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Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children and Adolescents Jointly sponsored by SUNY: Buffalo & NY State Office of Mental Health, in conjunction with The REACH Institute. This activity is supported solely by the joint sponsors, and received no commercial support of any kind. Wanda Fremont MD 1/27/12 Special thanks: The REACH Institute

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Page 1: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

ADHD or Bipolar Disorder?Assessment and Differential

Diagnosis ofBipolar Disorder in Children and

Adolescents

ADHD or Bipolar Disorder?Assessment and Differential

Diagnosis ofBipolar Disorder in Children and

Adolescents

Jointly sponsored by SUNY: Buffalo & NY State Office of Mental Health,

in conjunction with The REACH Institute. This activity is supported solely

by the joint sponsors, and received no commercial support of any kind.

Wanda Fremont MD 1/27/12

Special thanks:

The REACH Institute

Page 2: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Prevalence in Community Samples of Pediatric Bipolar Disorder:

<1%

Prevalence in Community Samples of Pediatric Bipolar Disorder:

<1%

Author Measure Bipolar I Bipolar II Bipolar NOS

Carlson and Kashani (1988)

DICA 0.6% 7.0% 10.0%

Lewinsohn et al. (1996)

K-SADS 0.1% 0.06% 0.3%

Costello et al. (1996) CAPA 0.0% 0.1%

Shaffer/MECA DISC 1.2 0.6

Page 3: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Criteria for Manic Episode (I)Criteria for Manic Episode (I)DSM criteria written with adults in mindA. Distinct period of abnormally and persistently elevated, expansive, or

irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1) Inflated self-esteem or grandiosity

2) Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3) More talkative than usual or pressure to keep talking

4) Flight of ideas or subjective experience that thoughts are racing

5) Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7) Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

(Adapted from DSM-IV-TR, 2000)

Page 4: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Bipolar Disorder in Children:The Broad Phenotype

Bipolar Disorder in Children:The Broad Phenotype

• There is a large group of children who show many manic symptoms

– Especially the affective storms & rages

– Don’t clearly cycle between mood states

– May not have bipolar in family pedigree

– Severe Mood Dysregulation (Leibenluft et al 2003)

• Are these bipolar cases? – Will they grow up to look more classic?

Page 5: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Developmental Differences in the Expression of Manic and Depressive Symptoms

Developmental Differences in the Expression of Manic and Depressive Symptoms

Weckerly J., Developmental Behav. Ped.,Vol 23, No. 1, 42-56.

Page 6: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

SYMPTOM ADULT CHILD

Racing thoughts

Jumping from one thought to another in an illogical manner

Describes mind is like a video on fast forward

Pressured speech

Hard to interrupt and not phased when you do

Child talks continuously and difficult to redirect

Developmental Differences in the Expression of Manic and Depressive Symptoms

Developmental Differences in the Expression of Manic and Depressive Symptoms

Weckerly J., Developmental Behav. Ped.,Vol 23, No. 1, 42-56.

Page 7: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

ADHD vs. BipolarADHD vs. Bipolar

• Irritability is non-specific:

– Irritability does not = Bipolar

– Geller et al 2002 found irritability in 72% of Children with ADHD and 97.9% of Children with Bipolar Disorder

• Again elation, grandiosity, flight of ideas/racing thoughts, decreased need for sleep and hypersexuality provide the best discrimination between ADHD and BD in children and adolescents (Geller et al 2002)

Page 8: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

The Unipolar Depression vs.Bipolar Distinction

The Unipolar Depression vs.Bipolar Distinction

• First mood episode of pediatric bipolar disorder is often a depressive episode

• MDD in children often associated with high rates of irritability…i.e., children with depression can present with irritable mood, not depressed mood

• Children and adolescents with major depressive disorder can have very labile mood

• What do you mean by mood swings? – euthymia to depressed vs. depressed to manic or

hypomanic

Page 9: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Substance Abuse vs.Pediatric Bipolar Disorder

Substance Abuse vs.Pediatric Bipolar Disorder

• The substance abuse may mimic a bipolar presentation– Check urine drug screens, educate patients and

families

• There are high rates of co-morbid substance abuse in adolescents with bipolar disorder– The substance abuse must be addressed

