Probleem 4
Vignet 1
- Kan een BD gevonden en gediagnosticeerd worden in kinderen?
- En hoe is dit anders dan bij volwassenen?
- Hoe kan een BD bij kinderen onderscheiden van andere stoornissen bij kinderen (ADHD)?
Vignet 2
- Wat + hoe is de relatie tussen creativiteit en BD?
Art. Power vooraf Keller lezen (= commentaar over Power), niet verdwaald raken in genetische
details.
Vignet 3
- Hoe kan een leefstijl interventie dat zich focust op fysieke activiteit, mindfulness, gezond
dieet en stress reductie ingezet worden in de behandeling van BD?
Art. Firth en Sun veel statische methodologieën wat je kan overslaan
Vignet 4
- Hoe zijn geweld en agressie geassocieerd met BD?
- Wat weten van de public conceptions (beelden van maatschappij) van gevaarlijke
psychiatrische patiënten?
https://docs.google.com/document/d/1GQSCiqxuFl0tA7viCEx-ciQCDG08tZeO_gU61lFoS9s/edit
4.1 Kowatch 2016 - Diagnosis, Phenomenology,
Differential Diagnosis, and Comorbidity of Pediatric
Bipolar Disorder
Prevalentie kinderen BD lifetime 2.3% voor 13-17 jarigen. Meestal eerste episode BD tussen 15 en 19
jaar.
Diagnose
- BD 1: zelfde diagnose nodig voor kinderen als voor volwassenen. Meestal criteria voor manie
niet gevonden bij kinderen meer bij adolescenten. Bij manie kan kind niet goed functioneren
op school en met vrienden. Bij hypomanie kunnen ouders gedragsverandering zien bij kind.
Bij adolescenten vaak een heftige depressie en pas later een manische periode -> mis
gediagnosticeerd met depressie.
- BD 2: zelfde diagnose nodig voor kinderen als voor volwassenen.
- Cyclothymic disorder: kinderen hoeven deze symptomen 1 jaar te hebben ipv 2 jaar bij
volwassenen. En symptomen kunnen niet 2 maanden weg zijn.
Clinical points
- Pediatric patients may not present with adequate symptoms to meet criteria for a bipolar I or
II episode, and they may cycle through mood swings quickly.
- Consider prevalent disorders such as anxiety disorders and ADHD in the differential
diagnosis, but look for periods of mania or hypomania.
- Screening tools, such as the Child Mania Rating Scale, can aid the diagnostic process.
- Carefully evaluate the temporal course of symptoms to avoid a misdiagnosis of ADHD, ODD,
or another disorder.
Phenomenology
Cycle: een uitgesproken verschuiving in stemming en energie van het ene uiterste naar het andere.
Episode: een langere periode van stemming ontregeling omvat vaak meerdere cycli in polariteit.
Rapid cycling: het voorkomen van 4 of meer stemmingsepisodes in 1 jaar.
, For many pediatric patients in my practice, parents have described a cycle in which children
wake up in a giddy or silly mood for no reason and have pressured speech, which is followed by
a normal day at school. They then have a depressed or irritable mood once they return home,
again with no reason. This phenomenology does not mean that the patients have rapid cycling
bipolar disorder, because the number of distinct episodes remains small. While both children
and adolescents may have daily mood cycling, mood episodes (extended periods of mood
dysregulation) typically do not become evident until adolescence.
Red flag symptoms and features
- Woede en agressie voor uren op een dag. Ook verlaging van slaap door manisch of hypo
manische episode wat dagen kan aanhouden. Terwijl ADHD bijv insomnia heeft.
- Spontane stemmingswisselingen bij familie en niet extern, en adolescenten hoog gevoel van
grandiosity
- Als BD in familie voorkomt -> oppassen.
Differential diagnosis
Weinig kinderen die BD symptomen hebben worden gediagnosticeerd met BD, meestal met ADHD of
ODD.
