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Lecture

Psychology 2320A/B Lecture Notes - Major Depressive Episode, Mixed Affective State, Bipolar Disorder


Department
Psychology
Course Code
PSYCH 2320A/B
Professor
Prof

Page:
of 7
ABNORMAL CHILD PSYC LAB March 14
Ask teacher why so many words aren’t
grammatically correct in psychology 3/14/2013 11:32:00 AM
Bipolar Disorder
• Previously “manic-depressive illness, circular type”
• Thus bipolar disorder is a “cyclic” or “periodic” illness, with patients cycling
“up” into a manic or mixed-manic episode, then returning to normal, and
cycling “down” into a depressive episode.
• Most people return to their normal state of functioning in between
episodes.
Mania in adults
• A distinct period of abnormally and persistently elevated, expansive or
irritable mood (1 week) + 3 of the following:
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative
• Flight of ideas or subjective experience of thoughts racing
• Distractibility
• Increase in goal-directed activity
• Excessive involvement in pleasurable activities that have a high potential
for painful consequences e.g., unrestrained buying sprees.
Mania in children
• Irritability or rage
• Silly, giddy, overexcited, overtalkative behavior combined with expansive,
grandiose beliefs.
• May engage in dangerous behaviors due to the belief they ARE
superhuman or powerful (e.g. can walk on water or jump off buildings
without hurting themselves, etc)
Mania in children continued
• Restlessness
• Agitation
• Sleeplessness
• Sexual Disinhibition
• Unrealistic elevations in self-esteem
• Vast surges of energy (go for days with little sleep)
• Hyper (e.g. concentrating for hours on one activity) or Hypo-attentive
(distractible).
• This mood disturbance must be uncharacteristic of the child as per their
developmental history (i.e., a change from their normal behavior)
• Children believe their manic thoughts with great conviction no matter
how illogical
Pressured speech: talk too much and too fast, change topics too
quickly, and cannot be interrupted.
Racing thoughts: thoughts come one after another and interrupt each
other
Flight of ideas: jump from one idea to another completely unconnected
idea
• Visual and auditory hallucinations in extreme cases.
• Changes un surroundings lead to extreme distractibility.
Diagnosis
MANIC EPISODE (mood disturbance)
• discrete period of 1 week or more of ongoing, pervasive, and unusually
elevated or irritable mood with sxs present as previously described.
• Does not meet depressive episode criteria during this time.
• Not due to substance use/abuse or medical condition
• Causes significant impairment in activities or requires hospitalization
MIXED EPISODE
• Child experiences both a manic episode and a major depressive episode for
a week or more
HYPOMANIC EPISODE
• Resemble manic episode but the mood disturbance and symptoms are less
severe, or shorter duration, and result in less impairment in functioning.
BIPOLAR DISORDER
• Requires evidence for a manic or mixed episode, and one or more major
depressive episodes
BIPOLAR 2 DISORDER
• Requires a hypomanic episode and one or more MD episodes
CYCLOTHYMIC DISORDER
• Child displays numerous and persistent hypomanic and depressive
symptoms for a year or more that cause considerable distress and
impairment in functioning but do not meet manic or mixed episode or MD
episode criteria.
Issues with diagnosis in kids
• In youth BPD:
- occurs infrequently
- changes in mood and behavior more erratic than persistent
- irritability and belligerence occur more frequently than euphoria and
grandiosity
- shows extreme variability in presentation within and across episodes
- overlaps in symptoms with more common childhood disorders such as?
ADHD
Prevalence and Incidence
• Lifetimes prevalence estimates range from 0.4% to 2.9%
• Most common dx is Bipolar 2 or Cyclothymic
Why not Bipolar 1?
• About 80% of children present with rapid cycling (at least 4 mood episodes
in one year)
• Incidence in children as young as 5-6 is extremely rare but matches that of
adults in late adolescence.
• Affects boys and girls equally BUT sxs expressed differently (boys more
mania and girls more depression)
• Early onset BPD (prior to age 13) may be more common in boys
• Little evidence for ethnic variation but little research!
• Since 1994, youth outpatient office visits for BP has increased 40-fold with
90% of kids receiving psychotropic medications.