, and musicians. It also finds that people with bipolar disorder or at risk for it show preferences for complex stimuli and rate themselves as creative, suggesting links between mild forms of bipolar disorder and enhanced creative thinking and accomplishments.
Bipolar disorder is a chronic illness that causes major shifts in mood and energy, impairing various areas of life. While not curable, effective treatment exists to control symptoms and the course of the disorder. Treatment may include hospitalization if the person is a danger to self or others or unable to function. Pharmacotherapy focuses on acute symptom suppression, continuation treatment to prevent symptom return, and maintenance treatment to prevent recurrence. Treatment options include mood stabilizers, antipsychotics, antidepressants, anticonvulsants, and combination drugs. Prognosis depends on factors like episode duration, age of onset, and substance abuse history. Psychotherapy and support groups can also help manage the disorder.
Bipolar disorder is a mental illness characterized by periods of depression and mania. During mania, people experience happiness, excitement, and increased energy, while depression causes low energy, loss of interest, and difficulty making decisions. Bipolar disorder can negatively impact self-esteem, judgment, concentration, and increase the risk of suicide. While the causes are not fully known, genetics and imbalances in brain chemistry likely play a role. Treatment involves medication and psychotherapy to manage mood swings and develop coping strategies. Common medications include lithium, Zyprexa, Seroquel, and Abilify. With proper treatment and support, many people with bipolar disorder can lead happy, successful lives.
The document discusses the history, definition, classification and symptoms of mood disorders. It notes that mood disorders have been described since ancient times and includes descriptions of depression, mania, bipolar disorder and their symptoms. Unipolar disorders involve only depression while bipolar disorders involve both depression and mania or hypomania. The document outlines the DSM-5 and ICD-10 classification criteria and diagnostic features of major depressive disorder, bipolar disorder, dysthymia and cyclothymia.
The document outlines treatment guidelines for bipolar disorder, beginning with initiating lithium, divalproex, aripiprazole, or a two-drug combination for patients not currently on medication or first-line medications. It then provides recommendations for augmenting or switching treatment based on a patient's response, including considering second-line, third-line, experimental, or ECT options if a patient does not respond adequately to first-line treatments. The guidelines list specific drug options for mono- and adjunctive therapy at different stages of treatment.
This document discusses differentiating between attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder in children. It poses four key questions about whether they are separate illnesses, overlapping syndromes, coexistent symptoms, or if ADHD is a warning sign of bipolar disorder. It then provides background on the history and diagnostic criteria of ADHD, as well as statistics on its prevalence. It also discusses the challenges of diagnosing pediatric bipolar disorder and lists common developmental manifestations of manic symptoms in children. The document notes that ADHD and bipolar disorder are highly comorbid conditions and explores some ways to differentiate between the two.
This document summarizes the case of an 18-year-old male engineering student diagnosed with bipolar disorder who has been admitted to the hospital three times previously. It outlines his medical history, symptoms, treatment goals and therapies including interpersonal social rhythm therapy, cognitive behavioral therapy, group therapy, and family focused therapy. It also summarizes several research studies supporting the use of these therapies for patients with bipolar disorder.
Bipolar disorder is a brain disorder that causes shifts in mood and energy levels. It can cause periods of mania and depression. There are four main types of bipolar disorder that are diagnosed based on symptoms and guidelines from the DSM. Treatment involves medications, therapy, social support and lifestyle changes. Famous people like Catherine Zeta-Jones and Vivien Leigh have been known to experience bipolar disorder.
Bipolar disorder causes extreme shifts in mood from mania to depression. It is a chronic illness often diagnosed in adolescence that has high rates of suicide. While the causes are unknown, genetic and environmental factors likely contribute. Diagnosis involves meeting DSM-5 criteria for manic or hypomanic episodes. Treatment includes medication, psychotherapy, and lifestyle changes. Lithium and anticonvulsants are commonly used to stabilize moods, while antidepressants may be used for depression but carry risk for inducing mania. Long-term management focuses on preventing recurrences through medication adherence and monitoring for risky behaviors.
