EARLY ONSET BIPOLAR DISORDER: Epidemiology, Educational Implications, and Interventions Shelley Hart...
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Transcript of EARLY ONSET BIPOLAR DISORDER: Epidemiology, Educational Implications, and Interventions Shelley Hart...
EARLY ONSET EARLY ONSET BIPOLAR BIPOLAR
DISORDER:DISORDER:Epidemiology, Educational Epidemiology, Educational
Implications, and Implications, and InterventionsInterventions
Shelley [email protected]
DIAGNOSIS DIAGNOSIS
DSM-IV-TRDSM-IV-TR
Five types of Five types of episodesepisodes
Four subtypesFour subtypes Four severity levelsFour severity levels Three course Three course
specifiersspecifiers
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision. Washington, DC: Author.
Manic EpisodeManic Episode
Symptoms:Symptoms:1.1. Inflated self-esteem or grandiosityInflated self-esteem or grandiosity
2.2. Decreased need for sleep Decreased need for sleep
3.3. Pressured speech or more talkative than Pressured speech or more talkative than usualusual
4.4. Flight of ideas or racing thoughtsFlight of ideas or racing thoughts
5.5. DistractibilityDistractibility
6.6. Psychomotor agitation or increase in Psychomotor agitation or increase in goal-directed activitygoal-directed activity
7.7. Hedonistic interestsHedonistic interests
Hypomanic EpisodeHypomanic Episode
Similarities with Manic Episode = Similarities with Manic Episode = Same symptomsSame symptoms
Differences = Differences = Length of timeLength of timeImpairment not as severeImpairment not as severe
Major Depressive EpisodeMajor Depressive Episode
Symptoms:Symptoms:
1.1. Depressed mood (in children can be irritable)Depressed mood (in children can be irritable)
2.2. Diminished interest in activitiesDiminished interest in activities
3.3. Significant weight loss or gainSignificant weight loss or gain
4.4. Insomnia or hypersomniaInsomnia or hypersomnia
5.5. Psychomotor agitation or retardationPsychomotor agitation or retardation
6.6. Fatigue/loss of energyFatigue/loss of energy
7.7. Feelings of worthlessness/inappropriate guiltFeelings of worthlessness/inappropriate guilt
8.8. Diminished ability to think or Diminished ability to think or concentrate/indecisivenessconcentrate/indecisiveness
9.9. Suicidal ideation or suicide attempt Suicidal ideation or suicide attempt
Mixed EpisodeMixed Episode
Both Manic and Major Depressive Both Manic and Major Depressive Episode criteria are met nearly every Episode criteria are met nearly every day for a least a one week period. day for a least a one week period.
SubtypesSubtypesBipolar Disorder I = more classic form; clear Bipolar Disorder I = more classic form; clear
episodes of depression & maniaepisodes of depression & mania
Bipolar Disorder II = presents with less intense Bipolar Disorder II = presents with less intense and often unrecognized manic phasesand often unrecognized manic phases
Cyclothymia = chronic moods of hypomania & Cyclothymia = chronic moods of hypomania & depression, often evolves into a more depression, often evolves into a more serious typeserious type
Bipolar Disorder Not Otherwise Specified (NOS) Bipolar Disorder Not Otherwise Specified (NOS) = largest group of individuals= largest group of individuals
Children vs. Adults Children vs. Adults (or early vs. late onset )(or early vs. late onset )
IrritabilityIrritability Depression Depression Lack of mood Lack of mood
reactivity reactivity Rejection Rejection
sensitivitysensitivity Less evident are Less evident are
the “classic” the “classic” symptoms of symptoms of maniamania
EPIDEMIOLOGYEPIDEMIOLOGY
PrevalencePrevalence
Estimated between 3-6%Estimated between 3-6%Subsyndromal bipolar disorderSubsyndromal bipolar disorderEqual distribution across gender Equal distribution across gender
variablesvariablesAverage age @ onset = 20 years oldAverage age @ onset = 20 years old
CourseCourse
Initial cycle typically major depressive Initial cycle typically major depressive episodeepisode
