bipolar disorders

Question 1

psychoanalytic theory

Answer 1

children lack higher level cognitive structures required for a diagnosis in bp

Question 2

the challenge of applying bp criteria to kids

Answer 2

harder to separate normal from abnormal
the boundary separating normal from abnormal changes across development
many criteria overlap or are associated with other pediatric psychiatric disorders
depression may be the earliest manifestation of the disorder

Question 3

diagnostic symptoms

Answer 3

• distinct period of elevated, expansive, or irritable mood >= 1 week = BP i
• at least 4 days = hypomania bp ii
• psychosis or hospitalization = bp i
• 3/7 if euphoric mood
  4/7 if irritable mood
• marked impairment

Question 4

diagnosis types

Answer 4

manic episode
mixed episode
hypomanic
bipolar i
bipolar ii
cyclothymia

Question 5

manic episode

Answer 5

elevated, expansive, irritable mood for at least 1 week
- 3 or 4 if mood only irritable

Question 6

hypomanic

Answer 6

symptoms for at least 4 days

Question 7

cyclothymia

Answer 7

1 year or more of six, no more than 2 mo symptom free

Question 8

BP I =

Answer 8

dysthymia + mania
major depression + mania

Question 9

BP II =

Answer 9

major depression + hypomania

Question 10

3 diagnostic dilemmas

Answer 10

the centrality of irritability
absence of pure BP disorder
episode length

Question 11

cycles in bp

Answer 11

rapid: >= 4 episodes/ year
ultra-rapid: episode = days instead of weeks
ultradian: several cycles within 24 hr period

Question 12

mania symptoms

Answer 12

• elevated/ expansive mood
• irritability
• grandiosity
• decreased need for sleep
• more talkative
• racing thoughts
• hyperactivity/ goal directed
• high risk activities
• distractibility

Question 13

strep

Answer 13

• sore throat is the most common symptom
• but only 5% of children w a sore throat have strep
• by analogy, only a small percentage of children with irritability will have mania

Question 14

the bp 4-point play

Answer 14

• parents like it because they have an explanation
• kids like it because they’re not to blame
• doctors like it because they have sth to call it and sth they can try and fix
• drug companies love it because we use their medications

Question 15

predictors of poor outcome

Answer 15

early onset
diagnosis of BP NOS - not otherwise specified
long illness duration
low SES
family history of mood disorders

Question 16

researchers do agree

Answer 16

• chronicity with long episodes
• predominantly mixed episodes and/or rapid cycling
• prominent irritability
• high rate of comorbid ADHD
• high rate of comorbid anxiety disorders

Question 17

predictors - risk factors

Answer 17

20-40% of youth with MDD go on to have a manic episode

Question 18

family studies

Answer 18

• offspring of parents with BP have a 2.7x increased risk of developing any psychiatric condition
• and a 4x increase risk of developing a mood disorder