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"Each of us must come to care about everyone else's children. We must recognize that the well being of our own children is intimately linked to the well being of all other people's children. After all, when one of our children needs life-saving surgery, someone else's child will perform it. When one of our children is harmed by violence, someone else's child will commit it. The good life for our own children can be secured only if it is also secured for all other people's children. But to work for the well being of all children is not just a practical matter-- it is also right!" - Lilian G. Katz, Phd.

Thursday, November 29, 2007

Childhood Onset Bipolar Disorder

(EDIT: I use Firefox, so did not realize how badly the paste showed up in IE. I will get it fixed soon.... meanwhile, may I recommend Firefox?)


This was the outline for a Public Speaking Class:

Krista Long Informative Speech

Title: Childhood Onset Bipolar Disorder

Topic: Childhood Onset Bipolar Disorder

General Purpose: To Inform.

Specific Purpose: To inform my audience about the prevalence, symptoms, and treatment of Childhood Onset Bipolar Disorder.

Thesis Statement: Bipolar Disorder occurs in children, has a broad range of symptoms, and is treatable, although not curable.

1) Welcome to my family! We look like an average family, but we have been dealing with something for a long time that gives us more challenges than most families face.

2) My eldest son was diagnosed at the age of 5 with Childhood Onset Bipolar Disorder.

3) Who here today has heard of this disorder? (Pause- Note how many have heard of it)

4) As you can see-

a) (if few) Not many have heard of it, but it is becoming more frequently diagnosed in the U.S.

b) (if many) That is not surprising, considering the increase in diagnosis as doctors become more familiar with the research into this disorder.

5) I am here today to discuss with you the prevalence, presentation, and treatment of this disorder.

What is Bipolar Disorder?

1) Bipolar disorder (formerly known as manic-depression) is a serious but treatable illness.

a) It is a disorder of the brain that presents with extreme changes in mood, energy, thinking and behavior.

b) Symptoms may be present from infancy or early childhood, or may appear suddenly adolescence or adulthood.

2) Previously, it was thought that children could not suffer the mood shifts of bipolar, but researchers have discovered that the disorder (or early features of it) can occur in very young children, and that it is much more common that thought.

a) This has been supported by research findings, clinical experience and family accounts.

Rate of Occurrence

1) Research has found rates of major depression in adults to be around 17% for a lifetime.

a) Almost 1/5 the population.

2) Bipolar disorder is less common, occurring at a rate of 1% in the general population.

a) Some believe the diagnosis is often overlooked because mania is too rarely reported as an illness.

3) About 1 in 10 children in the U.S. suffers from a mental illness severe enough to cause impairment.

4) Although once thought rare, studies have shown that approximately 7% of children seen at psychiatric facilities fit bipolar disorder using research standards.

Presentation & Symptoms

1) Bipolar disorder is characterized by marked changes in mood and energy.

a) Ongoing moods of extreme elation or agitation accompanied by high energy are called mania.

b) Ongoing moods of extreme sadness or irritability accompanied by low energy are called depression.

2) The illness often looks different in the pediatric form than it does in the adult form.

a) Children usually have an ongoing, continuous mood disturbance that is a mix of mania and depression.

b) This rapid and severe cycling of moods produces chronic irritability and few clear periods of wellness between episodes.

3) Symptoms of mania and depression in children and adolescents may present through many different behaviors.

a) When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric.

b) When depressed, there may be many physical complaints such as:

i) Headaches

ii) Muscle aches

iii) Stomachaches

iv) Tiredness

v) Frequent absences from school or poor performance in school

vi) Talk of or efforts to run away from home

vii) Irritability

viii) Complaining

ix) Unexplained crying

x) Social isolation

xi) Poor communication

xii) Extreme sensitivity to rejection or failure.

c) Other manifestations of manic and depressive states may include alcohol or substance abuse (self-medicating, as it is often referred to) and difficulty with relationships.

