Bipolar Pt.2
Diagnosis, Phenomenology, Differential Diagnosis & Comorbidity of
Pediatric BP (Kowatch, 2016)
Introduction 2.3% prevalence in adolescents
Common age of onset: 15-19y, 10-14, 20-24
DSM-V for It does not vary based on onset age
children - Unlikely to have hypomanic symptoms b4 puberty (not sleeping, silly, more energy)
- Different functioning compared to peers
- Severe dep episode followed by manic one, immediately or months after (include psychotic,
melancholic features, severe depressions)
Phenomenolo Children may have thousands of mood swings per year
gy ● Cycle: shift in mood & energy from one extreme to another
● Episode: extended period of mood dysregulation - multiple cycles in an episode (one day good, one
bad)
● Cycling: 4+ episodes in a year (= not rapid cycling, children: which is within a day (AM happy, PM sad
& differ to mood episodes in adolescence).
● 70% of participants had: increased energy, irritability, mood lability, distractibility, goal directed-activity-
more subsyndromal. More experience dep than mania.
Children <13y usually get diagnosed w/ other BP related disorders due to lack of symptoms meeting criteria &
have a worse course of illness.
Adolescents: meet criteria: elation, grandiosity + substance abuse & suicidal attempts
Red flags 1. Rage & aggression: several times a day
symptoms & 2. Decreased need for sleep: but act tired & sluggish, could also be ADHD
features 3. Spontaneous Mood shifts: mood swings out of context, ado have lvl of grandiosity
4. Pediatric patients: high risk beh, if action not appropriate in context.
- Higher sus if family history of mood disorder
- Other risk factors: early onset-dep, psychotic features, recurring episodes of dep
Screening Don’t think this is important- in class, if it is, rewrite them here.
tools
Differential In a study, out of a 100 patients: 12% had BP, 39% ADHD, 15 had ODD & ADHD, 15 had GAD, 10% had
diagnosis secondary mood disorder (fetal alcohol spectrum disorder)
ATTENTION DEFICIT/HYPERACTIVITY DISORDER
, Pediatric BP often mistaken for ADHD
● Hyperactivity, impulsiveness, rapid speech, distractibility are present in both
● Change in hyperactive beh: key to diagnosis
OPPOSITIONAL DEFIANT DISORDER
= aggressive behavior, lose temper, act defiant towards authorities= chronic, no manic symptoms.
● Can have both ODD & BP
ANXIETY DISORDER= causes mood swings & irritability
FETAL ALCOHOL SYNDROME (FAS)= brain damage, different facial features, behavior problems.
COMORBID DISORDERS
● 60-90% have ADHD
● 47-88% have ODD
● Higher chance of having anxiety disorders & developing SUD
Can you name a couple of differences between younger and older bipolar patients?
- Difference
- Aggression more in Ch
- Rage more in Ch
- In Ch rarely a full blown mania
- Ch usually have lower level BP symptoms
- 60-90% of CH with BP also have ADHD
- Same
- Decreased need for sleep
- Mood shifts
- Displaying high risk behaviors
- Family history of mood disorders
- Young: Rage and aggression, decreased need for sleep, high risk of disruptive behaviour (conduct
disorder), depressive symptoms, oppositional defiant disorder. Accompanied by ADHD. more cycles.
- Children under 13yo will be diagnosed with other specified bipolar and related disorder due to lack of
symptoms meeting criteria for an episode.
- Whereas adolescents often meet the criteria.
- In Pediatric patients rage and aggression are redflags (in comparison to adults)
- Higher level of grandiosity → more disconnected from reality
What is rapid cycling, and what do you know about the difference between younger and older patients in
this respect?
, - Rapid cycling: 4 or more episodes in a year
- Cycling: a daily mood cycle in children → this is NOT ‘rapid cycling’ because it is not separate ‘episodes’
What is the difference between an episode and a cycle?
- Episode: an extended period of mood dysregulation often encompassing multiple cycles in polarity.
