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Pediatric Bipolar Disorder

(3-24-15)

  • Bipolar Disorder
    • mood disorder affecting 1 to 3.9 % of adult population (Bipolar I & II)
    • possibly most heritable major mental disorder
    • untreated episodes progressively more severe and treatment resistant
  • Bipolar Disorder in Children
    • less common: .4 to 1.2% prevalence for any bipolar; BP II, BP NOS, & cyclothymia more common
      • most common DSM-IV diagnosis in children: Bipolar Disorder Not Otherwise Specified (because did not meet duration criteria for either BP I or BP II)
    • “most comorbid” disorder: 99% of the time there is a second diagnosis
    • Modal Child Presentation: ultra-rapid cycling and comorbid ADHD, “rage attacks” most common presenting symptom
    • DSM-5 attempts to address the over diagnosis of bipolar disorder in youth (and attendant skyrocketing rates of prescriptions of neuroleptic medications) by introducing new diagnositic category:
      • Dysphoric Mood Disregulation Disorder, within the Depressive Disorders grouping
        • the impact of this new diagnosis remains to be seen
  • Differentiation of PBD and ADHD
    • most useful symptoms:
      • elevated mood
      • grandiosity/inflated self-esteem
      • pressured speech
      • racing thoughts
      • decreased need for sleep
      • hypersexuality
    • less useful
      • bizarre appearance
      • lack of insight
    • aggression probably most impairing symptom
      • highly sensitive
      • not very specific
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