RecoveryRecoveryRelapseRelapseRapid CyclingRapid Cycling
Rapid cycling=4 episodes/yearRapid cycling=4 episodes/yearUltrarapid cycling=5-364 episodes/yearUltrarapid cycling=5-364 episodes/yearUltradian cycling=>365 episodes/yearUltradian cycling=>365 episodes/year
Age at OnsetAge at Onset
Pediatric, prepubertal, or early Pediatric, prepubertal, or early adolescent (prior to age 12)adolescent (prior to age 12)
Adolescent (12 - 18 years)Adolescent (12 - 18 years)Adult onset (+ 18 years)Adult onset (+ 18 years)
IMPAIRMENTSIMPAIRMENTS
ComorbidityComorbidity
Attention Deficit Hyperactivity Attention Deficit Hyperactivity Disorder (ADHD)Disorder (ADHD)Between 60-80%Between 60-80%
Criteria ComparisonCriteria Comparison
Bipolar Disorder Bipolar Disorder (mania)(mania)
1.1. More talkative than More talkative than usual, or pressure to usual, or pressure to keep talkingkeep talking
2.2. DistractibilityDistractibility3.3. Increase in goal Increase in goal
directed activity or directed activity or psychomotor psychomotor agitationagitation
ADHDADHD1.1. Often talks Often talks
excessivelyexcessively
2.2. Is often easily Is often easily distracted by distracted by extraneous stimuliextraneous stimuli
3.3. Is often “on the go” Is often “on the go” or often acts as if or often acts as if “driven by a motor”“driven by a motor”
Differentiation= elated mood, grandiosity, decreased need for sleep, hypersexuality, and irritable mood.
ComorbidityComorbidity(cont.)(cont.)
Oppositional Defiant Disorder Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD)(ODD) & Conduct Disorder (CD)70-75%70-75%
Substance AbuseSubstance Abuse40-50%40-50%
Anxiety DisordersAnxiety Disorders35-40%35-40%
Suicidal BehaviorsSuicidal Behaviors
Prevalence of suicide attemptsPrevalence of suicide attempts40-45%40-45%
Age of first attemptAge of first attemptMultiple attemptsMultiple attemptsSeverity of attemptsSeverity of attemptsSuicidal ideationSuicidal ideation
Cognitive DeficitsCognitive Deficits
Executive FunctionsExecutive FunctionsAttentionAttentionMemoryMemorySensory-Motor IntegrationSensory-Motor IntegrationNonverbal Problem-SolvingNonverbal Problem-SolvingAcademic DeficitsAcademic Deficits
MathematicsMathematics
Psychosocial DeficitsPsychosocial Deficits
Relationships Relationships PeersPeersFamily membersFamily members
Recognition and Regulation of Recognition and Regulation of EmotionEmotion
Social Problem-SolvingSocial Problem-SolvingSelf-EsteemSelf-Esteem Impulse ControlImpulse Control
TREATMENT TREATMENT APPROACHESAPPROACHES
PsychopharmacologicalPsychopharmacological
DEPRESSIONDEPRESSION Mood StabilizersMood Stabilizers
LamictalLamictal Anti-ObsessionalAnti-Obsessional
PaxilPaxil Anti-DepressantAnti-Depressant
WellbutrinWellbutrin Atypical AntipsychoticsAtypical Antipsychotics
ZyprexaZyprexa
MANIAMANIA Mood StabillizersMood Stabillizers
Lithium, Depakote, Lithium, Depakote, Depacon, TegretolDepacon, Tegretol
Aypical AntipsychoticsAypical AntipsychoticsZyprexa, Seroquel, Zyprexa, Seroquel,
Risperdal, Geodon, Risperdal, Geodon, AbilifyAbilify
Anti-AnxietyAnti-AnxietyBenzodiazepinesBenzodiazepines
Klonopin, AtivanKlonopin, Ativan
TherapyTherapy
PsychoeducationPsychoeducationFamily InterventionsFamily InterventionsCognitive-Behavioral TherapyCognitive-Behavioral TherapyRAINBOW Program RAINBOW Program Interpersonal and Social Rhythm Interpersonal and Social Rhythm
TherapyTherapySchema-focused TherapySchema-focused Therapy
EDUCATIONAL EDUCATIONAL IMPLICATIONSIMPLICATIONS
IDEA ClassificationIDEA Classification
Emotional Disturbance (ED) vs. Other Emotional Disturbance (ED) vs. Other Health Impaired (OHI)Health Impaired (OHI)
ConsiderationsConsiderations
Rapidly changing moods of depression, Rapidly changing moods of depression, irritability, grandiosity, pressured speech, irritability, grandiosity, pressured speech, racing thoughts, etc.racing thoughts, etc.