This document provides information on the nursing management of clients with mania. It begins with definitions of mood and affect. It then discusses the classification and diagnosis of bipolar disorder and mania. The clinical manifestations of mania include elevated mood, decreased need for sleep, racing thoughts, and hyperactivity. Treatment involves hospitalization if needed for safety, along with pharmacotherapy including lithium, valproate, carbamazepine, benzodiazepines, and antipsychotics to reduce manic symptoms and prevent relapse. Close monitoring of the client and medication levels is important.
Bipolar disorder is characterized by recurrent episodes of mania and depression. It is classified into Bipolar I and II based on the severity of manic episodes. The exact causes are unknown but genetic and biochemical factors are thought to play a role. Clinical features include changes in mood, energy, sleep patterns, and risk-taking behavior. Treatment involves mood stabilizers like lithium, antipsychotics, and antidepressants to control symptoms and prevent future episodes. Prognosis depends on factors like comorbidities, stress levels, and medication compliance.
Bipolar disorder is a mental illness characterized by periods of depression and elevated mood. It is caused by both genetic and environmental factors that result in abnormalities in brain structure and function. The symptoms of bipolar disorder include nervousness, anxiety, sadness, talking very fast, inability to relax or sleep, being overly active, and thoughts of death or suicide. It is important to diagnose and treat bipolar disorder early through medication and therapy in order to prevent suicide, substance abuse, relationship problems, and work issues. Famous people who are known to have bipolar disorder include Vincent van Gogh, Elizabeth Taylor, Britney Spears, and Catherine Zeta-Jones.
Bipolar disorder is a cyclical mood disorder that results in pathological mood swings from mania to depression. It has been recognized and studied for hundreds of years. There is strong evidence that bipolar disorder has a genetic component, with family and twin studies showing increased risk among relatives of those diagnosed. While specific genetic variants have not been consistently identified, heritability is stronger for bipolar disorder than for unipolar depression. Proper diagnosis distinguishes between bipolar I and II, as well as related disorders like cyclothymia, based on the presence and duration of manic or hypomanic episodes.
Barclay Gr 11 19 08 Pediatric Bipolar Disorder Revised111708gpbmd
There is ongoing debate around the diagnosis and treatment of pediatric bipolar disorder (PBD). While PBD clearly exists, diagnostic criteria remain uncertain due to softening of guidelines and the influence of medication use. Most children diagnosed have comorbid conditions and fall into a "broad" phenotype category that may be over-diagnosed. Proper evaluation is important to differentiate PBD from other disorders, and treatment should be multimodal and avoid reliance solely on medication when possible. More research is still needed to establish best practices.
The document discusses the controversy around diagnosing pediatric bipolar disorder. It outlines key perspectives, diagnostic criteria, and a lack of conclusive research evidence. Symptoms used to diagnose bipolar disorder in children are subjective and overlap with other disorders. International views show more skepticism about the validity of the diagnosis in pre-pubescent children. Further research is still needed to definitively diagnose or rule out the existence of bipolar disorder in young children.
This document discusses adolescent depression, including its history, scope, causes, clinical manifestations, suicide risk, and management. It notes that depression is a common and serious medical illness in adolescents, with a prevalence of 4-8% having experienced depression in the past year. Left untreated, adolescent depression can lead to suicide, which is a leading cause of death among youth. The document explores the complexities in diagnosing and treating depression in adolescents due to developmental factors and outlines approaches to assessing and managing adolescent depression.
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This is the slide set to the lectures I provided to the medical staff of Child and Adolescent Behavioral Health in Canton, OH during the Fall-Winter of 2018
Zoned, Stoned And Blown - by Louis B. Cady, M.D. and Lisa Seif, LCSW, CADAC02...Louis Cady, MD
This presentation reviews the diagnosis, treatment, and sobriety maintenance of dual diagnosis disorders ( psychiatric disorders coupled with chemical dependency and/or alcoholism), using a synthetic blend of two talented clinicians' experiences, humor, and review of precision diagnosis, treatment formulations, and interventions.
