Common Comorbidities
Anxiety Disorders (Panic Attacks, Social
- Anxiety Disorder/Social Phobia, Specific Phobia)
- ADHD
- Oppositional Defiant Disorder
- Conduct Disorder
- Substance Use Disorder
Assessment Considerations
Assessment is extremely important before beginning any treatment for bipolar disorder, as this disorder has a high treatment threshold
Difficult to diagnose in youth:
- Symptoms confused with other conditions such as ODD, ADHD, anxiety disorders
- If psychotic symptoms present, it can be misdiagnosed as schizophrenia
Multi-method, multi-source
- Need collateral informants as discrepancies between parent, youth, teacher can be common
- Parents are best raters of BPD (Youngstrom et al., 2006)
Purpose of assessment: assess risk, prognosis, severity, develop case conceptualization, and develop treatment plans
Family history of bipolar disorder (genetics & family environmental processes)
Ongoing assessment of mood & energy and relapse prevention
Assessment Tools
Interview & Records Review
- Obtain history for child & family to assess risk, develop a case conceptualization & develop treatment
- Mental health history of parents
- Physical health of child
- Previous mental health services
- Description of symptom presentation
- Family strengths and weaknesses
Challenges to obtaining information
- Parent availability, reporter accuracy, & disclosure
- Parent mental health or family disruptions
Behavior Rating Checklists / Scales
- Screening, monitoring outcome, & may help to disentangle which behaviors are attributable to mood disorder vs. other contributing factors
- Parent report aids in differential diagnosis
Specific measures examples
- Child Behavior Checklist (CBCL)
- General Behavior Inventory (GBI)
- Mood Disorder Questionnaire (MDQ)
- BDI (Beck Depression Inventory)
- Young Mania Rating Scale (YMRS)
Diagnostic interviews
- Often used by clinicians to assess Bipolar Disorder
- Depends on validity of structured interviews
- Depends on training level of evaluator
- Administration time (1.5 - 6 hours)
Examples
K-SADS
Children’s Interview for Psychiatric Syndromes
Empirically Supported Treatments
Psychoeducational Treatments
Cognitive-Behavioral Therapy
Interpersonal Therapy- like AA meetings all share same problem
Medication- effective when a biological etiology
Family Focused Treatment (FFT)
For adolescents with bipolar disorder, adapted from FFT adults
Used as an adjunct to pharmacotherapy
Focused on the family
Improve caregiver’s ability to understand & cope with their child’s illness
Decreased caregiver’s levels of expressed emotion
Goals:
Increase adherence to meds to delay reoccurrence of manic episodes
Enhance adolescent’s knowledge of BPD, communication & coping skills
Minimize psychosocial impairment
3 components (approximately 20 sessions)
Psycho-education
Communication enhancement training
Problem solving skills training
RAINBOW Program
Child & family focused; CBT; Adapted from FFT model for children (8-12 yrs)
12 sessions protocol, sessions with parents alone, child alone, child and parents together, and parents with siblings
R (routine),
A (Affect Regulation),
I (I can Do it!),
N (No Negative thoughts & live in the now)
B (be a good friend & balanced lifestyle for friends),
O (Oh, How can we solve the problem)
W (Ways to get support)
Multi-Family Education Groups
Consists of 8 - 90 minute sessions for parents with concurrent sessions for children with another therapist
Psycho-educational in nature
Information on course, prognosis, & treatments
Designed for children with bipolar disorder or a diagnosis of depressive disorder
Allows parents to get support from other parents
Similar components to FFT & RAINBOW
Cognitive Behavioral Therapy
Focuses on identifying & altering negative thought patterns, beliefs, & actions that contribute to the maintenance of depressive disorders
Change mood through cognitive restructuring to help client focus on the learning & practicing of new or more effective coping skills
Interpersonal Therapy (IPT)
Designed to allow depressed individuals an opportunity to:
Focus on resolving areas of grief
Improve interpersonal relationships by reducing conflict
Identify & rectify personal difficulties
Key areas include Role transitions Role disputes Interpersonal skill deficits Grief resolution
Medication Treatment
Medication treatment guidelines: Child Psychiatric Workgroup on Bipolar Disorder (Kowatch et al., 2005)
Mood Stabilizers: Lithuim, Depocote, Tegretal
Used commonly to treat Acute mania in adults
Side-effects: thirst, tremors, weight gain
No methodologically sound research studies for lithium with adolescents
Comorbidity with personality disorders associated with decreased responsiveness
Neuropleptics
Combined with lithium
Side-effects - Increased rate of tardive dysknesia
Anti-convulsants
Carbamazepine and valpoiric acid
Benzodiazepines
Used for acute management of agitation & insomnia in mania
Not as successful as with adults
More research needed
