Running head: BIPOLAR DISORDER
Bipolar Disorder
Author's Name
Institutional Affiliation
BIPOLAR DISORDER
Group-Facilitated Discussion Plan: Bipolar Disorder
BipolarDisorder
Introduction:
Bipolar disorder is a serious mental illness that affects approximately 2.6% of adults in the
United States. It is a condition that causes significant shifts in mood, energy, and activity levels,
often leading to problems in personal relationships, work, and daily life. In this article, we will
discuss the symptoms, causes, and treatments of bipolar disorder, as well as some strategies
for managing the condition.
What is Bipolar Disorder?
Bipolar disorder, formerly known as manic depression, is a mental health disorder that causes
extreme mood swings that can range from depression to mania. People with bipolar disorder
experience alternating episodes of mania and depression. Mania is a state of heightened
energy, elevated mood, and sometimes grandiosity. Depression is a state of extreme sadness,
low energy, and hopelessness.
Bipolar disorder is a lifelong condition that can be managed with proper treatment, but there is
no cure. The severity and frequency of episodes vary from person to person, and the condition
can be classified into several subtypes based on the pattern of episodes.
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Symptoms of Bipolar Disorder:
The symptoms of bipolar disorder can vary depending on the type of episode. Manic episodes
are characterized by the following symptoms:
Elevated mood: People experiencing mania may feel extremely happy, euphoric, or irritable.
High energy: Mania can cause increased energy levels, hyperactivity, and restlessness.
Reduced need for sleep: People experiencing mania may feel like they don't need as much
sleep as usual.
Racing thoughts: Thoughts can race, making it difficult to concentrate or stay on task.
Grandiosity: People experiencing mania may have grandiose thoughts or beliefs, feeling
invincible or having special abilities.
Risky behavior: Mania can lead to impulsive behavior, such as reckless spending, substance
abuse, or risky sexual behavior.
Depressive episodes are characterized by the following symptoms:
Depressed mood: People experiencing depression may feel sad, empty, or hopeless.
Low energy: Depression can cause fatigue, lethargy, and loss of interest in activities.
Insomnia or hypersomnia: People experiencing depression may have trouble sleeping or sleep
excessively.
Difficulty concentrating: Depression can make it difficult to concentrate, remember details, or
make decisions.
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Loss of pleasure: People experiencing depression may lose interest in activities they once
enjoyed.
Suicidal thoughts: Depression can lead to thoughts of suicide or self-harm.
Causes of Bipolar Disorder:
The exact cause of bipolar disorder is unknown, but research suggests that genetic, biological,
and environmental factors all play a role. People with a family history of bipolar disorder are
more likely to develop the condition, indicating a genetic component.
Brain chemistry is also believed to play a role in the development of bipolar disorder.
Imbalances in neurotransmitters such as serotonin, dopamine, and norepinephrine can affect
mood regulation.
Environmental factors such as stress, trauma, and substance abuse can trigger bipolar episodes
in people with a genetic predisposition to the condition. Changes in sleep patterns, seasonal
changes, and medications can also trigger bipolar episodes.
Diagnosis of Bipolar Disorder:
Bipolar disorder is typically diagnosed by a mental health professional, such as a psychiatrist or
clinical psychologist. A thorough evaluation is necessary to rule out other conditions that can
mimic bipolar disorder, such as thyroid disorders, substance abuse, or other mental health
disorders.
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The diagnostic criteria for bipolar disorder include a history of at least one manic or hypomanic
episode and at least one depressive episode. The frequency and severity of episodes, as well as
any other symptoms or medical conditions, are taken into account in the diagnosis.
Treatment of Bipolar Disorder:
Bipolar disorder is a lifelong.
Bipolar disorder, also known as manic-depressive illness, is a mental disorder characterized by
extreme shifts in mood, energy, activity levels, and the ability to function normally in daily life.
It affects approximately 2.8% of adults in the United States, and it typically develops in late
adolescence or early adulthood. Bipolar disorder can have a significant impact on an individual's
life, and it requires careful management and treatment to achieve stability and improve quality
of life. In this article, we will explore the causes, symptoms, diagnosis, and treatment options
for bipolar disorder.
Causes of Bipolar Disorder:
The exact causes of bipolar disorder are still unknown, but research suggests that a
combination of genetic, biological, and environmental factors may contribute to its
development. Bipolar disorder often runs in families, and certain genetic variations may
increase the risk of developing the disorder. Additionally, imbalances in brain chemicals, such as
serotonin and dopamine, can affect mood regulation and contribute to bipolar disorder.
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Environmental factors, such as stressful life events, may also trigger the onset of bipolar
disorder in susceptible individuals.
