Mood disorders. Carolyn R. Fallahi, Ph. D.

Transcription

1 Mood disorders Carolyn R. Fallahi, Ph. D.

2 Childhood bipolar disorder Dramatic mood swings Occur in cycles Exhilaration and agitation = mania Depression Normal mood The typical adult cycle How do children s symptoms differ?

3 Extreme behavior Extreme behavior results in: Dangerous behaviors No energy Multiple hospitalizations Greater risk for substance abuse Greater risk for suicide

4 Child-onset Is there really a child-onset BPD? The similarity to schizophrenia Case study

5 Diagnosis and Assessment Diagnostic Criteria Bipolar I Bipolar II Cyclothymia Bipolar disorder NOS Manic episode Hypomanic episode

6 Criteria for Manic Episode Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing Distractibility Increase in goal-directed activity or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences

7 Criteria for Hypomanic Episode Same symptoms.but. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. No psychotic features.

8 Criteria for Mixed Episode Criteria met both for a manic episode and a major depression episode (except for duration) nearly every day during at least a one-week period. Mood disturbance is sufficiently severe to cause marked impairment in occupational functioning, or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others; or there are psychotic features.

9 The different types of BPD BPI BPII Cyclothymia Classification issues Common co-occurring disorders: ADHD, Conduct Disorder

10 Does BPD really occur in children? Increasing numbers of children are given the diagnosis of BPD Controversy continues about this disorder. Why? Sachs & Lafer (1998): BPD does not occur in children. The opposite view.

11 Research questions to answer if BPD occurs in children Research asks several different questions. 1) does bipolar disorder represent developmentally appropriate behavior? 2) What about genetic studies? Do they help answer this question? 3) does BPD represent manifestations of other disorders? ADHD and CD? 4) Is there evidence that ADHD and BPD are distinct classifications? 5) How does child-onset BPD differ from adult-onset BPD?

12 This makes us think. The disorder with a childhood onset may be different from the disorder with an adult onset. BPD might be the same disorder in children as in adults. Might there be two different disorders? One with rapid cycling of symptoms and one with slower cycling? Are children experiencing a distinct type of BPD? Are children experiencing symptoms that will lead to another disorder?

13 Characteristics of BPD Children Common misperception about periods of mania. Irritability Grandiosity Hyperactivity Dangerous Behaviors Associated Characteristics Co-morbidities Dangerous behaviors

14 Adolescents & BPD Greater rates of substance abuse More likely to attempt and complete suicide

15 Developmental expressions of manic and depressive symptoms (Haugaard, 2008, p ) Symptom Adult Presentation Child Presentation Grandiosity Decreased need for sleep Pressured speech Haugaard, (2008, p ) Adult claims to be the next Don Juan ; writes the world s greatest novel; etc Adult reports several nights in a row without sleep, usually without feelings of fatigue Adult is hard to interrupt Child tells school personnel that he s president s son; insists that a rock group is coming to his birthday party. Child has great difficulty settling down to sleep, wakes up frequently in the middle of the night, walks out of the house in the middle of the night. Child proselytizes, is difficult to interrupt, perseverates on a topic.

16 Developmental expressions of manic and depressive symptoms Symptom Adult presentation Child presentation Racing thoughts Distractibility Increased goaldirected activity Haugaard, (2008, p ) Adult jumps from one thought to another without a logical train of thinking Adult cannot stick to topic of conversation, comments on dress, extraneous events Adult begins spontaneous house renovations (without previous plans); adult joins many new social clubs Child talks nonstop; child is very hard to redirect Child unable to engage in usual activities; child moves from one activity to another Child wants to rearrange room at 10 p.m.; child sorts and resorts baseball cards.

17 Developmental expressions of manic and depressive symptoms Symptom Adult presentation Child presentation Excessive involvement in reckless activities / hypersexuality Irritability and/or tantrums Change in appetite Haugaard, (2008, p ) Adult goes gambling, on drinking or drug binges, on spending sprees; adult acts on hypersexual feelings without taking precautions Adult gets in fight at bar; adult throws plate at wall because of noise Adult loses appetite during a depressive episode Child tries to jump off roof; child begins selfstimulating without feeling self-conscious; child propositions adult; child removes clothing in public place Child threatens parent with a knife; child tries to smother siblings with a pillow; child kicks holes in walls Child shows wide variation in appetite from hardly eating to gorging or stuffing food.

18 Developmental expressions of manic and depressive symptoms Symptom Adult presentation Child presentation Feelings of worthlessness Recurrent thoughts of death or suicidal ideation Psychotic symptoms Haugaard, (2008, p ) Adult has feelings of being a failure; adults feels there is nothing to live for. Adult fears death, has thoughts about sudden death; adult expresses wish to die Adult sees spirit; adult sees image in the mirror change to other; adult hears voices of deceased relatives Child insists parents never wished child s birth; child expresses feelings of not belonging. Child talks about death; child makes explicit threats to harm self; child talks about wanting to be dead; child threatens to hang self with a belt Child believes classmates want to trick child; child sees snake coming out of the wall; child hears voices directing child to do bad things ; child reports seeing wall turn to red.

19 Prevalence Issues with prevalence Longitudinal studies Sex differences in childhood; adolescence The course of BPD

20 Etiology Neurological explanations Genetics Brain evidence Twin research The role of stress

21 Treatment The necessity for early intervention. Hospitalization. Medication Lithium Carbonate: Lithium Depakote Tegretol Issues with children and medication

22 Treatment Family therapy Psychoeducation Group therapy Individual therapy