This document discusses the treatment of depression in children and adolescents. It covers symptoms of depression, diagnostic criteria, course of illness, common comorbidities, treatment options including psychotherapy and medication management. Psychoeducation is recommended for all patients, while mild cases may only require supportive care. Moderate to severe depression is often treated with evidence-based therapies such as CBT or medication in addition to psychoeducation. The goals of treatment are response, remission, and recovery from depressive symptoms.
The document discusses the controversy around diagnosing and treating pediatric bipolar disorder. It notes a large increase in bipolar diagnoses in children despite many not meeting DSM-IV criteria. While medications are approved to treat bipolar disorder, they often cause weight gain and metabolic issues. The document proposes "temper dysregulation disorder" as an alternative for children presenting with irritability rather than clear mania or hypomania. Comprehensive treatment including medication and psychotherapy is recommended, though more research is still needed.
This document discusses bipolar disorder, including its prevalence, risk factors, clinical features, differential diagnosis, and neurobiology. Some key points:
- Bipolar disorder affects 1-3% of the population worldwide and has a strong hereditary component.
- It is associated with high rates of relapse, chronicity, cognitive impairment, and functional disability. Patients also have an increased risk of medical comorbidities.
- While genetic factors are important, environmental triggers like stressful life events can influence recurrence.
- Neurobiological studies have found abnormalities in monoaminergic neurotransmitter systems, but these have not fully explained the episodic nature and progression of bipolar disorder. It likely arises from complex gene-
“Teen Depression and Suicide,”
South Portland, Maine; April 26, 2005
Suicide Conference, Maine Suicide Prevention Program.
*Learn clinical presentation of adolescent depression
*Learn course and prognosis of pediatric depression
*Learn treatment of pediatric depression
*Discuss controversy of antidepressant medications in youth and suicidality
Bipolar disorder can present in children and adolescents with manic, hypomanic, or depressive episodes. It is a chronic and disabling condition associated with impaired functioning. Treatment involves medication, psychoeducation, and psychotherapy to stabilize mood symptoms, improve coping skills, and prevent recurrences. Lithium, anticonvulsants, and second-generation antipsychotics are commonly used but require careful monitoring due to side effect risks.
This document discusses the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adults, focusing on clinical aspects of medication management. It describes how stimulant medications like methylphenidate and amphetamines are the best documented and most effective treatment for ADHD symptoms. Behavioral therapies can also be effective, either alone or in combination with medication. The optimal treatment is medication management combined with behavioral therapy.
1) Pediatric mania may represent a developmental subtype of bipolar disorder that is characterized by predominantly irritable mood, a chronic rather than episodic course, and high rates of comorbidity with conditions like attention-deficit/hyperactivity disorder and conduct disorder.
2) Research has found high rates of ADHD (60-90%) in children and adolescents with mania, suggesting shared familial etiological factors.
3) The atypical presentation of pediatric mania, including irritability rather than euphoria and a chronic mixed state, has led to misdiagnoses; however, adolescent and adult longitudinal studies provide support for childhood-onset mania representing a valid disorder.
This document describes a study that aims to determine the prevalence and characteristics of attention deficit hyperactivity disorder (ADHD) in adults attending mental health outpatient clinics in Sligo/Leitrim, Ireland. The study will screen adult patients using self-report questionnaires, and those who screen positive will undergo further clinical testing. Data on demographics, comorbid conditions, and childhood and adult ADHD symptoms will be collected. The study aims to identify undiagnosed ADHD cases and understand the types of comorbid illnesses that are present.