Symptoms of Bipolar Disorder
Bipolar disorder is characterized by two main types of episodes: manic episodes and depressive
episodes. During manic episodes, individuals experience an elevated or irritable mood,
increased energy and activity levels, and a decreased need for sleep. They may also engage in
risky or impulsive behaviors, such as overspending, substance abuse, or sexual promiscuity. In
severe cases, individuals may experience hallucinations or delusions.
During depressive episodes, individuals experience a persistent low mood, loss of interest or
pleasure in activities, decreased energy and activity levels, and difficulty concentrating or
making decisions. They may also experience feelings of worthlessness or guilt, changes in
appetite or sleep patterns, and thoughts of suicide or self-harm.
Diagnosis of Bipolar Disorder
Diagnosing bipolar disorder can be challenging, as the symptoms can overlap with other mental
health conditions. A thorough evaluation by a mental health professional is necessary to make
an accurate diagnosis. The evaluation may include a physical exam, laboratory tests to rule out
medical conditions, and a psychological evaluation to assess symptoms and their impact on
daily life.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for
diagnosing bipolar disorder. To meet the criteria for bipolar disorder, an individual must have
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experienced at least one manic episode or hypomanic episode, as well as one or more
depressive episodes. The symptoms must also cause significant impairment in social,
occupational, or other areas of functioning.
Treatment of Bipolar Disorder
Bipolar disorder is a chronic condition that requires ongoing treatment and management.
Treatment typically involves a combination of medication, psychotherapy, and lifestyle changes.
Medication
Medications are often prescribed to help stabilize mood and prevent episodes of mania or
depression. Mood stabilizers, such as lithium, valproic acid, or carbamazepine, are commonly
used to treat bipolar disorder. Antipsychotic medications, such as risperidone or olanzapine,
may also be used to treat manic or mixed episodes. Antidepressant medications may be used to
treat depressive episodes, but they must be used with caution, as they can trigger manic
episodes in some individuals.
Psychotherapy
Psychotherapy, such as cognitive-behavioral therapy (CBT), can help individuals with bipolar
disorder learn coping skills and strategies to manage symptoms and prevent relapse. CBT
focuses on identifying and changing negative thought patterns and behaviors that contribute to
mood disturbances.
Lifestyle Changes
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Making lifestyle changes can also help manage bipolar disorder symptoms. Regular exercise, a
healthy diet, and adequate sleep can help improve mood and reduce stress. Avoiding alcohol
and drugs is also important, as they can trigger or worsen symptoms
Mood dysregulation is one of the most common psychological symptoms seen in children and
adolescents (Yearwood, E.L., Pearson, G.S., & Newland, J.A., 2012). Bipolar disorder severely
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affects the normal development and psychosocial functioning of youth and it increases the risk for
suicide, psychosis, substance abuse, behavioral, social, and legal problems (Brimaher, 2019). There
is a controversy over accurately diagnosing bipolar disorder in the pediatric population due to the
lack of epidemiological evidence (Yearwood et al, 2012).1 Some critics believe that a bipolar
diagnosis can be more tolerable to some parents, teachers, and physicians than other better-fitting
diagnoses, such as ADHD or ODD, because the bipolar label links the child's problematic moods
and behaviors to what is perceived to be a context-independent, genetic disorder (Parens1&
Johnston, 2010).11
This discussion will examine the role that advanced practice registered nurses have in recognizing
the symptoms of this disorder in an effort to establish a safety plan, promote a healthy therapeutic
alliance, and provide ongoing social support for the child and his/her family (Yearwood et al, 2012). It
is the duty of the clinician to exercise caution in prescribing psychopharmacological interventions in
treating mental health disorders in this population until other co-morbidities and previous treatments
are ruled out (APA, 2014).11
Resources
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·111111 For more information on diagnostic criteria and differentials please read this article
from1UpToDate.1
1Bipolar disorder in children and adolescents: Assessment and diagnosis.11
·111111 Additional resource on1identifying symptoms and course of illness111
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695748/11
·111111 Information regarding the controversies concerning the diagnosis and treatment of bipolar
disorder in children.1
1https://capmh.biomedcentral.com/articles/10.1186/1753-2000-4-911
·111111 For differentiating bipolar disorders from other psychiatric diagnoses in youth:
https://doi.org/10.1007/s10802-016-0182-4
1
Discussion
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1)1One of the most important concepts of treating mood dysregulation is safety and
anticipatory1guidance. Incorporating family participation is integral in the child/adolescent’s
treatment1plan. What other evidence-based treatment options are useful1in treating bipolar disorder
in children/adolescents?11
1
12) One of the main issues in pediatric bipolar disorder is how to properly diagnose it. On average, it
takes 10 years before bipolar patients are properly diagnosed and treated.1What are some of the
instruments/rating scales used in pediatric bipolar disorder screening?
1
3) What would be the differential diagnoses that could be considered in the face of a child or
teenager that might be suffering from Bipolar Spectrum Disorder?
