Pediatric Bipolar Disorder

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Pediatric Bipolar Disorder

• Mani N Pavuluri, MD, PhD
• Berger Colbeth Chair in Child Psychiatry
• Pediatric Brain Research and Intervention Center
  University of
  Illinois at Chicago
• _at_ copy righted

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Overview of the presentation

• How does it look?
• Measurement
• How to differentiate from ADHD
• Prevalence
• Onset
• Follow up
• Assessment Big picture

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What is a Pediatric Bipolar Disorder?

• Central feature
• Elevated, expansive mood or Irritable mood

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Equivalent description in a child

• Mood

• Constantly irritable
• Aggressive
• throwing pot plants
• slamming doors
• hard to transition
• Acidic
• Abrasive
• hostile in words
• Kicking
• screaming
• intense inconsolable
• out of proportion to the psychosocial stresses
  around them

• Excited
• Giggly
• Silly
• Giddy
• constantly on the go
• laughing fits
• joking and feels invincible
• overwhelming
• like wanting to jump on the bed

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Feeling good about myself 1) Generous gave
money to the schools mission collection 2)
Friendly to everyone 3) Share my lunch with my
friends getting up every morning at the regular
time not tired I eat breakfast, lunch and dinner
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Timeline

• Ultra Rapid Cycling Complex Cycling
• Mini cycles within a big cycle
• Frequency most days in a week
• Intensity severe enough to cause extreme
  disturbance in one domain or moderate disturbance
  in two or more domains
• Number three or four times a day
• Duration four or more hours a day  

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Mood Spectrum
Elevated Mood
Depressed Mood
Time
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Mood Spectrum
Elevated Mood
Normal
Depressed Mood
Time
9
Mood Spectrum
Elevated Mood
Normal
Major Depressive Disorder
Depressed Mood
Time
10
Mood Spectrum
Elevated Mood
Mania
Normal
Major Depressive Disorder
Depressed Mood
Time
11
Mood Spectrum
Elevated Mood
Mania
Normal
Major Depressive Disorder
Depressed Mood
Dysthymia
Time
12
Mood Spectrum
Elevated Mood
Mania
Hypomania
Normal
Major Depressive Disorder
Depressed Mood
Dysthymia
Time
13
Mood Spectrum
Pediatric Bipolar Disorder
Elevated Mood
Depressed Mood
Time
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Mood Spectrum
Mania
PBD
Elevated Mood
Hypomania
Normal
Major Depressive Disorder
Depressed Mood
Dysthymia
Bipolar
Time
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Distribution of Bipolar Subjects
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BP-NOS at Intake Convert to BP-I
Mania
Hypomania
BP-NOS
Euthymia
Dep-NOS
Major Depression
Birmaher et al, AACAP, 2003
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BP-II at Intake Convert to BP-I
Mania
Hypomania
BP-NOS
Euthymia
Dep-NOS
Major Depression
Birmaher et al, AACAP, 2003
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Diagnostic fashion runs in cycles!
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Child Mania Rating Scale, Parent Version
Pavuluri et al, aacap 2004
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How to use it?

• Have the parent focus on the childs behavior in
  the past month.
• Never/Rarely and Sometimes behavior that is
  causing minimal or no difficulty
• Often and Very Often behavior that is
  causing trouble.
• The childs score is the sum of all item scores.

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Interpreting the results

• A cut off score of 15 screens for the manic
  spectrum
• A cut off score of 20 is highly specific for
  mania

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Reliability

• Internal Consistency 0.96
• Test Re-test Reliability 0.96

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CMRS-P Total Score
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Why should I choose it?

• PROS
• DSM IV basis
• Singular item focus
• Integrated functionality
• Age specific items
• Timing of symptoms
• Language
• Linked examples

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Formulation
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Mania vs. ADHD

• ADHD
• Primarily a disorder of attention, not mood
• Onset before age 7
• Persistent, not episodic
• Problem of Comorbidity

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Comorbidity of ADHD In Pediatric Bipolars
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Distinguishing Between Bipolar and ADHD
Geller Zimerman 2002.
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Pediatric Bipolar Disorder
? 12 yr.
gt 12 yr.

• Prepubertal Early Adolescent Onset Bipolar
  Disorder (PEA - BD)
• Juvenile BD
• Atypical BD
• Childhood Onset BD

• Adolescent Onset Bipolar Disorder (AO-BD)

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Prevalence of BP in Adolescents
Diagnostic interviews with 1709 high school
students, ages 14-18 years
Findings 1.0 prevalence of BP (primarily BP II
and cyclothymia) 5.7 prevalence of BP NOS
Lewinsohn 1995
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Age of Symptom OnsetNDMDA Survey N500

• Lag to Diagnosis 8 Years

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28
20
59
16
15
14
10
12
9
5
lt 5
5-9
15-19
20-24
10-14
25-29
30
Years of Age
Lish 1994
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Recovery and Relapse
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Developing the language
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R A I N B O W
R A I N B O W
OUTINE
FFECT CONTROL
CAN DO IT
O NEGATIVE THOUGHTS LIVE IN THE NOW
E A GOOD FRIEND BALANCED LIFESTYLE
H! HOW CAN WE SOLVE IT?!
AYS TO GET SUPPORT