This presentation reviews studies exploring reasons for the increased diagnosis of bipolar disorder in children and adolescents. It is hypothesized that the increase is due to a lack of understanding how bipolar disorder affects this age group. Strengths and limitations of studies are examined. Evidence indicates bipolar disorder beginning in childhood may be a more severe form of the illness than in older adolescents. The controversy around diagnosing children/adolescents separately from adults stems from debates around separately defining and criteria for the two age groups.
This presentation reviews studies exploring reasons for the increased diagnosis of bipolar disorder in children and adolescents. It is hypothesized that the increase is due to a lack of understanding how bipolar disorder affects this age group. Strengths and limitations of studies are examined. Evidence indicates bipolar disorder beginning in childhood may be a more severe form of the illness than in older adolescents. The controversy around diagnosing children/adolescents separately from adults stems from debates around separately defining and criteria for the two age groups.
Mike Stawski: Who are These People? A Profile of Patients and their Families ...Beitissie1
The document summarizes key findings from a study conducted by the Outpatient Unit for Neurodevelopmental Psychiatry (OUDP) at Schneider Children's Medical Center in Israel. The study aimed to profile patients and examine treatment effectiveness. It found that most patients had behavioral problems, physical disabilities, and prior psychotropic medication. Treatment at OUDP involved less antipsychotics, more non-medical interventions, and led to improvements in irritability. The study also found correlations between patients' adaptive skills, behavioral problems, and parental mental health.
This document discusses Attention Deficit Hyperactivity Disorder (ADHD). It defines ADHD as a neurodevelopmental disorder characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and inattention. The document reviews the prevalence, symptoms, diagnostic criteria, comorbid conditions, developmental course, and potential causes of ADHD. Causes discussed include genetics, neurological insults, and differences found in brain structure and function through neuroimaging studies.
Pediatric bipolar disorder by DR Reham A Abd elmohsenReham Abdelmohsen
- Paediatric bipolar disorder (PBD) is characterized by recurrent episodes of alternating moods between mania/hypomania and depression in children. It is associated with negative outcomes like academic and social difficulties.
- The prevalence of PBD is estimated to be 1-1.8% in children and 0.2-0.4% in adolescents. It commonly co-occurs with disorders like ADHD, oppositional defiant disorder, anxiety disorders, and substance abuse.
- Diagnosis involves using rating scales and interviews to assess mood episodes, symptoms, impairment, and risk factors while ruling out medical and neurological conditions. A thorough family and developmental history is also important.
This study assessed the longitudinal course of bipolar disorder in 413 youth over 4 years using weekly symptom ratings. The results showed:
- 81.5% of youth recovered from their initial episode within 2.5 years, but 62.5% experienced a recurrence, most often depression, within another 1.5 years.
- Youth experienced subsyndromal or syndromal mood symptoms for about 60% of the follow-up period, most often depressive or mixed symptoms.
- Outcomes were worse for those with early onset, long duration of illness, bipolar disorder not otherwise specified diagnosis, low socioeconomic status, and family history of mood disorders.
The study followed 413 youths with bipolar spectrum disorders for an average of 4 years. Key findings include:
1) About 80% recovered from their initial episode within 2.5 years, but recurrence rates were high, with 62.5% experiencing a new episode 1.5 years later, mainly depression.
2) Participants experienced mood symptoms for 60% of the follow-up period, particularly subthreshold depression and mixed states, with frequent changes in polarity.
3) Worse longitudinal outcomes were associated with early onset, diagnosis of bipolar disorder not otherwise specified, long illness duration, low socioeconomic status, and family history of mood disorders.
The study followed 413 youths with bipolar spectrum disorders for an average of 4 years. Key findings include:
1) About 80% recovered from their initial episode within 2.5 years, but recurrence rates were high, with 62.5% experiencing a new episode 1.5 years later, mainly depression.
2) Participants experienced mood symptoms for 60% of the follow-up period, particularly subthreshold depression and mixed states, with frequent changes in polarity.