Common Behaviors

1) an expansive or irritable mood

2) extreme sadness or lack of interest in play

3) rapidly changing moods lasting a few hours to a few days

4) explosive, lengthy, and often destructive rages

5) separation anxiety

6) defiance of authority

7) hyperactivity, agitation, and distractibility

8) sleeping little or, alternatively, sleeping too much

9) strong and frequent cravings, often for carbohydrates and sweets

10) bed wetting and night terrors

11) excessive involvement in multiple projects and activities

12) impaired judgment, impulsivity, racing thoughts, and pressure to keep talking

13) dare-devil behaviors (such as jumping out of moving cars or off roofs)

14) inappropriate or precocious sexual behavior

15) delusions and hallucinations

16) grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

Diagnosing Bipolar Disorder in Children

1) The Diagnostic and Statistical Manual IV (DSM-IV) still requires that, for a diagnosis of bipolar disorder, adult criteria must be met.

a) There are as yet no separate criteria for diagnosing children.

2) Healthy children often have moments when they have difficulty staying still, controlling their impulses, or dealing with frustration.

a) Some behaviors by a child, however, should raise a red flag:

i) destructive rages that continue past the age of four

ii) talk of wanting to die or kill themselves

iii) trying to jump out of a moving car

3) The DSM-IV says that a hypomanic episode requires a “distinct period of persistently elevated, expansive, or irritable mood lasting throughout at least four days.”

a) Upwards of 70 percent of children with the illness have mood and energy shifts several times a day.

Treatment

1) Thorough evaluation and treatment are essential.

a) A biopsychosocial (medical, therapeutic, and community based) approach to intervention that has psychoeducation and school intervention is important.

b) The physician should discuss treatment options, including medication and psychotherapy.

c) The first line of treatment is to stabilize the child's mood and to treat sleep disturbances and psychotic symptoms if present.

i) Once the child is stable, therapy that helps him or her understand the nature of the illness and how it affects his or her emotions and behavior is important.

d) Education should include child and parent.

i) They should be informed of symptoms of manic and depressive episodes.

ii) They should be supported in the exploration and identification of behaviors and of future possible behaviors which could signal a recurrence.

2) Medications are also helpful.

a) Since few treatment studies have been conducted in children, though, most clinicians use drugs that have been tested and proved successful in adult forms of bipolar disorder.

b) Mood Stabilizers such as Lithium, Depakote and Tegretol are used.

(1) Lithium has been the market the longest and is the only medication that has been shown to be effective against future episodes of mania and of depression and of completed suicides.

ii) Newer agents such as Neurontin, Lamictal, and Topomax are currently under clinical investigation and are being used in children.

c) For the treatment of psychotic symptoms and aggressive behavior, Risperdal, Zyprexa and Abilify are commonly used newer agents.

d) Mellaril, Trilafon, and Haldol are more traditional antipsychotics that are not used as much anymore.

e) Anti-anxiety medications are also used to treat anxiety states, induce sleep, and put a slow down rapid-cycling swings.

Side Effects

1) Side effects that are particularly troublesome and that are worse in children include the following.

a) Atypical anti-psychotics and mood stabilizers (except Abilify) are associated with marked weight gain in many children.

i) The dangers of this weight gain include glucose problems that may include the onset of diabetes and increased blood lipids that may worsen heart and stroke problems later in life.

ii) Depakote may also be associated with increased weight and possibly with a disease called polycystic ovarian syndrome (POS).

(1) In some cases POS is associated with infertility later in life.

b) These drugs can cause an illness called tardive dyskinesia.

i) Tardive Dyskensia is irreversible, unsightly, repeated movements of the tongue in and out of the mouth or cheek and some other movement abnormalities.

c) Some people who take lithium over a long time will need a thyroid supplement and in rare cases may develop serious kidney disease.

2) It is very important that children on these medications be monitored for the development of serious side effects.

3) These side effects need to be weighed against the dangers of the illness itself, which can rob children of their childhood.