Page 10: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Conduct Disorder vs.Pediatric Bipolar Disorder

Conduct Disorder vs.Pediatric Bipolar Disorder

• Conduct Disorder– The negative

behaviors areoften calculating and predatory

• Pediatric Bipolar– The negative

behaviors are secondary to grandiosity and risky, poor judgment

Page 11: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

With Pediatric Bipolar DisorderThere Are High Rates of

Co-occurring Psychiatric Conditions

With Pediatric Bipolar DisorderThere Are High Rates of

Co-occurring Psychiatric Conditions

• ADHD

• ODD

• Conduct Disorder

• Learning Disabilities

• Substance Abuse

• Anxiety Disorders

Individually orin combination

Page 12: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

A Family History ofBipolar Disorder

A Family History ofBipolar Disorder

• Take a careful family psychiatric history

– Bipolar disorder in one parent = 5x odds of bipolar disorder in child (but still only ~5% prevalence; LaPalme et al., 1997), still less than likelihood of ADHD

– Bipolar disorder in parents, grandparents, and siblings is clinically meaningful but doesn’t rule out “bad” ADHD

– The presence of bipolar disorder in more distant relatives may not confer greater genetic risk

– No clear family history doesn’t rule out pediatric bipolar disorder

Page 13: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Pediatric Bipolar Rating ScalesPediatric Bipolar Rating Scales

• Young Mania Rating Scale for Parents P-YMRS (Gracious et al. JAACAP,2002) – the scale can be found at www.healthyplace.com/bipolar/p-ymrs.asp

• General Behavioral Inventory, GBI (Findling et al. Bipolar Disorder, 2002)– Self and parent report ages 5-17– Very long tool 73 mood items

• Life Mood Charts– Asking about mood symptoms throughout the patient’s life– Can be found at www.dballiance.org

• These rating scales do a better job of ruling out pediatric bipolar disorder then ruling it in

• Still very helpful to follow symptoms to assist with diagnosis and to follow symptoms

Page 14: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

SummarySummary• In evaluating pediatric bipolar disorder look for classic

criteria– elevated mood, grandiosity, decreased need for sleep,

racing thoughts

• High rates of psychiatric co-morbidity– Especially ADHD, ODD, Conduct Disorder and Learning

disabilities

• Careful family history– Focus on first and second degree relatives

• Rating scales do a better job of ruling out pediatric bipolar disorder then ruling it in

• If significantly concerned get a child psychiatry consultation

Page 15: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Bipolar DisorderTreatment Options

Bipolar DisorderTreatment Options

Page 16: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

FDA Pediatric Labeling for BDFDA Pediatric Labeling for BD

Brand name Generic Name Indicated Age

Cibalith-S Lithium citrate 12 and older

Eskalith Lithium CO312 and older

Lithobid Lithium CO3 12 and older

Risperdal Risperidone 10 and older

Abilify Aripiprazole 10 and older

Zyprexa Olanzapine 10 and older

Seroquel Quetiapine 10 and older

Page 17: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Updated Treatment Algorithm for Mania/

Hypomania in Children

& Adolescents

Updated Treatment Algorithm for Mania/

Hypomania in Children

& Adolescents

Page 18: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Depression Switching toBipolar Disorder

Depression Switching toBipolar Disorder

• Prepubertal depression BD

– Limited outcome studies

– 24/72 (33%) MDD children BD-I at age 20, 11/72 (11%) BD-II or hypomania (Geller et al., 2001)

• Adolescent depression BD

– Limited studies

– 58 MDD inpatients followed up in 24 months Overall: 5/58 (8.6%) BD; 0/40 without psychotic symptoms, 5/18 (28%) with psychotic

symptoms (Strober et al., 1992)

– Epidemiological sample; 275 teens with MDD, < 1% BD by age 24 (Lewinsohn et al., 2000)

– 5/26 (19%) of MDD adolescents had BD after ~7 year follow-up (compared to 0% of controls) (Rao et al.,1995)

Page 19: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Switching to Bipolar Disorder with Antidepressants:

Switching to Bipolar Disorder with Antidepressants:

• Antidepressants may induce mania in children with a bipolar diathesis

– In a survey of child and adolescent psychiatrists: 10/228 (4.4%) of children under 13 y/o treated by psychiatrists switched to BD (Reichart & Nolen, 2004)