3) Worse longitudinal outcomes were associated with early onset, diagnosis of bipolar disorder not otherwise specified, long illness duration, low socioeconomic status, and family history of mood disorders.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
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How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
2. Practice Parameter for the Assessment
and Treatment of Children and
Adolescents with Bipolar Disorder
Originally Published 1997
Revised, JAACAP, 2007, lead authors are
– Jon McClellan, MD
– Robert Findling, MD
– Robert Kowatch, MD
3. Bipolar Disorder
Areas of Debate
Bipolar Disorder in youth, especially Children,
typically has a different pattern of illness than the
classic adult syndrome
Is Juvenile Mania continuous with the adult onset
form?
Can the adult treatment literature be extrapolated to
children and adolescents?
How early can it be diagnosed?
4. Bipolar Disorder
Biphasic Disorder
– Well Demarcated Episodes of Mania and
Depression
– Episodes represent significant departure from
baseline functioning
Peak Ages of Onset Between 15 – 30 years
– Average age of Onset ~ 20 years of age
5. Bipolar Disorder
Bipolar I Disorder: At least one episode of Mania
Bipolar II Disorder: One or more episodes of Major
Depression and Hypomania, no Manic episodes
Cyclothymia: Numerous Hypomanic and Dysthymic
Episodes Persisting for at least One Year (Two years for
Adults)
Mixed Episode: Symptoms of Mania and a Major
Depressive Disorder, duration of at least 1 week
Rapid Cycling: At Least 4 Episodes of Mood disturbance
over a 12 month period
6. Bipolar Disorder
Manic Phase
n Persistently elevated mood (1 week or more)
n Pressured Speech
n Racing Thoughts
n Decreased Sleep
n Increased Energy
n Grandiosity
n Reckless or Dangerous Behavior
7. Pediatric Bipolar Disorder
Presentation Most often Considered “Atypical”
– Intense frequent outbursts of agitation, irritability
– Moods labile and reactive
– Course of illness varies from ultrarapid cycling to chronic baseline
impairment
High Rates of Comorbid Disruptive Behavioral Disorders, including
ADHD
– Mood problems common in children with behavioral disorders, but not part of
diagnostic criteria
Lots of Youth have significant emotional and behavioral
dysregulation that is not well characterized by current DSM categories
8.
9. Pediatric Bipolar Disorder
Is Pediatric Bipolar Disorder Continuous
with Classic Adult Onset Form?
– Epidemiology and Age of Onset
– Symptom Specificity and Course of Illness
– Longitudinal Follow-Up
– Family History
10. Bipolar Disorder
Epidemiology
Lifetime prevalence of bipolar I disorder in the general
population ranges from 0.4% to 1.6%, with an
additional ~ 0.5% having bipolar II (APA, 2000)
However, some studies of adults suggest rates as high
as ~ 6 % when including subthreshold or “spectrum”
cases (Judd and Akiskal, 2003)
Prevalence in Adults also a topic of debate
11. Pediatric Bipolar Disorder
Historically Onset Below Age 10 was thought to be Rare?
Surveys of Adult Patients
Kraeplin (1921): 0.4 % of 903 patients had onset below
age 10 years
Loranger and Levine, (1978): 0.5% (200 patients)
Goodwin and Jamison, (1990): 0.3% (898 patients)
However, later surveys (Lish et al., 1994; Perlis et al., 2004)
suggest symptoms commonly present first in childhood
Symptoms most often depression and hyperactivity
12. Pediatric Bipolar Disorder
Epidemiology
Most epidemiological surveys of youth have not assessed the disorder
Carlson and Kashani, 1988: Community Survey (14 - 16 yrs)
Lifetime prevalence of mania varied from 0.6% to 13.3%
depending on severity and duration criteria.
