Transcript early onset bipolar disorder

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