NU-664C-02-23PCS3 FamilyPsychiatric Ment.Hlth I
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- Week 12: Mood Disorders—Bipolar Spectrum
- Week 12: Group-Facilitated Discussion 1 – Group 3
Week 12: Group-Facilitated Discussion 1 – Group 3
To do: Make forum posts: 1
Value: 100 points
Due: Facilitating group to post by Day 1; all other students post to facilitating group discussion prompt by Day 4 and reply to at least two other peer posts by Day 7
Grading Category: Group Facilitated Discussions
Initial Post: Created by Facilitating Group
This is a student-led discussion.
- Please review the Week 7 Get Started: Group-Facilitated Communication Board and Instructions for assignment guidelines for this discussion to ensure that you have met all the criteria.
- The facilitating group should choose one member from their group who will be responsible for the initial post.
- On Day 1 of this week, the chosen group member will create an initial post that is to include the group’s discussion prompts, resources, and the instructions for what your classmates are to do with the resources.
- During this week, each member of your group is to participate in the facilitation of the discussion. This means making certain that everyone is engaged, questions from students are being answered, and the discussion is expanding.
- It is the expectation that the facilitating group will address all initial peer response posts by Day 7.
Reply Posts: Non-Facilitating Students
- If you are not a member of the facilitating group, you are to post a discussion prompt response according to the facilitating group’s instructions by Day 4. Your reply posts should include substantive reflection directed to the presenters.
- You are also expected to respond to at least two other peers’ initial discussion prompt posts.
- Pick out an idea from your peers’ initial post that you find most interesting and tell how you will use this information in practice.
Please refer to the Grading Rubric for details on how this activity will be graded. The described expectations meet the passing level of 80%. Students are directed to review the Discussion Grading Rubric for criteria which exceed expectations.
This is my peer’s post
Re: Week 12: Group-Facilitated Discussion 1 – Group 3
by Amanda Quezada Briones – Tuesday, 18 July 2023, 11:46 PM
Hello Whitney and group 3,
Thank you for presenting a summary about bipolar spectrum disorders in children and adolescents along with the study prompts; this is very useful. The resources you provided for us are also excellent. I will proceed with answering the questions now.
1.- What are the differences, if any, of the risk factors of bipolar disorders in children and adolescents with various ethnic backgrounds?
Some of the risk factors associated with bipolar disorders include childhood abuse, cannabis misuse, T. gondii infection, medical comorbidities such as irritable bowel syndrome and asthma and the presence of other psychiatric disorders. The prevalence of bipolar disorders seems to be higher in Caucasians populations compared with nonwhite populations; additionally, bipolar disorders in children and adolescents were found to have a slightly higher prevalence in the USA compared with other countries. A metanalysis of 25 studies conducted mostly in North or South America found a prevalence of 1.06% for bipolar type I disorders and 1.57% for bipolar type II. European countries including UK, Germany and Italy share a similar prevalence. The variations in international prevalence of this disorder are not well understood. It is believed that they may be explained by higher rates of misdiagnosis in nonwhite groups, migration, or cultural factors (Rowland & Marwaha, 2018).
2.- What effect do Adverse Childhood Events have on children and adolescents with diagnosis of mood disorders, particularly bipolar disorders?
Adverse childhood events such as neglect, abandonment, domestic violence, parental imprisonment, parental psychiatric disease, among others, have a negative impact on physical and mental health. For that reason, children exposed to those situations have a shorter life expectancy (Lippard & Nemeroff, 2019). The impact of adverse childhood events on children and adolescents diagnosed with bipolar disorders is reflected in their negative clinical outcomes; for example, it is common to observe in this population and earlier age at onset, the presence of mixed symptoms, presence of psychotic episodes, development of substance misuse, higher rate of suicide attempts and a worse life functioning in general (Park et al., 2020).
3.- Once you have evaluated and diagnosed a child with bipolar disorder what will be your course of treatment? What would be your course of treatment for an adolescent? Will you plan treatment with medications or therapy? Or both? Why or why not?
The course of treatment for bipolar disorders in children and adolescents is pharmacotherapy; Psychotherapy is essential, and it should be added as an adjunctive treatment. The preferred drugs to be prescribed during manic phases are second-generation antipsychotics such as aripiprazole, asenapine, olanzapine, quetiapine, risperidone, or ziprasidone. For patients who do not respond to multiple trials of second-generation antipsychotics, it is suggested to start them on lithium rather than any other medication. If the response continues to be inadequate, a combination therapy with second-generation antipsychotic and mood stabilizers can be started. After the acute bipolar mood episode is stabilized, it is recommended to maintain the same medications for preventing recurrences (Axelson, 2022).
