bipolar+disorder
DESCRIPTION
TRANSCRIPT
Epidemiology, Educational Implications, and Interventions
DSM-IV-TR
Five types of episodes
Four subtypesFour severity levelsThree course
specifiers
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision. Washington, DC: Author.
Manic Episode
Symptoms:1. Inflated self-esteem or grandiosity2. Decreased need for sleep 3. Pressured speech or more talkative than
usual4. Flight of ideas or racing thoughts5. Distractibility6. Psychomotor agitation or increase in
goal-directed activity7. Hedonistic interests
Hypomanic EpisodeSimilarities with Manic Episode =
Same symptoms
Differences = Length of timeImpairment not as severe
Major Depressive EpisodeSymptoms:1. Depressed mood (in children can be irritable)2. Diminished interest in activities3. Significant weight loss or gain4. Insomnia or hypersomnia5. Psychomotor agitation or retardation6. Fatigue/loss of energy7. Feelings of worthlessness/inappropriate guilt8. Diminished ability to think or
concentrate/indecisiveness9. 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.
SubtypesBipolar 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 ) IrritabilityDepression Lack of mood
reactivity Rejection
sensitivityLess evident are
the “classic” symptoms of mania
PrevalenceEstimated between 3-6%Subsyndromal bipolar disorderEqual distribution across gender variablesAverage age @ onset = 20 years old
CourseInitial cycle typically major depressive episodeRecoveryRelapseRapid Cycling
Rapid cycling=4 episodes/yearUltrarapid cycling=5-364 episodes/yearUltradian cycling=>365 episodes/year
Age at OnsetPediatric, prepubertal, or early adolescent
(prior to age 12)Adolescent (12 - 18 years)Adult onset (+ 18 years)
ComorbidityAttention Deficit Hyperactivity Disorder
(ADHD)Between 60-80%
Criteria ComparisonBipolar Disorder (mania)1. More talkative than
usual, or pressure to keep talking
2. Distractibility3. Increase in goal
directed activity or psychomotor agitation
ADHD1. Often talks
excessively2. Is often easily
distracted by extraneous stimuli
3. 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.)
Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD)70-75%
Substance Abuse40-50%
Anxiety Disorders35-40%
Suicidal BehaviorsPrevalence of suicide attempts
40-45%Age of first attemptMultiple attemptsSeverity of attemptsSuicidal ideation
Cognitive DeficitsExecutive FunctionsAttentionMemorySensory-Motor IntegrationNonverbal Problem-SolvingAcademic Deficits
Mathematics
Psychosocial DeficitsRelationships
PeersFamily members
Recognition and Regulation of EmotionSocial Problem-SolvingSelf-EsteemImpulse Control
Psychopharmacological
DEPRESSIONMood Stabilizers
Lamictal
Anti-Obsessional Paxil
Anti-Depressant Wellbutrin
Atypical Antipsychotics Zyprexa
MANIAMood Stabillizers
Lithium, Depakote, Depacon, Tegretol
Aypical Antipsychotics Zyprexa, Seroquel,
Risperdal, Geodon, Abilify
Anti-Anxiety Benzodiazepines
Klonopin, Ativan
TherapyPsychoeducationFamily InterventionsCognitive-Behavioral TherapyRAINBOW Program Interpersonal and Social Rhythm TherapySchema-focused Therapy
EDUCATIONAL IMPLICATIONS
IDEA ClassificationEmotional Disturbance (ED) vs. Other Health
Impaired (OHI)
ConsiderationsRapidly changing moods of depression,
irritability, grandiosity, pressured speech, racing thoughts, etc.
Need for movementPoor relationshipsDifficulties with concentration and focusDifficulties with task completionImpaired judgment and imulsivityDisorganizationBecoming overwhelmed with stressful
situations
Possible Accommodations/ModificationsProvide student with a safe place and person to
go to when feeling overwhelmed or stressedShortened day (permit late start as needed)Prior notice of transitions Consistent scheduleScheduling the student’s most challenging tasks
at a time of day when the child is best able to perform
Modified or shortened assignmentsPlan for unstructured times of the dayAdjust for medication needs, dispensing, as well
as plans for addressing side effects (e.g., sedation)
Other ConsiderationsEducating staffCommunicationHospitalization
RESOURCESBOOKS/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.
RESOURCESWEBSITES:
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