- Cycle: a pronounced shift in mood and energy from one extreme to another.
BP & ADHD: Comorbidity & Diagnostic Distinctions (Marangoni, De
Chiara, Faedda, 2015)
Introduction ADHD: early onset of persistent sympts of inattention &/or hyperactivity & impulsivity not consistent w/ developt,
causing impairment of functioning in 2 settings.⇒ Most common disorder in children, male majority (75%).
Difficult to diff bcs: onset age, retrospective parent reports, course of BP, ltd self-report sympts, symptomatic
overlap, reciprocal comorbidities.
BP= mood, sleep & aggressive behavior
ADHD= fidgeting, restlessness, disorganised performances from inattentiveness, distractibility & forgetfulness
Epidemiology ● ADHD prevalence= 1.7-16% in young pp (Persists in adult- 1/3rd ppl in childhood have it in adulthood)
● BP prevalence= 2.1% in adults, 1.8% in children (w/ 2/3rd having the onset <18y)
Similarities/Differences
+ Both more in males
- BD more comorbid w/ anxiety, ADHD, disruptive behavior & SUD
- ADHD & anxiety comorbidity negatively affects functioning, symptomatology
- Comorbidity btw ado ADHD & CD, ODD, anxiety or SUD increases risk of developing BD
Clinical Three approaches to differentiate the two:
features 1. One compares & contrasts the 2 syndromes by eliminating overlapping symptoms
● Elated mood, grandiosity, hypersexuality, less sleep, fast thoughts & everything else except
hyper-energy & distractibility= more in BP
● BUT if no psychotic, suicidal, or hyper-sexual behavior, clinical differentiation is hard
2. Alternative & complementary approach used chronological appearance of symptoms= some
evidence for differential & independent trajectories of psychopathology.
3. Child Behavior Checklist (CBCI)= Subscale diff them: elevation of the anxious/depressed, aggressive
beh & attention problems subscale (but some studies founds it’s not specific to BP).
Differences in
symptoms
BP ADHD
Diagnosis, Phenomenology, Differential Diagnosis & Comorbidity of
Pediatric BP (Kowatch, 2016)
Introduction 2.3% prevalence in adolescents
Common age of onset: 15-19y, 10-14, 20-24
DSM-V for It does not vary based on onset age
children - Unlikely to have hypomanic symptoms b4 puberty (not sleeping, silly, more energy)
- Different functioning compared to peers
- Severe dep episode followed by manic one, immediately or months after (include psychotic,
melancholic features, severe depressions)
Phenomenolo Children may have thousands of mood swings per year
gy ● Cycle: shift in mood & energy from one extreme to another
● Episode: extended period of mood dysregulation - multiple cycles in an episode (one day good, one
bad)
● Cycling: 4+ episodes in a year (= not rapid cycling, children: which is within a day (AM happy, PM sad
& differ to mood episodes in adolescence).
● 70% of participants had: increased energy, irritability, mood lability, distractibility, goal directed-activity-
more subsyndromal. More experience dep than mania.
Children <13y usually get diagnosed w/ other BP related disorders due to lack of symptoms meeting criteria &
have a worse course of illness.
Adolescents: meet criteria: elation, grandiosity + substance abuse & suicidal attempts
Red flags 1. Rage & aggression: several times a day
symptoms & 2. Decreased need for sleep: but act tired & sluggish, could also be ADHD
features 3. Spontaneous Mood shifts: mood swings out of context, ado have lvl of grandiosity
4. Pediatric patients: high risk beh, if action not appropriate in context.
- Higher sus if family history of mood disorder
- Other risk factors: early onset-dep, psychotic features, recurring episodes of dep
Screening Don’t think this is important- in class, if it is, rewrite them here.
tools
Differential In a study, out of a 100 patients: 12% had BP, 39% ADHD, 15 had ODD & ADHD, 15 had GAD, 10% had
diagnosis secondary mood disorder (fetal alcohol spectrum disorder)
ATTENTION DEFICIT/HYPERACTIVITY DISORDER
, Pediatric BP often mistaken for ADHD
● Hyperactivity, impulsiveness, rapid speech, distractibility are present in both
● Change in hyperactive beh: key to diagnosis
OPPOSITIONAL DEFIANT DISORDER
= aggressive behavior, lose temper, act defiant towards authorities= chronic, no manic symptoms.