– Treatment for Adolescent Depression Study (TADS), of 439 12-17 year olds: 0 switches to BD after 12-week follow-up (2004)

– large private insurance database, 5.4% switch rates, increased risk for youth on antidepressants and risk greatest for age group of 10-14 y/o (San Martin et al., 2004)

Page 20: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Switching to Bipolar Disorder with Stimulants:

Switching to Bipolar Disorder with Stimulants:

• Concerns that stimulants may precipitate mania or destabilize children with bipolar who are not stabilized on other medications

– However…

– In the Multimodal Treatment Study of Children with ADHD (MTA), children with ADHD and some manic symptoms responded well to stimulants with decrease in ADHD symptoms and without increased rates of developing bipolar disorder (Galanter et al 2003, 2005)

– “Follow-back” study of children originally diagnosed and treated for “minimal brain dysfunction.”

Those diagnosed with bipolar spectrum disorders as young adults had responded well to stimulants as children

Those children with more comorbidities did not develop higher rates of bipolar as compared to those with uncomplicated ADHD (Carlson et al 2000)

Page 21: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

CAP PC: Child and Adolescent Psychiatry for Primary Care

Providers: Consultation, Education and

Linkage/Referral Support:Wanda Fremont MD

1/27/12

Special thanks to David Kaye MD

Page 22: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

OMH EFFORTS TO ADDRESS THE NEEDS OF PCPs FOR INCREASED SUPPORT

FROM CAPsProject TEACH (Training and Education for

the Advancement of Children’s Health)

Two Project TEACH programs covering NYS:

1. CAPES (Child and Adolescent Psychiatry Education and Support)

Northeastern NY State – Jeff Daly MD

2. CAP PC: (Child and Adolescent Psychiatry for Primary Care)

Rest of NY State – David Kaye MD , (5 Medical Univ)

Page 23: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

CAP PC:The program’s intent is to

provide support for PCPs to manage children and

adolescents with mild-moderate mental health problems and to

assist with linkage/referral services for those patients

Page 24: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

CAP PC Collaboration:$2.6 million 3 yr grant

NY State Office of Mental Health American Academy of Pediatrics

American Academy of Family Medicine (AAFP)

NY State Conference of Local Mental Hygiene Directors

Page 25: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

5 Academic University Centers:

Columbia UniversityLong Island Jewish /Northshore

SUNY BuffaloSUNY Upstate

University of Rochester

Page 26: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

CAP PC SERVICES

1. Phone consultation/Linkage Referral

2. Website

3. Face to Face Consultation

4. REACH training

5. Outcomes Evaluation

Page 27: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Most Common Childhood Problems:

1. ADHD

2. Anxiety

3. Depression

4. Behavioral Problems

Page 28: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

What CAPPC Grant Does Not Cover:

• Childhood Schizophrenia• Bipolar Disorder• Moderate or Greater Intellectual Disability• Substance Abuse• Persons who have had their 22nd birthday• Persons seriously and persistently

mentally ill, whatever the diagnosis (es)

Page 29: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

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1. Phone Consultation and Linkage/referral

Page 30: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

ANY PCP in the State of New York is eligible to call the

1-855-CAP-PC72 line

1-855-227=7272

(9-5 M-F, excluding holidays)

For child psychiatric consultations by phone.

Page 31: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Coverage is provided :Coverage is provided :

Monday: Upstate SyracuseTuesday: LIJ/NSU

Wednesday: ColumbiaThursday: Buffalo ChildrensFriday: Rochester (Strong)

Page 32: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Regional Site Teams

Each site team consists of a:

1. Child/adolescent Psychiatrist

2. Liaison Coordinator (MSW/PhD)

Page 33: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Work Flow for Phone Consultations

The Liaison Coordinator will take the initial phone call and will

respond to all calls within their scope of training and expertise.

If a child psychiatrist is appropriate or requested then

the covering CAP will return the phone call within 2 hours.

Page 34: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

HIPPA IHIPPA IPhone calls are considered

educational consultations to the PCP about patient management, not a clinical service to patients. It is

critical that PCPs maintain patient confidentiality and that

communications are HIPPA-compliant in these phone calls.