The initial treatment for bipolar depression in children and adolescents contemplates the use of a second-generation antipsychotic such as lurasidone plus a selective serotonin reuptake inhibitor (SSRI). If the patient has a partial response to this treatment, a mood stabilizer or omega-3 fatty acids could be added. If the patient does not respond to this regimen, it is reasonable to try a mood stabilizer or omega-3 fatty acids alone or to use them with a second-generation antipsychotic discontinuing the antidepressant. Another treatment option is to use a combination of mood stabilizers with antidepressants. If the treatment is well tolerated, it can be maintained for preventing relapse (Axelson, 2022b).
Psychotherapy is recommended for all bipolar disorders in pediatric populations as an adjuvant to pharmacotherapy because it has been proven to improve mood symptoms. Psychoeducation is the first-line treatment. If the patient does not respond to this therapy, they could try family therapy (Axelson, 2022).
4.- What screening tools will you use to evaluate a child or adolescent for bipolar? What signs or symptoms might you notice when seeing a patient with bipolar disorder? How can you differentiate between bipolar disorder and depression in a youth?
Pediatric patients suffering from bipolar disorders may display three different presentations. These are mania, hypomania and major depression. Mania is characterized by an elevated mood and behaviors such as grandiosity, decreased need for sleep, racing thoughts, distractibility, psychomotor agitation or reckless behavior. Hypomania is similar to mania, and it shares the same symptoms, but the intensity is lower, and the episode is shorter. Major depression symptoms must meet criteria for diagnosis, and these may include depressed mood, diminished interest or pleasure in activities, weight changes, sleeping patterns changes, psychomotor changes, fatigue, feelings of worthlessness, impaired cognitive abilities or thoughts of death. Bipolar disorders can be classified in bipolar I disorder which is diagnosed in patients with a history of at least one episode of mania; bipolar II disorder characterized by at least one hypomanic episode and one episode of major depression, without a history of manic episodes; or cyclothymic disorder when the patient present some periods of hypomanic symptoms that do not meet criteria for a hypomanic episode, and periods of depressive symptoms that do not meet criteria for a major depressive episode (Birmaher, 2022).
Despite the DSM-5 criteria for diagnosing bipolar disorders was not created specifically for evaluating pediatric populations, it is still widely used and accepted for establishing diagnosis in this group. For revealing symptoms of this disorder, clinicians can use the help of some screening tools. Some examples of these are the Kiddie Schedule for Affective Disorders and Schizophrenia for school age children, the Young Mania Rating Scale (YMRS), or the Child Mania Rating Scale for Parents (Birmaher, 2021).
References
Axelson, D. (2022). Pediatric bipolar disorder: Overview of choosing treatment. UpToDaTe. Retrieved July 18, 2023 from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/pediatric-bipolar-disorder-overview-of-choosing-treatment?search=bipolar%20disorder%20in%20children%20and%20adolescents&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Axelson, D. (2022b). Pediatric bipolar major depression: Choosing treatment. UpToDaTe. Retrieved July 18, 2023 from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/pediatric-bipolar-major-depression-choosing-treatment?search=bipolar%20disorder%20in%20children%20and%20adolescents&topicRef=15925&source=see_link#H11278230
Birmaher, B. (2021). Pediatric bipolar disorder: Assessment and diagnosis. UpToDaTe. Retrieved July 18, 2023 from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/pediatric-bipolar-disorder-assessment-and-diagnosis?search=bipolar%20disorder%20in%20children%20and%20adolescents%20diagnosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H190481588
Birmaher, B. (2022). Pediatric bipolar disorder: Clinical manifestations and course of illness. UpToDate. Retrieved from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/pediatric-bipolar-disorder-clinical-manifestations-and-course-of-illness?search=pediatric%20bipolar&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3
Lippard, E., & Nemeroff, C. (2019). The devastating clinical consequences of child abuse and neglect: Increased disease vulnerability and poor treatment response in mood disorders. The American Journal of Psychiatry, 177(1), 20-36. https://doi.org/10.1176/appi.ajp.2019.19010020
Park, Y., Shekhtman, T., & Kelsoe, J. R. (2020). Effect of the type and number of adverse childhood experiences and the timing of adverse experiences on clinical outcomes in individuals with bipolar disorder. Brain Sciences, 10(5), 254. https://doi.org/10.3390/brainsci10050254
Rowland, T., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251-269. https://doi.org/10.1177/2045125318769235
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