Great Smoky Mountains Study of Youth (Costello et al., 1996)
• Predominantly rural sample
• No cases of mania in 9, 11, or 13 year old youth
Lewinsohn et al., 1995: School Survey (ages 14 - 18 yrs)
1 % Lifetime Prevalence Rate (mostly Bipolar II)
6 % Subthreshold Symptomatology
13. Pediatric Bipolar Disorder
Diagnosis of bipolar disorder in youth is now common
Rates of hospitalization for pediatric bipolar disorder doubled
from 1995 – 2000 (Harpaz-Rotem et al., 2005)
Child & Adolescent Bipolar Foundation Survey:
• 24% of the respondents’ affected children (n = 854) were
between the ages of 1 and 8 years (Hellander, 2002).
Diagnosis being applied to preschoolers (Wilens et al., 2002)
High rates specific to US populations (Soutullo et al., 2005)
14. Prevalence of Bipolar Disorder Across Age Span?
9%
8%
7%
6%
5% Historical Definition
4% Pediatric Bipolar Disorder
3%
2%
1%
0%
< 10 Years 15 Years 30 years
15.
16. Pediatric Bipolar Disorder
Diagnostic Controversy
Symptom and Course of Illness Specificity
– Is all irritability manic?
– What is grandiosity in child?
– How do you define an episode?
– How do you differentiate behavior problems
from mood symptoms?
17. Juvenile Bipolar Disorder
Definitions (Geller et al., 2000)
Ultrarapid Cycling: Very brief frequent manic
episodes lasting hours to days (< 4 days)
5 – 364 cycles per year.
Ultradian Cycling: Repeated brief (minutes to hours)
cycles that occur daily.
> 365 cycles per year.
18. Pediatric Bipolar Disorder
Prepubertal and Early Adolescent Bipolar Disorder Phenotype
(PEA-BP)
10% Ultrarapid cycling & 77% Ultradian cycling
– None Met DSM – IV criteria for Rapid Cycling
– 3.7 ± 2.1 cycles per day
Average age of onset: 7.3 ± 3.5 years
Average duration of episode: 3.6 ± 2.5 years
High rate (87%) of comorbid ADHD
PEA-BP appears reliable and stable at 6 months, 1, 2 and 4
years
– A low rate of recovery over a four-year period
– Community Treatment (including mood stabilizers) did
not appear to impact outcome
Geller et al., 2000, 2002, 2004
19. Pediatric Bipolar Disorder
20 % of Children with ADHD (n = 206) met DSM-III-R
Criteria for mania
– Predominately mixed episodes, with irritability and
explosiveness
Average age of onset: 4.4 ± 3.1 years
Average duration of Illness: 3.0 ± 2.1 years
High rates (98%) of comorbid ADHD
– Also conduct disorder, anxiety and substance abuse
Chronic vs Cyclical Course
– 23 % “mania always present” (i.e., represents
baseline state of functioning)
Biederman et al., 2004, Wozniak et al. 1995
20. Pediatric Bipolar Disorder
Bipolar Disorder in Very Young Children
Wilens et al., (2002): 26% of preschoolers with
ADHD have bipolar disorder, a rate significantly
higher than found in their comparison school age
sample
21.
