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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.

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Early onset bipolar disorder

EARLY ONSET BIPOLAR DISORDER:

Epidemiology, Educational Implications, and Interventions

Shelley Hart

[email protected]



Dsm iv tr
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
Manic Episode

Symptoms:

  • Inflated self-esteem or grandiosity

  • Decreased need for sleep

  • Pressured speech or more talkative than usual

  • Flight of ideas or racing thoughts

  • Distractibility

  • Psychomotor agitation or increase in goal-directed activity

  • Hedonistic interests


Hypomanic episode
Hypomanic Episode

  • Similarities with Manic Episode =

    • Same symptoms

  • Differences =

    • Length of time

    • Impairment not as severe


Major depressive episode
Major Depressive Episode

Symptoms:

  • Depressed mood (in children can be irritable)

  • Diminished interest in activities

  • Significant weight loss or gain

  • Insomnia or hypersomnia

  • Psychomotor agitation or retardation

  • Fatigue/loss of energy

  • Feelings of worthlessness/inappropriate guilt

  • Diminished ability to think or concentrate/indecisiveness

  • Suicidal ideation or suicide attempt


Mixed episode
Mixed Episode

Both Manic and Major Depressive Episode criteria are met nearly every day for a least a one week period.


Subtypes
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
Children vs. Adults (or early vs. late onset )

  • Irritability

  • Depression

  • Lack of mood reactivity

  • Rejection sensitivity

  • Less evident are the “classic” symptoms of mania



Prevalence
Prevalence

  • Estimated between 3-6%

  • Subsyndromal bipolar disorder

  • Equal distribution across gender variables

  • Average age @ onset = 20 years old


Course
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
Age at Onset

  • Pediatric, prepubertal, or early adolescent (prior to age 12)

  • Adolescent (12 - 18 years)

  • Adult onset (+ 18 years)



Comorbidity
Comorbidity

  • Attention Deficit Hyperactivity Disorder (ADHD)

    • Between 60-80%


Criteria comparison

Bipolar Disorder (mania)

More talkative than usual, or pressure to keep talking

Distractibility

Increase in goal directed activity or psychomotor agitation

ADHD

Often talks excessively

Is often easily distracted by extraneous stimuli

Is often “on the go” or often acts as if “driven by a motor”

Criteria Comparison

Differentiation= elated mood, grandiosity, decreased need for sleep, hypersexuality, and irritable mood.


Comorbidity cont
Comorbidity(cont.)

  • Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD)

    • 70-75%

  • Substance Abuse

    • 40-50%

  • Anxiety Disorders

    • 35-40%


Suicidal behaviors
Suicidal Behaviors

  • Prevalence of suicide attempts

    • 40-45%

  • Age of first attempt

  • Multiple attempts

  • Severity of attempts

  • Suicidal ideation


Cognitive deficits
Cognitive Deficits

  • Executive Functions

  • Attention

  • Memory

  • Sensory-Motor Integration

  • Nonverbal Problem-Solving

  • Academic Deficits

    • Mathematics


Psychosocial deficits
Psychosocial Deficits

  • Relationships

    • Peers

    • Family members

  • Recognition and Regulation of Emotion

  • Social Problem-Solving

  • Self-Esteem

  • Impulse Control


Treatment approaches
TREATMENT APPROACHES


Psychopharmacological

DEPRESSION

Mood Stabilizers

Lamictal

Anti-Obsessional

Paxil

Anti-Depressant

Wellbutrin

Atypical Antipsychotics

Zyprexa

MANIA

Mood Stabillizers

Lithium, Depakote, Depacon, Tegretol

Aypical Antipsychotics

Zyprexa, Seroquel, Risperdal, Geodon, Abilify

Anti-Anxiety

Benzodiazepines

Klonopin, Ativan

Psychopharmacological


Therapy
Therapy

  • Psychoeducation

  • Family Interventions

  • Cognitive-Behavioral Therapy

  • RAINBOW Program

  • Interpersonal and Social Rhythm Therapy

  • Schema-focused Therapy


Educational implications
EDUCATIONAL IMPLICATIONS


Idea classification
IDEA Classification

  • Emotional Disturbance (ED) vs. Other Health Impaired (OHI)


Considerations
Considerations

  • 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 imulsivity

  • Disorganization

  • Becoming overwhelmed with stressful situations


Possible accommodations modifications
Possible Accommodations/Modifications

  • 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
Other Considerations

  • Educating staff

  • Communication

  • Hospitalization


Resources
RESOURCES

BOOKS/BOOKLETS:

  • 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.


Resources1
RESOURCES

WEBSITES:

  • The Child and Adolescent Bipolar Foundation

    • www.bpkids.org

  • Depression and Bipolar Support Alliance

    • www.dbsalliance.org

  • The Bipolar Child

    • www.bipolarchild.com

  • Parents of Bipolar Children

    • www.bpparent.org

  • The Gray Center for Social Learning and Understanding

    • www.thegraycenter.org/Social_Stories.htm

  • National Institute of Mental Health (NIMH)

    • www.nimh.org


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