Presentation is loading. Please wait.

Presentation is loading. Please wait.

Pediatric Bipolar Disorder Mani N Pavuluri, MD, PhD Berger Colbeth Chair in Child Psychiatry Pediatric Brain Research and Intervention Center University.

Similar presentations


Presentation on theme: "Pediatric Bipolar Disorder Mani N Pavuluri, MD, PhD Berger Colbeth Chair in Child Psychiatry Pediatric Brain Research and Intervention Center University."— Presentation transcript:

1 Pediatric Bipolar Disorder Mani N Pavuluri, MD, PhD Berger Colbeth Chair in Child Psychiatry Pediatric Brain Research and Intervention Center University of Illinois at copy righted

2 Pavuluri, 2012  How does it look?  Measurement  How to differentiate from ADHD  Prevalence  Onset  Follow up  Assessment: Big picture Overview of the presentation

3 Pavuluri, 2012

4 What is a Pediatric Bipolar Disorder? Central feature: Elevated, expansive mood or Irritable mood

5 Pavuluri, 2012 Equivalent description in a child  Excited  Giggly  Silly  Giddy  constantly on the go  laughing fits  joking and feels invincible  “ overwhelming ”  “ like wanting to jump on the bed ”  Constantly irritable  Aggressive  throwing pot plants  slamming doors  hard to transition  Acidic  Abrasive  hostile in words  Kicking  screaming  intense & inconsolable  out of proportion to the psychosocial stresses around them Mood

6 Pavuluri, 2012 Feeling good about myself 1) Generous gave money to the school’s mission collection 2) Friendly to everyone 3) Share my lunch with my friends getting up every morning at the regular time not tired I eat breakfast, lunch and dinner

7 Pavuluri, 2012

8 Timeline  Ultra Rapid Cycling: Complex Cycling  “Mini cycles within a big cycle”  Frequency: most days in a week  Intensity: severe enough to cause extreme disturbance in one domain or moderate disturbance in two or more domains  Number: three or four times a day  Duration: four or more hours a day

9 Pavuluri, 2012 Specific to PBD Irritability 77-98% Mixed Mania 20-84% Chronicity 42  29 months; 84% Rapid Cycling 46-87% Comorbid ADHD 75-98%

10 Pavuluri, 2012 Mood Spectrum: Time Depressed Mood Elevated Mood Normal

11 Pavuluri, 2012 Mood Spectrum: Time Depressed Mood Elevated Mood Major Depressive Disorder Normal

12 Pavuluri, 2012 Mood Spectrum: Time Depressed Mood Elevated Mood Normal Major Depressive Disorder Mania

13 Pavuluri, 2012 Mood Spectrum: Time Depressed Mood Elevated Mood Normal Major Depressive Disorder Mania Dysthymia

14 Pavuluri, 2012 Mood Spectrum: Time Depressed Mood Elevated Mood Normal Major Depressive Disorder Mania Dysthymia Hypomania

15 Pavuluri, 2012 Mood Spectrum: Time Depressed Mood Elevated Mood Normal Major Depressive Disorder Mania Hypomania Bipolar Disorder Dysthymia

16 Pavuluri, 2012 Mood Spectrum: Time Depressed Mood Elevated Mood Pediatric Bipolar Disorder

17 Pavuluri, 2012 Mood Spectrum Time Depressed Mood Elevated Mood Normal Major Depressive Disorder Mania Hypomania Dysthymia Bipolar PBD

18 Pavuluri, 2005 Distribution of Bipolar Subjects

19 Pavuluri, 2012 BP-NOS at Intake – Convert to BP-I Birmaher et al, AACAP, 2003 Major Depression Dep-NOS Euthymia BP-NOS Hypomania Mania

20 Pavuluri, 2012 BP-II at Intake – Convert to BP-I Mania Hypomania BP-NOS Euthymia Dep-NOS Major Depression Birmaher et al, AACAP, 2003