22. Pediatric Bipolar Disorder
Symptom Specificity
DSM manic symptoms
– grandiosity, psychomotor agitation, and reckless behavior
Common Symptoms of Childhood Disorders
– hyperactivity, irritability, dangerous play, and inappropriate
sexualized activity
Common Normal Childhood Phenomena
– boasting, imaginary play, overactivity, and youthful
indiscretions
“Manic” symptoms may be nonspecific markers for emotionality
and severity (Thuppal et al., 2002; Carlson et al., 1998; Hazell et
al., 2003)
23. Pediatric Bipolar Disorder
Symptom Specificity
Geller (2002) required elation and grandiosity as
part of diagnostic criteria
However, Definitions may lack Development Context
Elation
excessive silliness and giggling
Grandiosity
saying it is not wrong to steal after getting caught
believing he/she can grow up to be a famous athlete even
though he/she is not good at sports
Telling peers how to do homework when he/she fails to
do it themselves
24. Pediatric Bipolar Disorder
Specificity of Symptoms
Mania ADHD
Irritability Grumpy
Increased Energy Hyperactive
Pressured Speech Talking Fast
Reckless Behavior Reckless Behavior
Grandiosity Bragging
Distractibility Distractibility
Decreased Sleep Restless Sleeper
28. Pediatric Bipolar Disorder
Long Term Follow-up
Lewinsohn et al. (2000)
– DSM-IV-defined bipolar disorder during later adolescence
predicted continuity of the disorder at age 24 years
– Subsyndromal cases (e.g., bipolar disorder NOS): increase in
psychopathology and adverse outcomes as young adults
(including borderline and/or antisocial traits)
No Increase in bipolar disorder in the spectrum cases
Hazell et al. (2003) (6-year follow-up study)
– Manic symptoms in boys with ADHD did not persist or evolve
into DSM-IV-defined bipolar disorder
Atypical presentations persist (Geller et al., 2004; Biederman et al.,
2004), but so far do not appear to evolve into the classic form
29. Pediatric Bipolar Disorder?
ADHD versus Bipolar Disorder?
Manuzza et al., 1993: 91 males with ADD (mean age 18.3 years,
mean f/u 16 years) vs. 100 controls:
– Increased Rates of ADHD, Antisocial Personality Disorder and
Drug Abuse
– No cases of Bipolar Disorder
Weiss et al., 1985: 63 youth with ADD vs. 41 controls (ages 21 - 33
years):
– Increased rates of ADD symptoms/Antisocial Personality Disorder
– No Increase in Mood Disorders
30. Pediatric Bipolar Disorder?
ADHD versus Bipolar Disorder?
NIMH Multimodal Treatment Study of ADHD (MTA
Study)
– 579 children with ADHD (ages 7 to 9 years) at 6 sites
– No cases of bipolar disorder
For “bipolar disorder nos”, boys with ADHD plus manic-
like symptoms appear to respond as well as those without
manic symptoms to methylphenidate
Stimulant treatment did not precipitate progression into
bipolar disorder (Carlson et al., 2000; Carlson and Kelly,
2003; Galanter et al., 2003)
31. Pediatric Bipolar Disorder
Family History
The heritability of early-onset bipolar disorder appears
to be high (Faraone and Tsuang, 2003)
– Supports a link between juvenile and more typical
later-onset forms
However, studies have used broader definitions in both
youth and adults
– e.g., rates in control samples much higher than
expected in some family studies
32. Pediatric Bipolar Mania
Is it the same illness as the Classic Adult Illness?
Limited Evidence Suggests
Different Pattern of Illness
Different Age of Onset
Few Longitudinal Studies have not demonstrated juvenile
form progresses into the adult-onset form
Therefore, cannot readily extrapolate adult treatment
literature to juvenile mania
35. Pediatric Bipolar Disorder
Psychopharmacology
The effective of mood stabilizers and atypical
antipsychotic agents well established in adults
The adult treatment literature may not apply to the
juvenile form
Treatment response does not equal diagnosis
In youth, Polypharmacy is common, with some youth
taking five or more drugs (Duffy et al., 2005).