References
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American Psychiatric Association. (2014). Choosing wisely.1ABIM Foundation. Retrieved
from:1http://www.choosingwisely.org/clinician-lists/american-psychiatric-association-antipsychotics-
in-children-or-adolescents/11
Birmaher, B. (2019). Bipolar disorder in children and adolescents: Assessment and
diagnosis.1UpToDate. Retrieved from:111
11111111111111https://www-uptodate-com.regiscollege.idm.oclc.org/contents/bipolar-disorder-in-children-
and-adolescents-assessment-and-diagnosis?sear11
Bringewatt, E. (2017). Delivering diagnoses: Parents as translators and withholders of children’s
mental health diagnoses.1Journal of Child & Family Studies,126(7), 1958–
1969.1https://doi.org/10.1007/s10826-017-0709-5
Johnson, K. & Vanderhoef, D. (2016).1Psychiatric-mental health nurse practitioner review & resource
manual1(4th ed.). Silver Spring, MD: American Nurses Credentialing Center.
Parens, E., & Johnston, J. (2010). Controversies concerning the diagnosis and treatment of bipolar
disorder in children.1Child and Adolescent Psychiatry and Mental Health,14(1), 9. Retrieved
from1https://capmh.biomedcentral.com/articles/10.1186/1753-2000-4-911
Ong, M.-L., Youngstrom, E. ed., Chua, J., Halverson, T., Horwitz, S., Storfer-Isser, A., … Arnold, L.
E. (2017). Comparing the CASI-4R and the PGBI-101M for differentiating bipolar spectrum disorders
from other outpatient diagnoses in youth.1Journal of Abnormal Child Psychology,145(3), 611–623.
Retrieved from1https://doi.org/10.1007/s10802-016-0182-
Singh, T. (2008). Pediatric bipolar disorder: Diagnostic challenges in identifying symptoms and
course of illness.1Psychiatry,15(6), 34–41. Retrieved from1https://search.ebscohost.com/login.aspx?
direct=true&db=psyh&AN=2008-08962-005&site=eds-live11
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Stahl, S. (2013).1Essential psychopharmacology: Neuroscientific basis and practical
applications.1(4th ed.). Cambridge, England: Cambridge University Press.
Yearwood, E.L., Pearson, G.S., & Newland, J.A. (2012).1Child and adolescent behavioral1health.
Southern Gate, Chichester, West Sussex: John Wiley & Sons.11
One of the most important concepts of treating mood dysregulation is safety and
anticipatory guidance. Incorporating family participation is integral in the
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child/adolescent's treatment plan. What other evidence-based treatment options are useful
in treating bipolar disorder in children/adolescents?
There are several evidence-based treatment options for bipolar disorder in children and
adolescents. These include:
Psychotherapy
The first treatment option is psychotherapy. According to Boston Children's Hospital (2019),
"psychotherapy, or "talk therapy," is designed to help your child learn the best ways to identify
and respond to his manic and depressive symptoms when they occur." For instance,
psychotherapy involves teaching children/adolescents how to anticipate and manage the onset of
their mood episodes. In addition, the clinician helps change the patient's negative and potentially
harmful thought patterns, feelings and behaviors through a process known as Cognitive
Behavioral Therapy (CBT). Through psychotherapy, the clinician also teaches the patient new
healthy ways of relating with their family members, friends, teachers, and peers.
Medications
The second treatment option is medications. Some of the commonly used mediation for treating
bipolar disorder among children and adolescents include; mood stabilizers (such as lithium,
Carbamazepine (Tegretol), and Oxcarbazepine (Trileptal), antipsychotic medications (uetiapine,
Aripiprazole, and Ziprasidone), and antidepressants (Fluoxetine, Escilatpram, and Sertraline)
(Stahl, 2013).
Noteworthy, the clinician may also combine both medications and psychotherapy in order to
improve the effectiveness of the treatment.
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One of the main issues in pediatric bipolar disorder is how to properly diagnose it. On
average, it takes 10 years before bipolar patients are properly diagnosed and treated. What
are some of the instruments/rating scales used in pediatric bipolar disorder screening?
One of the effective instruments used in pediatric bipolar disorder screening is Kiddie Schedule
for Affective Disorders and Schizophrenia (KSADS). Essentially, KSADS is a semi-structured
interviewed being used for bipolar disorder screening in primary care settings. KSADS is often
referred to as the gold standard in both children and adolescent psychiatric diagnoses. There are
several types of KSADS including Clinician-administered KSADS, Youth Self-administered
KSADS, and Parent Self-administered KSADS. Unlike some of the other assessment
instruments, KSADS relies on the answers to interview as opposed to only observations
(Yearwood et al. 2012).
Mood Disorders Questionnaire (MDQ) is the other bipolar disorder screening scale that is often
considered a proper standard screening tool. The tool was developed primarily to address the
need for timely as well as a more accurate evaluation of bipolar disorder. It takes about five
minutes to complete but any positive screen should be followed by an additionally compressive
evaluation.