- ADHD: A study by Geller and colleagues 20 sought to find the differences that exist between
patients with bipolar disorder and ADHD. In a sample of 120 youths (with mean ages of 11.0
years for the bipolar disorder group and 9.6 years for the ADHD group), they found that most
manic symptoms were significantly more prevalent in patients with bipolar disorder than in
those with ADHD. Features that were common to both groups—and therefore not useful in
differentiating the disorders —were irritability, hyperactivity, accelerated speech, and
distractibility. Clinicians should remember that one symptom alone does not define a bipolar
diagnosis but rather a cluster of symptoms. Parents of children with ADHD typically report
that since their children were young, they were impulsive and hyperactive, and these
symptoms have not changed much, whereas a child with bipolar disorder will often display a
change in mood and behavior when an episode occurs.
- Oppositional Defiant Disorder ODD: vaak agressief gedrag, chronische disorder. Patients
with ODD do not exhibit the manic symptoms (eg, euphoria, grandiosity, decreased need for
sleep, pressured speech) that patients with bipolarity will present with; however, some
patients have both disorders. For children with bipolar disorder, clinicians should focus first
on stabilizing mood in order to determine whether or not ODD is present during euthymic
periods.
- Anxiety disorders: Anxiety disorders may cause mood swings and irritability, and some
children experience increased anxiety at the beginning of the school year. Clinicians should
focus on whether or not the patient is also exhibiting signs of manic behavior, as that will be
a clear indicator of bipolarity.
- Fetal Alcohol Syndrome FAS: Fetal alcohol syndrome (FAS) or neurobehavioral disorder
associated with prenatal alcohol exposure can occur in children who were exposed to alcohol
in utero. Clinically, FAS is easy to diagnose using the parental history and dysmorphic signs.
However, other children may have another FAS spectrum disorder known as alcohol-related
neurodevelopmental disorder. For these patients, the family history is unclear—perhaps the
mother used drugs while pregnant or the clinician is not sure whether she drank alcohol—
and they exhibit symptoms such as poor impulse control, deficits in school performance
(especially mathematics), and mood dysregulation.
Comorbid disorders
60-90% van BD kinderen worden beschreven als dat ze ADHD hebben, en 47-88% ODD.
Clinicians should examine which came first, mood symptoms or behavior symptoms, and should ask
what happens when children begin having mood cycles. Typically, behavioral symptoms worsen
Vignet 1
- Kan een BD gevonden en gediagnosticeerd worden in kinderen?
- En hoe is dit anders dan bij volwassenen?
- Hoe kan een BD bij kinderen onderscheiden van andere stoornissen bij kinderen (ADHD)?
Vignet 2
- Wat + hoe is de relatie tussen creativiteit en BD?
Art. Power vooraf Keller lezen (= commentaar over Power), niet verdwaald raken in genetische
details.
Vignet 3
- Hoe kan een leefstijl interventie dat zich focust op fysieke activiteit, mindfulness, gezond
dieet en stress reductie ingezet worden in de behandeling van BD?
Art. Firth en Sun veel statische methodologieën wat je kan overslaan
Vignet 4
- Hoe zijn geweld en agressie geassocieerd met BD?
- Wat weten van de public conceptions (beelden van maatschappij) van gevaarlijke
psychiatrische patiënten?
https://docs.google.com/document/d/1GQSCiqxuFl0tA7viCEx-ciQCDG08tZeO_gU61lFoS9s/edit
4.1 Kowatch 2016 - Diagnosis, Phenomenology,
Differential Diagnosis, and Comorbidity of Pediatric
Bipolar Disorder
Prevalentie kinderen BD lifetime 2.3% voor 13-17 jarigen. Meestal eerste episode BD tussen 15 en 19
jaar.
Diagnose
- BD 1: zelfde diagnose nodig voor kinderen als voor volwassenen. Meestal criteria voor manie
niet gevonden bij kinderen meer bij adolescenten. Bij manie kan kind niet goed functioneren
op school en met vrienden. Bij hypomanie kunnen ouders gedragsverandering zien bij kind.
Bij adolescenten vaak een heftige depressie en pas later een manische periode -> mis
gediagnosticeerd met depressie.
- BD 2: zelfde diagnose nodig voor kinderen als voor volwassenen.
- Cyclothymic disorder: kinderen hoeven deze symptomen 1 jaar te hebben ipv 2 jaar bij
volwassenen. En symptomen kunnen niet 2 maanden weg zijn.