Identifying health information will NOT be requested and should not

be provided! De-identified demographic information about you and the patient will be requested to provide feedback and evaluation of

the project.

Page 35: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

HIPPA II HIPPA II

While informed consent is not required for HIPPA -compliant

discussion of patient care issues by telephone, CAP PC

encourages PCPs to inform families and obtain verbal consent about these phone

consultations

Page 36: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

PCP Cheat Sheet

• Contact information for you

• Patient grade in school; support services?

• Global assessment of function score

• Screens completed: ?Vanderbilt; ?PSC

• Insurance

• Current mental health treatment

• Psychotropic med history

• Medical history

• Family history of mental illness

Page 37: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

2. WEBSITE

Cappcny.org

Page 38: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Website Contents:

• Screening Tools: e.g. Vanderbilt, SCARED, PHQ9, MOAS, PSC17 and 35

• Links: AAP Bright Futures, AACAP Practice

• References

Page 39: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

3. FACE TO FACE CONSULTS

OPENto ALL PCPs

in NEW YORK STATE(Direct or Telepsych)

Page 40: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Face to Face ConsultationsSelected cases will be seen for a

one time only face-to-face (or telepsychiatric if the patient is

geographically distant from one of the program sites) consultation

with a program child psychiatrist. Face to face (FTF) evaluations will be scheduled within a few weeks

with the local child/adolescent psychiatrist (CAP).

Page 41: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Selection of Face to Face Consultations

FTF evaluation will be offered for cases which are

diagnostically confusing or complex, or it is unclear

whether it is appropriate for PCP management.

Page 42: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Face to Face Evaluations are Consultations Only

Face to face evaluations are consultations only; patients cannot

be picked up by the child psychiatrist for ongoing treatment

and medication management. Please be sure to educate your

patients/families about this.

Page 43: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Our Promise

Following completion of the FTF evaluation, verbal feedback and

a written report will be provided by the evaluating CAP to the

referring PCP.

Page 44: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Emergency Cases

In urgent situations PCPs may call

the 1-855 line for assistance with

referral to an appropriate emergency service in the

region. Face to face evaluations will not be scheduled on an

urgent basis and should NOT be looked to for emergency cases!

Page 45: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Jumping the Queue for Linkage/Referral

AssistancePlease note that CAP PC can not

provide assistance with referral and linkage services for routine cases. These cases should be referred to

local mental health agencies or child mental health professionals in private practice. The same is true

for patients/families who have been dismissed from mental health agencies or clinics because of

noncompliance or poor attendance.

Page 46: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

4. Education:REACH TRAINING

Page 47: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

About REACH

• Yearly three day continuing education workshop

• Developed by Peter Jensen, Child Psychiatrist

• Interactive dynamic innovative

• Open to 20-25 PCPs in each of the 5 sites

• Biweekly conference calls for the next 6 months

• Up to 32 hours FREE CME

Page 48: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

5. Outcomes Assessment

Page 49: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Important requirements for the use of the CAP-PC service

• Necessity of Evaluation– Required by New York State as part of this

program• What is involved- details are still being

worked out– Clinician practice questionnaire-

• Before this training• End of this training• After phone call meetings• At some future time

Page 50: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Important requirements for the use of the CAP-PC service

• Evaluation of phone consultations and face-to-face consultations–Brief questionnaire follow-up about

ease of access and usefulness of consultations

–Brief questionnaire follow-up about further contacts with the child, the implementation of recommendations, and the functioning of the child.

Page 51: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Direction for the Future

• With regard to moderately to severely intellectually disabled patients, we recommend that this group be the subject of discussion between OMH and OMRDD with the goal of coming up with a pilot project similar to CAP-PC to serve this chronically underserved population.

Page 52: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Summary 1-855-CAP-PC72www.cappcny.org

• Phone consultation/Linkage Referral

• Website

• One time Face-to-Face Consults

• REACH training• Outcomes Evaluation

Page 53: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Page 54: Copyright © 2011 The REACH Institute. All rights reserved. ADHD or Bipolar Disorder? Assessment and Differential Diagnosis of Bipolar Disorder in Children

Copyright © 2011 The REACH Institute. All rights reserved.

Thank you!Thank you!

QUESTIONS?QUESTIONS?