– Diagnosis associated with substantial increased use of
psychotropics in preschoolers (Zito et al., 2000)
36. Early Onset Bipolar
Disorder
Pharmacology
Child and Adolescent Bipolar Foundation Survey of
children and adolescents diagnosed with bipolar
disorder
– Anticonvulsants and Atypical Antipsychotics are
agents most often used
– Polypharmacy is common
14 % (n = 854) on 5 or more drugs
Hellander et al., 2002
37. Pediatric Psychopharmacology
Lithium
Few Positive Small Controlled Trials for Youth
with “manic-like” symptoms (Delong and Neiman,
1983; McKnew et al., 1981)
Helpful for Bipolar Disorder plus Substance Abuse
in Adolescents (Geller et al., 1998)
Large Open Label Trial (Kafantaris et al., 2003) (n
= 100) had a 63% response rate in adolescents with
Bipolar I
Lithium FDA Approved for Youth 12 years of age
or older with Bipolar
38. Pediatric Psychopharmacology
Valproate
FDA Approved for Acute Mania in Adults
May work better for rapid cycling or mixed episodes
No Controlled Trials for Juveniles
Dosing
Therapeutic Blood Levels 50 - 120 ug/ml
Potential Side-Effects
Hepatic
Hematologic
PolyCystic Ovary Disease
Drug-Drug Interactions (e.g., BCP)
39. Pediatric Psychopharmacology
Other Anticonvulants
Lamotrigine
Effective In Adult Studies of Bipolar Depression
Rash is greatest Concern
Oxcarbazepine
Few Adult Studies Show Efficacy
Negative Trial in Youth
Carbamazepine
Adult Studies Not as Robust as for VPA
Gabapentin
Large Controlled Trial in Adults was negative
40. Psychopharmacology of Early
Onset Bipolar Disorders
Atypical Antipsychotics
Case Reports and Adult Studies Suggest that Atypical
antipsychotics may be used as first line agents for youth
with manic and mixed manic episodes
Delbello et al., 2002: Double blind trial found
quetiapine plus valproate superior to valproate alone for
adolescent mania
Youth may be at greater risk for problems with weight
gain with atypical agents
41. Antipsychotics
Side-Effects
Youth appear to have the same spectrum of adverse events
noted in adults
With Atypical Agents, Metabolic Side Effects are the greatest
Concern
Youth appear to be at great risk for Weight Gain than
Adults
Long-term Safety Monitoring is Needed:
• ADA Guidelines for Metabolic Syndrome
Weight/BMI
Fasting Glucose
Triglycerides/Lipids
Blood Pressure
• Abnormal Movements
• Other Drug Specific Monitoring (e.g., ECG’s with
ziprasidone, liver functions, especially with weight gain)
42. Early Onset Bipolar Disorder
Psychopharmacology
Combined Therapies
Combinations of mood stabilizers may be helpful and
appear well tolerated in youth (Findling et al., 2003;
Kowatch et al., 2003).
Kafantaris et al., (2001) found lower relapse rates when
antipsychotic agents were maintained for at least four
weeks, in combination with lithium
Justification for polypharmacy better supported for classic
bipolar versus bipolar nos.
43. Early Onset Bipolar Disorder
Antidepressants
All Antidepressants have the potential risk of Inducing
Mania
Antidepressants should only added to stable mood
stabilizer regimens
SSRI’s may cause irritability, dysinhibition, or
hypomania, thus worsening aggression
FDA warnings regarding risk for increased suicidality in
youth with Paroxetine
Lamotrigine Effective in Adult Studies of Bipolar
Depression, may be a better alternative
44. Early Onset Bipolar Disorder
Stimulants
Despite concerns to the contrary, methylphenidate
has been found to be helpful in boys with ADHD
plus “manic-like” symptoms (Carlson et al., 2002;
Galanter et al., 2003)
For clearly defined bipolar disorder, stimulants are
generally avoided until mood symptoms are well
controlled with mood stabilizers
45. Early Onset Bipolar Disorder
Treatment Strategies
o Psychosocial Treatments as an adjunct to
Medications
Parent/Family Psychoeducation
Relapse Prevention
CBT or IPT for Depression
Interpersonal and Social Rhythm Therapy
Family Focused Therapy
Community Support Programs
46.
47. Bipolar Disorder Research at
Children’s Hospital
Social Rhythm Therapy for Adolescents
– Stefanie Hlastala Ph.D. 206 – 368 – 4813
Lithium For the Treatment of Pediatric Mania
– NICHD multi-center trial
– Recruitment to begin by ~ 3/07
Contact
– Jon McClellan MD 253 - 756- 2319
– Leslie Pierson 206 - 713 - 3717