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EARLY ONSET

BIPOLAR DISORDER:
Epidemiology, Educational
Implications, and
Interventions

Shelley Hart
shelley_hart@charter.net
DIAGNOSIS
DSM-IV-TR 

 Five types of
episodes
 Four subtypes
 Four severity levels
 Three course
specifiers

 American Psychiatric Association. (2000). Diagnostic and Statistical Manual of


Mental Disorders-Fourth Edition-Text Revision. Washington, DC: Author.
Manic Episode
Symptoms:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. Pressured speech or more talkative than usual
4. Flight of ideas or racing thoughts
5. Distractibility
6. Psychomotor agitation or increase in goal-
directed activity
7. Hedonistic interests
Hypomanic Episode
 Similarities with Manic Episode =
 Same symptoms

 Differences =
 Length of time
 Impairment not as severe
Major Depressive Episode
Symptoms:
1. Depressed mood (in children can be irritable)
2. Diminished interest in activities
3. Significant weight loss or gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue/loss of energy
7. Feelings of worthlessness/inappropriate guilt
8. Diminished ability to think or
concentrate/indecisiveness
9. Suicidal ideation or suicide attempt
Mixed Episode

Both Manic and Major Depressive Episode


criteria are met nearly every day for a least a
one week period.
Subtypes
Bipolar Disorder I = more classic form; clear
episodes of depression & mania

Bipolar Disorder II = presents with less intense


and often unrecognized manic phases

Cyclothymia = chronic moods of hypomania &


depression, often evolves into a more serious
type

Bipolar Disorder Not Otherwise Specified (NOS)


= largest group of individuals
Children vs. Adults
(or early vs. late onset )
 Irritability
 Depression
 Lack of mood
reactivity
 Rejection sensitivity
 Less evident are the
“classic” symptoms of
mania
EPIDEMIOLOGY
Prevalence
 Estimated between 3-6%
 Subsyndromal bipolar disorder
 Equal distribution across gender variables
 Average age @ onset = 20 years old
Course

 Initial cycle typically major depressive


episode
 Recovery
 Relapse
 Rapid Cycling
 Rapid cycling=4 episodes/year
 Ultrarapid cycling=5-364 episodes/year
 Ultradian cycling=>365 episodes/year
Age at Onset
 Pediatric, prepubertal, or early adolescent
(prior to age 12)
 Adolescent (12 - 18 years)
 Adult onset (+ 18 years)
IMPAIRMENTS
Comorbidity
 Attention Deficit Hyperactivity Disorder
(ADHD)
 Between 60-80%
Criteria Comparison
Bipolar Disorder ADHD
(mania) 1. Often talks
1. More talkative than excessively
usual, or pressure to
2. Is often easily
keep talking
distracted by
2. Distractibility
extraneous stimuli
3. Increase in goal
directed activity or 3. Is often “on the go” or
psychomotor often acts as if
agitation “driven by a motor”
Differentiation= elated mood, grandiosity,
decreased need for sleep, hypersexuality, and
irritable mood.
Comorbidity
(cont’d…)

 Oppositional Defiant Disorder (ODD)


& Conduct Disorder (CD)
 70-75%

 Substance Abuse
 40-50%

 Anxiety Disorders
 35-40%
Suicidal Behaviors
 Prevalence of suicide attempts
 40-45%

 Age of first attempt


 Multiple attempts
 Severity of attempts
 Suicidal ideation
Cognitive Deficits

 Executive Functions
 Attention
 Memory
 Sensory-Motor Integration
 Nonverbal Problem-Solving
 Academic Deficits
 Mathematics
Psychosocial Deficits
 Relationships
 Peers
 Family members
 Recognition and Regulation of Emotion
 Social Problem-Solving
 Self-Esteem
 Impulse Control
TREATMENT
APPROACHES
Psychopharmacological

DEPRESSION MANIA
 Mood Stabilizers  Mood Stabilizers
 Lamictal  Lithium, Depakote,
 Anti-Obsessional Depacon, Tegretol
 Paxil  Atypical Antipsychotics
 Anti-Depressant  Zyprexa, Seroquel,
Risperdal, Geodon, Abilify
 Wellbutrin
 Anti-Anxiety
 Atypical Antipsychotics
 Benzodiazepines
 Zyprexa
 Klonopin, Ativan
Therapy
 Psycho-education
 Family Interventions
 Cognitive-Behavioral Therapy
 RAINBOW Program
 Interpersonal and Social Rhythm Therapy
 Schema-focused Therapy
EDUCATIONAL
IMPLICATIONS
IDEA Classification
 Emotional Disturbance (ED) vs. Other
Health Impaired (OHI)
Considerations
 Rapidly changing moods of depression,
irritability, grandiosity, pressured speech, racing
thoughts, etc.
 Need for movement
 Poor relationships
 Difficulties with concentration and focus
 Difficulties with task completion
 Impaired judgment and impulsivity
 Disorganization
 Becoming overwhelmed with stressful situations
Possible Accommodations/Modifications
 Provide student with a safe place and person to
go to when feeling overwhelmed or stressed
 Shortened day (permit late start as needed)
 Prior notice of transitions
 Consistent schedule
 Scheduling the student’s most challenging tasks
at a time of day when the child is best able to
perform
 Modified or shortened assignments
 Plan for unstructured times of the day
 Adjust for medication needs, dispensing, as well
as plans for addressing side effects (e.g.,
sedation)
Other Considerations
 Educating staff
 Communication
 Hospitalization
RESOURCES
BOOKS/BOOKLETS:
 Mondimore, F. (1999). Bipolar disorder: A guide for
patients and families. City: Johns Hopkins Press.
 Geller, B., & DelBello, M. P. (Eds.). (2003). Bipolar
disorder in childhood and early adolescence. New
York: Guilford Press.
 Educating the child with bipolar disorder. Available
from: www.bpkids.org
 Anderson, M., Kubisak, J.B., Field, R., & Vogelstein,
S. (2003). Understanding and educating children and
adolescents with bipolar disorder: A guide for
educators.
RESOURCES
WEBSITES:
 The Child and Adolescent Bipolar Foundation
 www.bpkids.org
 Depression and Bipolar Support Alliance
 www.dbsalliance.org
 The Bipolar Child
 www.bipolarchild.com
 Parents of Bipolar Children
 www.bpparent.org
 The Gray Center for Social Learning and
Understanding
 www.thegraycenter.org/Social_Stories.htm
 National Institute of Mental Health (NIMH)
 www.nimh.org