● Can have both ODD & BP
ANXIETY DISORDER= causes mood swings & irritability
FETAL ALCOHOL SYNDROME (FAS)= brain damage, different facial features, behavior problems.
COMORBID DISORDERS
● 60-90% have ADHD
● 47-88% have ODD
● Higher chance of having anxiety disorders & developing SUD
Can you name a couple of differences between younger and older bipolar patients?
- Difference
- Aggression more in Ch
- Rage more in Ch
- In Ch rarely a full blown mania
- Ch usually have lower level BP symptoms
- 60-90% of CH with BP also have ADHD
- Same
- Decreased need for sleep
- Mood shifts
- Displaying high risk behaviors
- Family history of mood disorders
- Young: Rage and aggression, decreased need for sleep, high risk of disruptive behaviour (conduct
disorder), depressive symptoms, oppositional defiant disorder. Accompanied by ADHD. more cycles.
- Children under 13yo will be diagnosed with other specified bipolar and related disorder due to lack of
symptoms meeting criteria for an episode.
- Whereas adolescents often meet the criteria.
- In Pediatric patients rage and aggression are redflags (in comparison to adults)
- Higher level of grandiosity → more disconnected from reality
What is rapid cycling, and what do you know about the difference between younger and older patients in
this respect?
, - Rapid cycling: 4 or more episodes in a year
- Cycling: a daily mood cycle in children → this is NOT ‘rapid cycling’ because it is not separate ‘episodes’
What is the difference between an episode and a cycle?
- Episode: an extended period of mood dysregulation often encompassing multiple cycles in polarity.
- Cycle: a pronounced shift in mood and energy from one extreme to another.
BP & ADHD: Comorbidity & Diagnostic Distinctions (Marangoni, De
Chiara, Faedda, 2015)
Introduction ADHD: early onset of persistent sympts of inattention &/or hyperactivity & impulsivity not consistent w/ developt,
causing impairment of functioning in 2 settings.⇒ Most common disorder in children, male majority (75%).
Difficult to diff bcs: onset age, retrospective parent reports, course of BP, ltd self-report sympts, symptomatic
overlap, reciprocal comorbidities.
BP= mood, sleep & aggressive behavior
ADHD= fidgeting, restlessness, disorganised performances from inattentiveness, distractibility & forgetfulness
Epidemiology ● ADHD prevalence= 1.7-16% in young pp (Persists in adult- 1/3rd ppl in childhood have it in adulthood)
● BP prevalence= 2.1% in adults, 1.8% in children (w/ 2/3rd having the onset <18y)
Similarities/Differences
+ Both more in males
- BD more comorbid w/ anxiety, ADHD, disruptive behavior & SUD
- ADHD & anxiety comorbidity negatively affects functioning, symptomatology
- Comorbidity btw ado ADHD & CD, ODD, anxiety or SUD increases risk of developing BD
Clinical Three approaches to differentiate the two:
features 1. One compares & contrasts the 2 syndromes by eliminating overlapping symptoms
● Elated mood, grandiosity, hypersexuality, less sleep, fast thoughts & everything else except
hyper-energy & distractibility= more in BP
● BUT if no psychotic, suicidal, or hyper-sexual behavior, clinical differentiation is hard
2. Alternative & complementary approach used chronological appearance of symptoms= some
evidence for differential & independent trajectories of psychopathology.
3. Child Behavior Checklist (CBCI)= Subscale diff them: elevation of the anxious/depressed, aggressive
beh & attention problems subscale (but some studies founds it’s not specific to BP).
Differences in
symptoms
BP ADHD
