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Early Onset Bipolar Disease by Mind Map: Early Onset Bipolar Disease
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Early Onset Bipolar Disease

Practitioner Dos and Don'ts

Dos

Be a collaborator

Listen

Be empathic

Separate the child from the symptoms

Avoid blame

Be willing to refer

Don'ts

Don't talk about the child in front of the child.

Don't ignore mood

New nodeDon't blame children for lack of treatment success

Diagnosis

USE MULTIPLE INFORMANTS!!

Presenting Symptoms

Common Presenting Symptoms in Children, Episodes of deprssed mood/hopelessness, Excessive mood lability, Periods of increased or decreased energy, episodes of decreased need for sleep, anger dyscontrol, markedly irritable moods, frequent argumentativeness, bold/intrusive/demanding behaviors

Adolescent Presentation, discrete episodes of mania and depression, rapid symptom onset, mood-congruent psychotic features, hospitalization more common due to severity

Early Onset BPD vs. Adult BPD, Less discrete episodes, often mixed states, ultrarapid cycling, sometimes cycling more then once a day (ultradian), irritability across episodes, emotionally labile, explosive outbursts

Difficult to diagnose

Why?, Low base rate, Variable clinical presentation, Effects of development on presentation, High comorbidity!, ADHD 40-90%, Anxiety disorders 20-40%, Conduct Disorders 20 to 50%, ODD 20-60%, Disorder not clearly defined by the profession

Differential diagnosis

ADHD, persistent vs. episodic in nature, ADHD earlier onset

Conduct Disorder, CD usually longer standing, BPD more likely to have family history of affective disorder

Psychosis/Schizophrenia, Hard to differentiate during mania--need to observe closely, BPD commonly misdiagnosed as schizophrenia, look for family history of schizophrenia or schizotypal disorder, Determine premorbid symptoms

Diagnostic Instruments

Young Mania Rating Scale (YMRS), Parent Version (PDF)

Child Mania Rating Scale (CMRS), Parent Version (PDF)

K-SADS Mania Rating Scale

Child Behavior Checklist (CBL)

Assess for suicide!

Mood Tracking

Track relationships between

Symptoms

Behavior

Medication

Environmental variables

Online Mood Tracking

healthyplace.com mood journal

moodchart.org, part of a research study, Sends daily email summaries., Allows easy restrospective charting.

Offline Mood Charts

Software, bStable, Comprehensive system for, patients, family members, health care providers, Tracks:, moods, exercise, medication, hospitalization records, clinical notes, from McGraw Systems for $99

Printable, Monthly charts, Excel or PDF, Succinct introduction to charting, Charts for children, Very accessible for kids!, Blank chart and example, Mass General Mood Chart (PDF), NIMH Mood Chart (PDF)

Professional Articles

AAACAP Practice Parameters (PDF)

CABF Workgroup Treatment Guidelines (PDF)

Course and Outcome of Bipolar Spectrum Disorder in Children and Adults: A Review of the Literature (PDF)

Pediatric bipolar disorder: Evidence for its diagnostic validity and recommendations for making the diagnosis (PDF)

The Role of the Family in the Course and Treatment of Bipolar Disorder (PDF)

Psychosocial Interventions for Children with Early-Onset Bipolar Spectrum Disorder.

Bipolar Disorder in Childhood and Adolescence (PDF)

Treatment

First Line: Pharmacotherapy

MONITOR CLOSELY!, Encourage parents to monitor and chart symptoms and side effects, Don't let side effects settle in too long., Small changes in meds can sometimes make a big difference.

Encourage use of Pharmacotherapy Algorithm, Algorithm Diagram (PDF), Link to more info

Know principles of EOBPD prescription hygiene, Obtain history, Rapidly wean off all ineffective medications, Discontinue SSRIs, Discontinue stimulants

Work closely with pediatricians/MHMR doctors/psychiatrists

Let parents know it can sometimes take a long time to get the meds adjusted correctly

Know the meds, Traditional mood stabilzers, Lithium, Only med FDA approved for EABPD, Divalproex sodium (Depakote), Carbamazepine (Tegretol), Lamotrogine (Lamictal), Atypical antipsychotics, Quetaipine (Seroquel), Olanzapine (Zyprexa), Ziprasidone (Geodon), Risperidone (Risperdel)

Second Line: Psychsocial

CBT Intervention, Psychoeducation, Medication compliance, Mood monitoring, Modify unhelpful thinking, Identify stressors/triggers, Family Communication, Sleep maintenance

Child- and Family-Focused CBT, Grounded in biological theory of excessive reactivity, Description Document (Word doc), Family conflict has high impact on symptoms, High levels of expressed emotion has negative impact too

Multi-family Psychoeducation Groups (MFPG)

Dialectical Behavior Therapy (DBT)

Interpersonal and Social Rhythm Therapy

Strategy for comorbid conditions

monitor and assess w/condition-specific instruments

Stabilize BPD symptoms

IF comorbid conditions have negative effect on functioning sequentially treat with, symptom specific medication, may aggravate BPD symptoms, psychosocial interventions, dont' generally cause mood dysregulation

Important Points

Family involvement CRUCIAL!!

Prescription hygiene critical.

Attack it from all sides., medication, parent education, psychosocial therapy, web-based support

Assess for suicide.

EOPBD Controversies

Does it exist?

Three lines of evidence, One of the most heritable of the mental illnesses., Adult form more common and earlier age of onset than previously recognized., Efforts to validate the construct warrants additional investigation.

Is it over-diagnosed?

Possible reasons for "popularity" of diagnosis, Scholarly/medical research increased, BPParents ListServ, Papalos and Papalos 1999 book The Bipolar Child, Increased media exposure, Pharmaceutical advertising, Pharmaceutical company provided mood charting

Disagreement in the profession

Inconsistent diagnostic criteria

Inconsistent research design

Inconsistent terminology

Inconsistencies considered by some to be a black mark on the entire profession

Resources

Online Resources

NIMH-Bipolar Disorder in Children

www.depressedteens.com

Childhood and Adolescent Bipolar Foundation, About Bipolar Disorder in Children, Bookstore, Resource Links, research articles

Depression and Bipolar Support Alliance

American Academy of Childhood and Adolescent Psychiatry (AACAP) Bipolar Info, Excellent resource page, Facts for Families page

Facing Us, Depression and Bipolar Support Alliance site, An online "clubhouse", "peer-based, recovery-oriented empowering services and resources when, where and how they want them."

Georgia Childhood Bipolar Foundation, Techniques for dealing with a Bipolar Child

Juvenile Bipolar Support Alliance

Books

List of Books for Children

Interactive Book for Young Children

List of Books for Parents

The Life of a Bipolar Child: What Every Parent and Professional Needs to Know. 2000. T. Carlson

Understanding and Educating Children and Adolescents with Bipolar Disorder: A Guide for Educators. 2003. M. Andersen, J.

Videos

Rescuing Childhood: Understanding Bipolar Disorder in Children and Adolescents

News Story

Bipolar Disorder: A Documentary

Good Growing: Bipolar Disorder

List of DVDs/Audio