Need for movementNeed for movement Poor relationshipsPoor relationships Difficulties with concentration and focusDifficulties with concentration and focus Difficulties with task completionDifficulties with task completion Impaired judgment and imulsivityImpaired judgment and imulsivity DisorganizationDisorganization Becoming overwhelmed with stressful Becoming overwhelmed with stressful
situationssituations
Possible Possible Accommodations/ModificationsAccommodations/Modifications
Provide student with a safe place and person to Provide student with a safe place and person to go to when feeling overwhelmed or stressedgo to when feeling overwhelmed or stressed
Shortened day (permit late start as needed)Shortened day (permit late start as needed) Prior notice of transitions Prior notice of transitions Consistent scheduleConsistent schedule Scheduling the student’s most challenging tasks Scheduling the student’s most challenging tasks
at a time of day when the child is best able to at a time of day when the child is best able to performperform
Modified or shortened assignmentsModified or shortened assignments Plan for unstructured times of the dayPlan for unstructured times of the day Adjust for medication needs, dispensing, as well Adjust for medication needs, dispensing, as well
as plans for addressing side effects (e.g., as plans for addressing side effects (e.g., sedation)sedation)
Other ConsiderationsOther Considerations
Educating staffEducating staffCommunicationCommunicationHospitalizationHospitalization
RESOURCESRESOURCESBOOKS/BOOKLETS:BOOKS/BOOKLETS:
Mondimore, F. (1999). Mondimore, F. (1999). Bipolar disorder: A guide Bipolar disorder: A guide for patients and familiesfor patients and families. City: Johns Hopkins . City: Johns Hopkins Press.Press.
Geller, B., & DelBello, M. P. (Eds.). (2003). Geller, B., & DelBello, M. P. (Eds.). (2003). Bipolar disorder in childhood and early Bipolar disorder in childhood and early adolescenceadolescence. New York: Guilford Press.. New York: Guilford Press.
Educating the child with bipolar disorder. Educating the child with bipolar disorder. Available from: www.bpkids.orgAvailable from: www.bpkids.org
Anderson, M., Kubisak, J.B., Field, R., & Anderson, M., Kubisak, J.B., Field, R., & Vogelstein, S. (2003). Vogelstein, S. (2003). Understanding and Understanding and educating children and adolescents with bipolar educating children and adolescents with bipolar disorder: A guide for educatorsdisorder: A guide for educators. .
RESOURCESRESOURCESWEBSITES:WEBSITES:
The Child and Adolescent Bipolar FoundationThe Child and Adolescent Bipolar Foundationwww.bpkids.orgwww.bpkids.org
Depression and Bipolar Support AllianceDepression and Bipolar Support Alliancewww.dbsalliance.orgwww.dbsalliance.org
The Bipolar ChildThe Bipolar Childwww.www.bipolarchildbipolarchild.com.com
Parents of Bipolar ChildrenParents of Bipolar Childrenwww.bpparent.orgwww.bpparent.org
The Gray Center for Social Learning and The Gray Center for Social Learning and UnderstandingUnderstanding
www.thegraycenter.org/Social_Stories.www.thegraycenter.org/Social_Stories.htmhtm National Institute of Mental Health (NIMH)National Institute of Mental Health (NIMH)
www.www.nimhnimh.org.org