The other bipolar screening instruments being used include Mood Swings Questionnaire/Survey,
Bipolar Spectrum Diagnostic Scale, and the Hypomanic Checklist. The Bipolar Spectrum
Diagnostic Scale is essentially a descriptive story capturing various features of bipolar disorder.
On the other hand, Mood Swings Questionnaire/Survey is a brief, self-report screening tool used
by clinicians to identify individuals most likely to have bipolar disorder.
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What would be the differential diagnoses that could be considered in the face of a child or
teenager that might be suffering from Bipolar Spectrum Disorder?
The childhood-onset of bipolar disorder is often comorbid with different other psychiatric
disorders particular disruptive disorders. Also, youths with bipolar disorder also present
behaviors that closely mimic or even overlap with behaviors of other differential diagnoses. For
a child or teenager suffering from Bipolar Spectrum Disorder, there are several types of
differential treatments that the clinician can consider. For instance, the clinician may consider
differential diagnoses such as thyroid disorders, Attention deficit hyperactivity disorder
(ADHD), neurologic disorders, substance abuse, as well as to conduct disorder (Birmaher, 2019).
As such, the criteria used for accurate diagnoses of bipolar disorder entails factors such as; the
age of onset, lack of triggers, speed and the duration of the mood swings, family history as well
as the patient's response to medications.
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References
Birmaher, B. (2019). Bipolar disorder in children and adolescents: Assessment and diagnosis.
UpToDate. Retrieved from:
Boston Children's Hospital (2019). "Treatments for Bipolar Disorder in Children." Retrieved
from http://www.childrenshospital.org/conditions-and-treatments/conditions/b/bipolar-
disorder/treatments
https://www-uptodate-com.regiscollege.idm.oclc.org/contents/bipolar-disorder-in-
children-and-adolescents-assessment-and-diagnosis?sear
Stahl, S. (2013). Essential psychopharmacology: Neuroscientific basis and practical applications.
(4th ed.). Cambridge, England: Cambridge University Press
Yearwood, E.L., Pearson, G.S., & Newland, J.A. (2012). Child and adolescent behavioral health.
Southern Gate, Chichester, West Sussex: John Wiley & Sons.
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Instructions:
Reflect on your clinical experience by writing1(four to five sentences)1responses to each of the
following questions. Include references from the learning activities or from journal articles and
resources located in the1
1. What were the1highlights of this week's1clinical? Describe a particular patient, patient
interaction, or disease process that stood out to you.Bipolar 11
2. Reflect on a situation or a patient presentation that you1were unfamiliar with1during
clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe
how you handled this unfamiliar situation/case.1Amphetamine use disorder
3. Describe a situation or encounter from this week that led you to a1new understanding of
a specific mental health condition.
4. Discuss any interactions with patients that you observed, either in a therapy or a
medication management session, that were1missing some of the concepts1you have
been learning about regarding therapeutic relationships and communication.Neuroleptic
malignant syndrome
5. How did you1apply the content learned1in your online courses to your clinical setting this
week?
6. Which chief complaints did you see most often this week? Provide1details about how you
felt1about developing your own preliminary differential diagnoses lists for these patients
based on the complaints/symptoms they expressed.
7. Given the most frequent psychiatric disorders you encountered in your clinical rotation this
week, what is the1most useful set of guidelines1(i.e., depression guidelines, Beer’s
criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?
8. Thinking about the common mental health conditions you saw in your clinical this week
(see question #7), did you feel that you had1adequate knowledge1to discuss these
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diagnoses with your preceptor? If not, what preparation work do you have planned to help
you feel more confident for the upcoming clinical week?
9. List a1brief plan of care1for one of the patients you saw this week. Include your
preceptor’s plan, too. Discuss, briefly, whether or not you agree with your preceptor’s plan
of care. If not, describe what you would have done differently and why.
10. What situation or patient presentation did you see in your clinical setting this week that
has1not yet been covered1in your online psychiatric courses?1Catatonia
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What were the highlights of this week's clinical? Describe a particular patient, patient
interaction, or disease process that stood out to you.
The key highlight of this week was the successful management of a middle-aged man with
Bipolar I Disorder. The patient was brought to the facility with abnormal behaviors such as
flying from one idea to another, hypersensitivity, and agitation and seemingly inflated self-
image. All these were exhibited on his rapid uninterruptible loud speech. Upon prescribing mood
stabilizers (divalproex sodium (Depakote) for the patient, we succeeded in stabilizing his moods.
A combination of these mood stabilizers and a few sessions of Interpersonal and social rhythm
therapy (IPSRT), we were able to control the patient's manic episode.