21 Pavuluri, 2012 “Diagnostic fashion runs in cycles!”

22 Pavuluri, 2012

23 Child Mania Rating Scale, Parent Version The following questions concern your child’s mood and behavior in the past month. Please place a check mark or an ‘x’ in a box for each item. Please consider it a problem if it is causing trouble and is beyond what is normal for your child's age. For example, check ‘never' if the behavior is not causing trouble. 1. Have periods of feeling super happy for hours or days at a time, extremely wound up and excited, such as feeling "on top of the world" 2. Feel irritable, cranky, or mad for hours or days at a time 3. Think that he or she can be anything or do anything (e.g., leader, best basketball player, rap singer, millionaire, princess) beyond what is usual for that age 4. Believe that he or she has unrealistic abilities or powers that are unusual, and may try to act upon them, which causes trouble Never Sometimes Often Very Often /Rarely Pavuluri et al, aacap 2004

24 Pavuluri, 2012 How to use it?  Have the parent focus on the child’s behavior in the past month.  “Never/Rarely” and “Sometimes” = behavior that is causing minimal or no difficulty  “Often” and “Very Often” = behavior that is causing trouble.  The child’s score is the sum of all item scores.

25 Pavuluri, 2012 Interpreting the results  A cut off score of 15 screens for the manic spectrum  A cut off score of 20 is highly specific for mania

26 Pavuluri, 2005 Reliability  Internal Consistency: 0.96  Test Re-test Reliability: 0.96

27 Pavuluri, 2012 CMRS-P Total Score

28 Pavuluri, 2012 Why should I choose it? PROS DSM IV basis Singular item focus Integrated functionality Age specific items Timing of symptoms Language Linked examples

29 Formulation Diagnosis DD 1. (w/3 main symptoms) Interpersonal Relationships Functioning Other… Family Friends Teacher Home School OutcomePrecipitating Factor Why now? Temperament and Personality Style Strengths Coping Mechanisms/Defenses - Support - stresses Attachment/Goodness of Fit Parenting Capacity Context Background Mother - Dev. Hx Personality Father Personal Resources (knowledge, skills, attitude, motivation) M-F (partnership) Child Siblings Family Structural (roles, relationships) C – C, M – C, F – C, etc. Strategic (problem solving, family beliefs) Systemic (theme) Maturity Work Psychopathology *Central Issue *EMIC vs. ITIC *Find the Person/s

30 Pavuluri, 2012 Mania vs. ADHD Z ADHD Z Primarily a disorder of attention, not mood Z Onset before age 7 Z Persistent, not episodic Z Problem of Comorbidity

31 Pavuluri, 2012

32

33

34

35 Pavuluri, % / 72%1160Geller et al., %6.168Faraone et al., %1648Kafantaris et al., %1142Kowatch et al., Mean Age 65%34DelBello et al., %43Wozniack et al., %14West et al., 1995 ADHDnStudy Comorbidity of ADHD In Pediatric Bipolars

36 Distinguishing Between Bipolar and ADHD Geller & Zimerman 2002.

37 Pavuluri, 2012 Pediatric Bipolar Disorder Z Prepubertal & Early Adolescent Onset Bipolar Disorder (PEA - BD) Z Juvenile BD Z Atypical BD Z Childhood Onset BD Adolescent Onset Bipolar Disorder (AO-BD)  12 yr. > 12 yr.

38 Pavuluri, 2012

39 Prevalence of BP in Adolescents Lewinsohn 1995 Findings 1.0% prevalence of BP (primarily BP II and cyclothymia) 5.7% prevalence of BP NOS Diagnostic interviews with 1709 high school students, ages years

40 Pavuluri, 2012 Age of Symptom Onset NDMDA Survey N=500 Lag to Diagnosis = 8 Years < % 20% 10% % 14% 12% 5% 15% 9% 16% Years of Age Lish %

41 Pavuluri, 2012 Recovery and Relapse

42 Pavuluri, 2012 Developing the language Symptom List FIND Invisible Fist Signature Brain Disorder

43 Pavuluri, 2012 OUTINE FFECT CONTROL CAN DO IT O NEGATIVE THOUGHTS; LIVE IN THE NOW E A GOOD FRIEND: BALANCED LIFESTYLE H! HOW CAN WE SOLVE IT?! AYS TO GET SUPPORT


Download ppt "Pediatric Bipolar Disorder Mani N Pavuluri, MD, PhD Berger Colbeth Chair in Child Psychiatry Pediatric Brain Research and Intervention Center University."

Similar presentations


Ads by Google