Discussion Questions

1) Using the literature provided above and/or that of your own research, along with DSM 5 information on differential diagnoses, what features of bipolar disorder are shared with other childhood psychiatric diagnoses?

 
     There can be many different childhood psychiatric diagnoses that have similar features of bipolar disorder which is why it is so difficult to diagnose. It can be complicated when assessing a child because some of the behaviors that they are displaying may be age appropriate. Youth often receive a diagnosis of another psychiatric disorder that has symptoms that overlap with those of bipolar disorder but are chronic rather than episodic in nature, including ADHD (hyperactivity, distractibility), oppositional defiant disorder (ODD) (risk-taking behavior, irritability), and disruptive mood dysregulation disorder (DMDD)/dysthymia (irritability) (Swartz,et al., 2019). Symptoms of hyperactivity, distractibility, irritability, and risk-taking behavior are seen with bipolar as well as other childhood psychiatric disorders.

 
2) What features distinguish bipolar disorder from what appear to be other similar illnesses? Discuss current treatment options for children with bipolar disorder and what education you would provide to the parent and child (if appropriate), specific to treatment and pediatric bipolar disorder in general.

 
    The primary differences in the course of bipolar disorder (BD) among youths compared with adults with BD is more mixed presentations and more mood polarity changes (Goldstein, et al., 2020). In children the mania and depression cycle very fast compared to adults. When children are experiencing mania they become hyper-focused, act silly/inappropriately giggling, highly imaginative, rapid speech, hypersexuality/engaging in risky behavior, temper tantrums, become extremely upset when small problems arise, and lack sleep but do not feel tired. When children are showing depressed symptoms in bipolar, they feel sad or unusually wheepy, sleep excessively, sudden change in appetite, complaints of headache, stomachaches, stomach ulcers, missing school frequently, sudden loss in activities that they previously enjoyed, unusual thoughts, or suicidal comments. FDAapproved indications for aripiprazole in the paediatric population are bipolar I mania (as monotherapy or adjunctive therapy to lithium or valproate), schizophrenia, Tourette syndrome and irritability associated with autism (Atkin, et al., 2017). Olanzapine is FDA approved for manic/mixed episodes in ages 13 and older (Stahl, 2020). Quetiapine is FDA approved for manic/mixed episodes in ages 10 and older (Stahl, 2020). When tailored for bipolar disorder, CBT typically incorporates strategies such as management of sleep and routines, attention to medication adherence, and PE about bipolar disorder (Swartz, et al., 2019).

3) What are some of the psychiatric comorbidities associated with bipolar disorder? How might bipolar disorder and/or these comorbidities impact the child developmentally?

     Youths with more comorbid disorders, environmental stressors, poor psychosocial functioning, low socioeconomic status, and family history of psychopathology, including mood disorders, have worse prognosis (Goldstein, et al., 2020). In youth, BD I is associated with elevated risk of legal charges, substance use disorders, interpersonal problems (e.g., peer and family relationships), dysfunction with mood regulation, psychiatric comorbidities, cardiometabolic risk, and neurocognitive deficits, compared with the general population (Swartz,et al., 2019). The onset of BD typically occurs in adolescence or early adulthood following subclinical symptoms, likely due to the biological, psychological and social development youths experience, which culminate at approximately 16 to 30 years (Quide, et al., 2020).