Reflect on a situation or a patient presentation that you were unfamiliar with during
clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe
how you handled this unfamiliar situation/case
On the first day of the week, I encountered a patient with quite unfamiliar symptoms. The patient
exhibited a strong craving for amphetamine, high levels of intolerance, insomnia, and confusion.
These were somewhat familiar symptoms to me hence I had to consult our preceptor, who
immediately established the patient's condition to be Amphetamine use disorder. Through the
preceptor's plan of care, I learned that clinicians should take blood samples to determine the level
of Amphetamine in the patient's system. In addition, physical exams as we as order tests should
be performed to detecting health problems resulting from the patient's Amphetamine use.
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Describe a situation or encounter from this week that led you to a new understanding of a
specific mental health condition.
Attending to the patient suffering Amphetamine use disorder led me to a better understanding of
the condition's causes, symptoms, and treatment options. From the preceptor's plan of care, I
learned that frequent and prolonged use of Amphetamine is the major cause of dependence.
However, some individuals, such as the patient in this case who had used the substance for only
six months, become dependent faster than others. In addition, I learned that individuals at a
higher risk of developing Amphetamine use disorder are those with easy access to the substance,
those with depression, bipolar disorder and schizophrenia as well as those living stressful
lifestyles.
Discuss any interactions with patients that you observed, either in therapy or a medication
management session that were missing some of the concepts you have been learning about
regarding therapeutic relationships and communication.
Earlier in the week, I also encountered an elderly female patient with Neuroleptic malignant
syndrome. Some of the symptoms exhibited by the patient included high fever (103F), excessive
sweating, anxiety, and more saliva than usual. However, interacting with this particular patient
with quite difficult due to her confused state of mind. Ineffective communication between us
made it difficult to build a strong therapeutic relationship. According to Kornhaber et al (2016)
"therapeutic interpersonal relationships have the capacity to transform and enrich the patients'
experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is
imperative for health care professionals to therapeutically engage with patients to improve
health-related outcomes."
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How did you apply the content learned in your online courses to your clinical setting this
week?
The content learned from our online course was very instrumental in our clinical settings and
activities this week. Firstly I relied on this content to develop care plans for different patients
with different conditions. More importantly, this content helped improve the quality of care
provided to the patients. For instance, consulting this content helped me avoid costly errors that
could potentially compromise the quality of care and the safety of patients.
Which chief complaints did you see most often this week? Provide details about how you
felt about developing your own preliminary differential diagnoses lists for these patients
based on the complaints/symptoms they expressed
The chief complaints seen this week were anxiety and depression. A bigger percentage of
patients attended this week were either diagnosed with anxiety or depression and the majority of
them complained about symptoms such as agitation, anxiety, insomnia, restlessness, and loss of
appetitive. It was quite an informative and interesting experience developing my preliminary
differential diagnoses lists for the different patients.
Given the most frequent psychiatric disorders you encountered in your clinical rotation
this week, what is the most useful set of guidelines (i.e., depression guidelines, Beer's
criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?
The two chief psychiatric disorders encountered this week included anxiety and depression. The
most useful set of guidelines I referred to for additional information was Beer's criteria and
depression guidelines. Essentially, Beer's criteria were developed to enhance medication
selection, minimizes adverse drug events and provide clinicians with an efficient tool for
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assessing costs, quality of drugs being used for individuals aged 65 years or older (American
Psychiatric Association, 2013). Beer's criteria were particularly vital when attending elderly
patients On the other hand, depression guidelines provide comprehensive recommendations for
treating depression in multiple patient generations.
Thinking about the common mental health conditions you saw in your clinical this week
(see question #7), did you feel that you had adequate knowledge to discuss these diagnoses
with your preceptor? If not, what preparation work do you have planned to help you feel
more confident about the upcoming clinical week?
Personally, I don't believe I possess adequate knowledge to discuss the diagnoses of anxiety and
depression with our preceptor. Everything learned in class coupled with knowledge gained from
our online course materials significantly improved my understanding of these two mental
conditions. However, I believe further external research and repeat practice will significantly
improve my knowledge and confidence for the upcoming week.
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List a brief plan of care for one of the patients you saw this week. Include your preceptor's
plan, too. Discuss, briefly, whether or not you agree with your preceptor's plan of care. If
not, describe what you would have done differently and why
Below is my preceptor's plan of care for a patient suffering depression
Assessment Data Expected Outcomes Nursing
Interventions
Rationale
Agitation, anxiety,
insomnia,
restlessness, mood
swings, changes in
appetite and weight,
increased fatigue and
sleep problems,
feelings of
worthlessness and
guilt and anxiety.
Reduce anxiety
Improve the patient’s
sleeping patterns.
Overcome feelings of
agitation, restlessness and
loss of interest in activities.
Reduce the patient’s
ideation of feelings of
worthlessness and guilt
Return to the previous
level of work functioning.