Clinical points
- Pediatric patients may not present with adequate symptoms to meet criteria for a bipolar I or
II episode, and they may cycle through mood swings quickly.
- Consider prevalent disorders such as anxiety disorders and ADHD in the differential
diagnosis, but look for periods of mania or hypomania.
- Screening tools, such as the Child Mania Rating Scale, can aid the diagnostic process.
- Carefully evaluate the temporal course of symptoms to avoid a misdiagnosis of ADHD, ODD,
or another disorder.
Phenomenology
Cycle: een uitgesproken verschuiving in stemming en energie van het ene uiterste naar het andere.
Episode: een langere periode van stemming ontregeling omvat vaak meerdere cycli in polariteit.
Rapid cycling: het voorkomen van 4 of meer stemmingsepisodes in 1 jaar.
, For many pediatric patients in my practice, parents have described a cycle in which children
wake up in a giddy or silly mood for no reason and have pressured speech, which is followed by
a normal day at school. They then have a depressed or irritable mood once they return home,
again with no reason. This phenomenology does not mean that the patients have rapid cycling
bipolar disorder, because the number of distinct episodes remains small. While both children
and adolescents may have daily mood cycling, mood episodes (extended periods of mood
dysregulation) typically do not become evident until adolescence.
Red flag symptoms and features
- Woede en agressie voor uren op een dag. Ook verlaging van slaap door manisch of hypo
manische episode wat dagen kan aanhouden. Terwijl ADHD bijv insomnia heeft.
- Spontane stemmingswisselingen bij familie en niet extern, en adolescenten hoog gevoel van
grandiosity
- Als BD in familie voorkomt -> oppassen.
Differential diagnosis
Weinig kinderen die BD symptomen hebben worden gediagnosticeerd met BD, meestal met ADHD of
ODD.
- ADHD: A study by Geller and colleagues 20 sought to find the differences that exist between
patients with bipolar disorder and ADHD. In a sample of 120 youths (with mean ages of 11.0
years for the bipolar disorder group and 9.6 years for the ADHD group), they found that most
manic symptoms were significantly more prevalent in patients with bipolar disorder than in
those with ADHD. Features that were common to both groups—and therefore not useful in
differentiating the disorders —were irritability, hyperactivity, accelerated speech, and
distractibility. Clinicians should remember that one symptom alone does not define a bipolar
diagnosis but rather a cluster of symptoms. Parents of children with ADHD typically report
that since their children were young, they were impulsive and hyperactive, and these
symptoms have not changed much, whereas a child with bipolar disorder will often display a
change in mood and behavior when an episode occurs.
- Oppositional Defiant Disorder ODD: vaak agressief gedrag, chronische disorder. Patients
with ODD do not exhibit the manic symptoms (eg, euphoria, grandiosity, decreased need for
sleep, pressured speech) that patients with bipolarity will present with; however, some
patients have both disorders. For children with bipolar disorder, clinicians should focus first
on stabilizing mood in order to determine whether or not ODD is present during euthymic
periods.
- Anxiety disorders: Anxiety disorders may cause mood swings and irritability, and some
children experience increased anxiety at the beginning of the school year. Clinicians should
focus on whether or not the patient is also exhibiting signs of manic behavior, as that will be
a clear indicator of bipolarity.
- Fetal Alcohol Syndrome FAS: Fetal alcohol syndrome (FAS) or neurobehavioral disorder
associated with prenatal alcohol exposure can occur in children who were exposed to alcohol
in utero. Clinically, FAS is easy to diagnose using the parental history and dysmorphic signs.
However, other children may have another FAS spectrum disorder known as alcohol-related
neurodevelopmental disorder. For these patients, the family history is unclear—perhaps the
mother used drugs while pregnant or the clinician is not sure whether she drank alcohol—
and they exhibit symptoms such as poor impulse control, deficits in school performance
(especially mathematics), and mood dysregulation.
Comorbid disorders
60-90% van BD kinderen worden beschreven als dat ze ADHD hebben, en 47-88% ODD.
Clinicians should examine which came first, mood symptoms or behavior symptoms, and should ask
what happens when children begin having mood cycles. Typically, behavioral symptoms worsen