Therapeutic Parenting

1) Parents of children with bipolar disorder have discovered numerous techniques that the Child and Adolescent Bipolar Foundation refers to as therapeutic parenting.

a) These techniques help calm their children when they are symptomatic and can help prevent and contain relapses.

b) Such techniques include:

i) practicing and teaching their child relaxation techniques

ii) using firm restraint holds to contain rages

iii) prioritizing battles and letting go of less important matters

iv) reducing stress in the home, including learning and using good listening and communication skills

v) using music and sound, lighting, water, and massage to assist the child with waking, falling asleep, and relaxation

vi) becoming an advocate for stress reduction and other accommodations at school

vii) helping the child anticipate and avoid, or prepare for stressful situations by developing coping strategies beforehand

viii) engaging the child's creativity through activities that express and channel their gifts and strengths

ix) providing routine structure and a great deal of freedom within limits

x) removing objects from the home (or locking them in a safe place) that could be used to harm self or others during a rage, especially guns; keeping medications in a locked cabinet or box.

Prognosis

1) At this time, regrettably, the disease appears more severe and with a much longer road to recovery than is seen with adults.

a) While some adults may have episodes of mania or depression with better functioning between episodes, children seem to have continuous illness over months and years.

2) Although there is no cure for bipolar disorder, in most cases treatment can stabilize mood and allow for management and control of symptoms.

3) A good treatment plan includes

a) Medication

b) close monitoring of symptoms

c) education about the illness

d) counseling or psychotherapy for the individual and family

e) stress reduction

f) good nutrition

g) regular sleep and exercise

h) participation in a network of support.

4) Factors that complicate treatment are:

a) lack of access to competent medical care

b) time lag between onset of illness and treatment

c) not taking prescribed medications

d) stressful and inflexible home and school environment

e) the co-occurrence of other diagnoses

f) use of substances such as illegal drugs and alcohol

5) The good news is that with appropriate treatment and support at home and at school, many children with bipolar disorder achieve a marked reduction in the severity, frequency and duration of episodes of illness.

6) With education about their illness (as is provided to children with epilepsy, diabetes, and other chronic conditions) they learn how to manage and monitor their symptoms as they grow older.

Conclusion

1) Learning that one's child has bipolar disorder can be traumatic.

a) Diagnosis usually follows months or years of the child's mood instability, school difficulties, and damaged relationships with family and friends.

b) However, diagnosis can and should be a turning point for everyone concerned.

c) Once the illness is identified, energies can be directed towards treatment, education, and developing coping strategies.

2) Our family has seen our share of tragedy and triumph.

a) We will continue to do so, but I have hope and faith in our ability to learn to live with this disorder.

b) Although there will be bumps in the road ahead, with the advances in treatment that are being made every year, my son should have a healthy, functional life.

Bibliography

“About Pediatric Bipolar Disorder.” Child and Adolescent Bipolar Foundation. 27 October 2002. 9 September 2005 http://www.bpkids.org/site/PageServer?pagename=lrn_about .

Cogan, Mary Beth. “Diagnosis and Treatment of Bipolar Disorder in Children and Adolescents.The Psychiatric Times. May 1996: 13:5. 9 September 2005 http://www.psychiatrictimes.com/p960531.html .

“Facts About Childhood-Onset Bipolar Disorder.National Alliance for the Mentally Ill. January 2004. 9 September 2005 http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=13107 .

“Mood Disorders.” National Mental Health Association. 9 September 2005 http://www.nmha.org/infoctr/factsheets/moodDisorders.cfm .

National Institute of Mental Health. “Child and Adolescent Bipolar Disorder: An Update from the National Institute of Mental Health.” 2000. 9 September 2005 http://www.nimh.nih.gov/publicat/bipolarupdate.cfm

Papolos, Demitri and Janice Papolos. “Frequently Asked Questions About Early-Onset Bipolar Disorder.The Bipolar Child. 9 September 2005 http://www.bipolarchild.com/articles.html#faq .