Collaborate
with work
the patient on
a one-to-one
basis.
Activity
scheduling
Prescribe
Selective
serotonin
reuptake
inhibitors
(SSRIs).
Cognitive
restructuring,
cognitive
behavior
Improve the
patient’s
understanding
of her
depression.
To stabilize
the patient’s
thought
pattern and
mood swings
CBT, IPT
and cognitive
restructuring
will be used
in identifying
cognitive
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therapy
(CBT),
Interpersonal
therapy (IPT)
and Behavior
Therapy.
Cognitive
restructuring
distortions.
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In this depression treatment plan, my preceptor employed both medications and different
therapies (cognitive behavior therapy (CBT), Interpersonal therapy, and cognitive restructuring).
According to Jongsma & Bruce (2012) using a combination of these treatment options helps the
patient to better cope and manage her feelings, overcome problems and positively transform his
or her behavior patterns that contribute to her symptoms.
What situation or patient presentation did you see in your clinical setting this week that
has5not yet been covered5in your online psychiatric courses?
Towards the end of the week, I came across a patient suffering Catatonia. However, this
particular condition has not been covered in our online psychiatric courses.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.) (DSM-5). Washington DC: APA Press. “Bipolar and Related Disorders”
Jongsma, A. E., & Bruce, T. J. (2012). Evidence-based treatment planning for eating disorders
and obesity. Hoboken, N.J: Wiley.
Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic
interpersonal relationships in the acute health care setting: An integrative review. Journal
of multidisciplinary healthcare, 9, 537.
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Laura Besada
Group-Facilitated Discussion Plan: Bipolar Disorder
Discussion
1)1One of the most important concepts of treating mood dysregulation is safety and
anticipatory1guidance. Incorporating family participation is integral in the child/adolescent’s
treatment1plan. What other evidence-based treatment options are useful1in treating bipolar disorder
in children/adolescents?
The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological
Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar
disorder1mentions that1
Manic symptoms in bipolar mixed states appeared responsive to treatment with several
atypical antipsychotics, the best evidence resting with olanzapine
For depressive symptoms, the addition1 of ziprasidone to treatment, as usual, may be
beneficial
othe evidence base is much more limited than for the treatment of manic
symptoms
Besides olanzapine and quetiapine, valproate and lithium should also be considered for
recurrence prevention
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(WFSBP, 2017)1
However, for children1Psychotherapy, or “talk therapy,” is recommended to help the child to learn the
best ways to identify and respond to his manic and depressive symptoms when they occur. Along
with psychotherapy:
1Mood-stabilizing medications are prescribed to1stop the rapid shift from high to low moods
and back again. They are particularly useful in preventing manic episodes.1
Some of the most common mood stabilizers used to treat bipolar disorder
are:1Lithium;1Valproic acid (Depakene);1Lamotrigine (Lamictal);1Carbamazepine (Tegretol);
and1Oxcarbazepine (Trileptal), (Childrenshospital.org, n.d.).
Antipsychotic medications can serve two purposes: They can act as mood stabilizers (like
the drugs above), and they also can treat children who have mood episodes that are so
severe that they experience a break in reality (psychosis).1
Antipsychotic medications include:1Quetiapine (Seroquel);1Aripiprazole
(Abilify);1Risperidone (Risperdal);1Olanzapine (Zyprexa); and1Ziprasidone (Geodon),
(Childrenshospital.org, n.d.).
Antidepressants are a class of medications that can be used to control depressive episodes
in bipolar disorder. These are usually prescribed along with a mood stabilizer or
antipsychotic—generally not as a standalone since antidepressants can't manage the
manic symptoms experienced by a child with bipolar disorder and may even activate or
worsen mania when used alone. Some antidepressant medications commonly prescribed
antidepressants include:1Fluoxetine (Prozac);1Escitalopram (Lexapro); and1Sertraline
(Zoloft). However, since 2004, the U.S. Food and Drug Administration has placed a black
box warning label on all antidepressant medications. The black box warns of the1increased
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risk of suicidal thinking and behavior (suicidality) in short-term studies in children and
adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders.
(Childrenshospital.org, n.d.)
12) One of the main issues in pediatric bipolar disorder is how to properly diagnose it. On average, it
takes 10 years before bipolar patients are properly diagnosed and treated.1What are some of the
instruments/rating scales used in pediatric bipolar disorder screening?
According to a review conducted by1Washburn, West, & Heil (2011,1Pediatric Bipolar Disorder
(PBD), diagnosis remains challenging.1Developmental differences can make the separation of
normative behavior and the symptoms of bipolar disorder challenging. The co-occurrence of bipolar
disorder with other disorders such as ADHD, disruptive behavior disorders, complicates differential
diagnosis due to the1overlap of symptoms (Washburn, West, & Heil, 2011). Alexian Brothers
Behavioral Health Hospital to improve the reliability of diagnoses of PBD across psychiatrists.1
The Alexian Brothers diagnostic protocol for PBD includes 5 steps: (1) screening for mania; (2)
establishing an actuarial estimate of the likelihood of PBD; (3) evaluating diagnostic criteria with high
specificity to PBD; (4) obtaining evidence of episodes; and (5) extending the window of assessment .
