Children and Adolescents with Bipolar Disorder

Children and Adolescents with Bipolar Disorder
By: Boris Birmaher MD
Department of Child Psychiatry
Western Psychiatric Institute and Clinic
University of Pittsburgh Medical Center

Do children and adolescents have Bipolar Disorder (BP)?
Bipolar Disorder in Youth
Clinical Manifestations
Bipolar Disorder – Classical Clinical Manifestations
DSM-IV Manic episode
DSM-IV Hypomanic episode
Bipolar Disorder Clinical Manifestations
DSM-IV Major depression episode
Subtypes of Bipolar Disorder
Bipolar I disorder
o Manic
o Depressed
o Mixed
o Rapid cycling
o Psychotic

Bipolar II disorder (hypomania and MDD episodes)
Cyclothymic disorder (hypomania and mild depressions)
Bipolar Not Otherwise Specified (NOS)
Difficulties Diagnosing Pediatric Bipolar Disorder
Developmental Manifestations of Manic Symptoms in Children
To clarify the diagnosis:
Retrospective Studies of Adults with BP-I
Frequent Prodromal Features Before Onset of BP-I
WPIC Child Mood & Anxiety Disorder Outpatient Clinic
Hamilton Depression Scores
Child & Adolescent Bipolar Services (CABS)
Course and Outcome of Bipolar Youth (COBY)
Demographics (COBY) (Cont’)
COBY Subjects – Lifetime Presence of Psychiatric Diagnoses
Prepubertal Bipolar Disorder
In General, BP in youth can presented as:
* Typical phenotype (DSM Bipolar I and II)
o Many have frequent episodes and mixed bipolar episodes
* Typical phenotype but for a short time (DSM-IV BP NOS or rapid cycling)
o Many have frequent episodes and mixed episodes
* Broad phenotype (DSM-IV BP NOS or rapid cycling)
Clinical Manifestations - Questions?
In addition to different subtypes of BP disorder, severity of symptoms, and rapid changes in symptomatology it is difficult to diagnose BP in children because:

1) Coexisting disorders
2) Overlap in symptoms with other disorders
Bipolar Disorder - Comorbidity
Bipolar Disorder - Differential Diagnoses
Diagnostic Overlap between Mania & ADHD
DSM-IV Criteria
Hyperactivity / goal-directed activity
DSM-IV Criteria
Distractibility
Inflated self-esteem / grandiosity Commonly associated
Epidemiology
BP-I Natural Course Multicenter
Pilot Study
BPD-I Natural Course
Course and Outcome of Bipolar Youth (COBY)
Diagnosis at Intake:
Bipolar Disorder - Natural Course
Natural Course General Conclusions
Sequela
Bipolar Disorder - Sequela
Pediatric Bipolar Disorder - WPIC Mood & Anxiety D/O Outpatients
Pediatric Bipolar Disorder Oregon Study
Predictors of Bipolar Disorder
Bipolar Disorder- Family Studies
Children of Parents with BP
NIMH-Bipolar Offspring Study (BIOS)
Bipolar Offspring Study (BIOS) Instruments
BIOS - SAMPLE
BIOS - Demographics – Offspring Preliminary Analyses
BIOS- Probands
Lifetime Disorders
BIOS- Offspring of BP parents-Lifetime Disorders- Definite/Probable
Any Substance/alcohol
Offspring of BP vs. Controls-CBCL Scores
Treatment
Bipolar Disorder - Psychoeducation
Pharmacological Treatment
Divalproex Treatment for Bipolar Disorder
Lithium for Adolescents with Acute Mania
Side Effects/Laboratory Tests Prior and During Psychopharmacological Treatment
Check for presence of “side effects” prior to starting treatment
Bipolar Depression - Treatment
Psychosocial Treatments
Family-Focused Treatment of Bipolar Disorder
Family-Focused Treatment for Adolescent Bipolar Patients
Interpersonal and Social Rhythms Therapy (IPSRT)
Bipolar Disorder – Treatment Other Considerations
Bipolar Disorder- Conclusions

Children and Adolescents with Bipolar Disorder.ppt