The use of the parent version of the Child Mania Rating Scale (CMRS)is recommended in the
protocol (Washburn, West, & Heil, 2011).
3) What would be the differential diagnoses that could be considered in the face of a child or
teenager that might be suffering from Bipolar Spectrum Disorder?
BIPOLAR DISORDER
As previously stated some disorders such as ADHD, disruptive behavior disorders can be used as a
differential diagnosis in the diagnosis of Pediatric Bipolar Disorder (PBD),1(Washburn, West, & Heil,
2011). In addition to1ADHD: attention-deficit/hyperactivity disorder; ARND: alcohol-related
neurodevelopmental disorder; ODD: oppositional defiant disorder can also be part of the differential
diagnosis (Kowatch, 2011).1
References
Childrenshospital.org. (n.d.). Treatments for Bipolar Disorder in Children. Retrieved
from1http://www.childrenshospital.org/conditions-and-treatments/conditions/b/bipolar-disorder/
treatments
Kowatch; Clinical Psychiatry,1R.1A. (2011, February). Not all mood swings are bipolar disorder.
Retrieved from1https://www.mdedge.com/psychiatry/article/64195/bipolar-disorder/not-all-mood-
swings-are-bipolar-disorder
The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological
Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder.
BIPOLAR DISORDER
(2017, November 3). Retrieved from1https://psychopharmacologyinstitute.com/publication/bipolar-
disorder-treatment-guidelines-a-2019-update-2206
Washburn, J. J., West, A. E., & Heil, J. A. (2011). Treatment of Pediatric Bipolar Disorder: A
Review.1Minerva psichiatrica,152(1), 21–35.1Retrieved
from1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150503/
BIPOLAR DISORDER
Bipolar disorder is a serious brain illness. It is also called manic-depressive illness or
manic depression. Children with bipolar disorder go through unusual mood changes. Sometimes
they feel very happy or “up,” and are much more energetic and active than usual or than other
kids their age. This is called aLmanic episode.LSometimes children with bipolar disorder feel very
sad and “down,” and are much less active than usual. This is called depression or aLdepressive
episode (Carlson, et al., 2017).
Bipolar disorder is not the same as the normal ups and downs every kid goes through. Bipolar
symptoms are more powerful than that. The mood swings are more extreme and are
accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar
symptoms are so strong, they can make it hard for a child to do well in school or get along with
friends and family members. The illness can also be dangerous. Some young people with bipolar
disorder try to hurt themselves or attempt suicide. Children and teens with bipolar disorder
should get treatment. With help, they can manage their symptoms and lead successful lives
(Chengappa, et al., 2013)
Bipolar “mood episodes” include unusual mood changes along with unusual sleep habits, activity
BIPOLAR DISORDER
levels, thoughts, or behavior. In a child, these mood and activity changes must be very different
from their usual behavior and from the behavior of other children. A person with bipolar disorder
may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both
manic and depressive symptoms. These mood episodes cause symptoms that last a week or two
or sometimes longer. During an episode, the symptoms last every day for most of the day
(DelBello, et al., 2011).
.
References:
Carlson GA, Potegal M, Margulies D, Gutkovich Z, Basile J. Rages--what are they and who has
them?LJournal of Child and Adolescent Psychopharmacology.L2017;19(3):281–288.
Chengappa KN, Kupfer DJ, Frank E, Houck PR, Grochocinski VJ, Cluss PA, Stapf DA.
Relationship of birth cohort and early age at onset of illness in a bipolar disorder case
registry.LAmerican Journal of Psychiatry.L2013;160(9):1636–1642.
DelBello MP, Geller B. Review of studies of child and adolescent offspring of bipolar
parents.LBipolar Disorders.L2011;3(6):325–334.
BIPOLAR DISORDER
1Lewis-Stevens
1 1 1 1 1 1 One of the first aspects to consider when treating children and adolescents with Bipolar Disorder is level of care needed to keep the person safe. During
periods of significant impairment or elevated risk of suicidal or dangerous behavior, inpatient, intermediate levels of care (partial hospitalization, intensive
outpatient programs, or in-home services), or frequent outpatient visits and phone contact may be required. When indicated, higher levels of care can provide a
safer treatment environment, closer monitoring of symptoms and side effects, more frequent adjustments of pharmacotherapy, and more intensive
psychotherapy (Axelson, 2019).
After safety concerns are addressed, the mainstay of treatment for bipolar disorder in children and adolescents is pharmacotherapy. The pharmacotherapy
suggested for pediatric mania and hypomania are second-generation antipsychotics and/or Lithium. The efficacy and tolerability of second-generation
antipsychotics has been established in many studies and consistent with multiple treatment guidelines (Axelson, 2019). Lithium is an alternative treatment for
pediatric mania if little or no response to multiple trials of second-generation antipsychotics occur. For patients who responded partially to initial treatment with
an antipsychotic, add lithium to the antipsychotic. For patients who demonstrate little or no response to antipsychotics, taper and discontinue the antipsychotic
over one to two weeks, and at the same time start lithium and titrate the dose up. Aside from second-generation antipsychotics plus lithium, other combinations
that may be useful include second-generation antipsychotics plus an antiepileptic, lithium plus an antiepileptic, and first-generation antipsychotics plus lithium or
an antiepileptic (Axelson, 2019). Finally, psychotherapy is nearly always indicated as an adjuvant to pharmacotherapy for pediatric bipolar disorder.
Rating scales do not provide a diagnosis but can reveal symptoms that may alert for further assessment of bipolar disorder. Rating instruments can also be
used during treatment to monitor the severity of symptoms over time. Examples of clinician administered rating scales include Young Mania Rating Scale
(YMRS) and Kiddie Schedule for Affective Disorders and Schizophrenia Mania Rating Scale (KSADS – MRS) for school age children. The General Behavior
Inventory and Child Mania Rating Scale for Parents about their children have been shown to be psychometrically sound and useful for the screening of bipolar
disorder symptoms in youth (Birmaher, 2019).
Differential diagnoses to consider in the face of a child or adolescent that might have bipolar disorder are attention deficit hyperactivity disorder (ADHD), autism
spectrum disorder, conduct disorder, disruptive mood dysregulation disorder (DMDD), oppositional defiant disorder (ODD), schizophrenia, substance abuse
disorder, unipolar depression, and borderline personality disorder. Conduct disorder, ADHD, ODD, and DMDD are the conditions most likely to be confused
with bipolar disorder in youth. Symptoms that occur in bipolar disorder but not in the other disorders listed include euphoria, grandiosity, decreased need for
BIPOLAR DISORDER
sleep, hypersexuality, and psychosis (Birmaher, 2019).
References
Axelson, D. (2019). Pediatric bipolar disorder: Overview of choosing treatment. In D. Solomon
(Ed.), UpToDate. Retrieved on November 18, 2019 from1https://www-uptodate-com.regiscollege.idm.oclc.org/contents/pediatric-bipolar-disorder-overview-of-
choosing-treatment?search=pediatric%20bipolar%20disorder&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H5072338
Birmaher, B. (2019). Bipolar disorder in children and adolescents: Assessment and diagnosis. In
D. Solomon (Ed.), UpToDate.
Tasha, Bipolar disorder is a serious brain illness. It is also called manic-depressive illness or manic
depression. Children with bipolar disorder go through unusual mood changes. Sometimes they feel very
happy or “up,” and are much more energetic and active than usual or than other kids their age. This is
called a manic episode. Sometimes children with bipolar disorder feel very sad and “down,” and are
much less active than usual. This is called depression or a depressive episode (Carlson, et al., 2017).
Bipolar disorder is not the same as the normal ups and downs every kid goes through. Bipolar symptoms
are more powerful than that. The mood swings are more extreme and are accompanied by changes in
sleep, energy level, and the ability to think clearly. Bipolar symptoms are so strong, they can make it
hard for a child to do well in school or get along with friends and family members. The illness can also be
dangerous. Some young people with bipolar disorder try to hurt themselves or attempt suicide. Children
and teens with bipolar disorder should get treatment. With help, they can manage their symptoms and
lead successful lives (Chengappa, et al., 2013)
Bipolar “mood episodes” include unusual mood changes along with unusual sleep habits, activity levels,
thoughts, or behavior. In a child, these mood and activity changes must be very different from their
usual behavior and from the behavior of other children. A person with bipolar disorder may have manic
episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive
BIPOLAR DISORDER
symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During
an episode, the symptoms last every day for most of the day (DelBello, et al., 2011)
.
References:
Carlson GA, Potegal M, Margulies D, Gutkovich Z, Basile J. Rages--what are they and who has
them? Journal of Child and Adolescent Psychopharmacology. 2017;19(3):281–288.
Chengappa KN, Kupfer DJ, Frank E, Houck PR, Grochocinski VJ, Cluss PA, Stapf DA. Relationship of birth
cohort and early age at onset of illness in a bipolar disorder case registry. American Journal of
Psychiatry. 2013;160(9):1636–1642.
DelBello MP, Geller B. Review of studies of child and adolescent offspring of bipolar parents. Bipolar
Disorders. 2011;3(6):325–334.
