Talk:Bipolar disorder in children/Archive 1

Creation

This article was created from the "Children" section in the main bipolar disorder article, because that section was growing overlong, and clearly needed a more detailed treatment in a separate article.

This allows the main article section to be greatly reduced in length, allowing the main work on this topic to be carried out here. Which is good, because this article currently needs much work, particularly in the area of verifiability. -- Karada 14:18, 4 January 2007 (UTC)

Miscellanea

I added cautions to the diagnostic section. I have had over 25 years experience in child psychiatry and have found that many psychiatrists have not taken the time to do proper evaluations before using making this diagnosis which can have profound effects upon the child's life, not to speak of the use of multiple medications some of which have not been shown to be safe in children. I believe that some of the motivation for the over-use of this diagnosis are: 1) the need to satisfy managed care companies with a diagnosis that justifies hospital stays; 2) the wish of both parent and clinician to find a pharmacologic answer to the problem, and 3) possible encouragement by pharmaceutical companies to prescribe off label. I am also wary of research funded by pharmaceutical companies.--Jhedberg 00:38, 12 April 2007 (UTC)

Your addition seemed more like a comment, and, if it was, belongs on this page. However, if you have citations to support the statements that would be good. As an encyclopedia article, the first person pronoun is not used. DPeterson^talk 12:28, 12 April 2007 (UTC)

If I write it in the proper format and list references, will you allow my cautions to stay in the article? I feel that an article for consumption by the general public should reflect in part the reality of our work "down in the trenches." I have attended many trainings by Harvard psychopharmacologists and one thing that is always stated is that diagnostic criteria must be adhered to when studying drug effectiveness and prognosis. They neglect to consider how the clinician in the field will use their data. I doubt(know) that most clinicians really follow the same criteria as do researchers. I have re-diagnosed many children who have been called bipolar and have changed, decreased, or stopped their psychotropic medications to their benefit. This is a result of my attention to detail and an individualized approach to each evaluation rather than a "checklist mentality."Jhedberg 03:18, 13 April 2007 (UTC)

Looking more into correlation between alcoholism in parents and bipolar disorder in children; help would be nice if possible! thanks —Preceding unsigned comment added by Ceail Linden (talk • contribs) 20:42, 5 January 2008 (UTC)

there must be controversy, please include. i'm watching Frontline: The Medicated Child on pbs. i think someone should write up the negatives, in case someone is looking into this issue 68.161.101.247 (talk) 04:54, 18 March 2008 (UTC)

Accuracy of the Diagnosis

From much of what I've read, it's unclear whether pediatric bipolar disorder is just the youthful version of adult bipolar disorder. The prominent mood symptom tends to be irritability ("rage attacks") rather than euphoria or depression. Ultraradian cycling is considered common (mood changing many times in a day); this sounds more like the affective lability of borderline personality disorder in adults than the sustained mood episodes of adult bipolar disorder. Also, the common comorbidities are ADHD, ODD, and conduct disorder, which I imagine would all be difficult to distinguish from pediatric bipolar disorder, especially as thus described. I haven't read anything that suggests these children grow into adults with more classical symptoms of bipolar disorder, but then I haven't read anything explicitly denying it either.--NeantHumain (talk) 00:56, 29 October 2009 (UTC)

Secondary sources

I intend to improve this article using some secondary sources so as to later improve the main article with probably the lead from this article.--Garrondo (talk) 18:57, 10 January 2011 (UTC)

Essay

Essay - A Child's Nightmare. The talk page is for discussing how to improve the article.
The following discussion has been closed. Please do not modify it.
A Child’s Nightmare The day turned dark when four year old Rebecca Riley was found dead. This four-year-old girl overdosed on medication meant to treat what doctors thought to be bipolar disorder. The cocktail mix of pills doctors claimed to be safe took Rebecca’s life and everything sweet and innocent about the child. Rebecca being a very hyper active two year old was taken to a psychologist and immediately was diagnosed with bipolar and started treatment right away: two years later, Rebecca was downing ten pills a day to offset her mood disorders states Patricia Wen from the Metro Desk. In America the disease keeps growing and is becoming more of a problem for children then it ever has been. The medication that has been given to such children is usually inaccurate and a lot of guessing is involved in their medications. Although there are alternative treatments to bipolar, parents are rejecting them. More children are dying of overdose everyday due to the treatments parents are allowing their children to partake in. Most parents follow the doctor in blind faith instead of asking questions about what type of pills are being put into their child. Parents need to realize what these medications are doing to their children, instead of following the doctors by faith. Before the 90’s bipolar was linked to only adults, but with further investigations and experiments, children have been found to have the same symptoms; thus, they are medicated the same way. Bipolar is a mood disorder that causes excessive shifts in behavior and changes the way they live. Bipolar effects people in different ways but the most common symptoms are sleep loss, an extreme high or low of moods, rapid speech, reckless activity, delusions, hallucinations, and impulsive thinking. The disease ranges by case and is treated in many different ways. The most popular way to treat it is by taking medication and seeking psychiatric visits. Some of the pills that are used to treat bipolar are as follows: anti-depressants, lithium, anticonvulsants, anti-psychotics, calcium, Paxil and Prozac. Some of these pills have black boxes on the label warning the parents of suicidal risks and extreme side effects the pills may create. Paxil, for example, has not been approved by the Food and Drug Administration (F.D.A) The F.D.A does not regulate medical procedures allowing psychologists to give children the drug even though the pill is frowned upon. The medication that the doctors prescribe is completely based on what the psychologist thinks is best at the time. The F.D.A frowns upon the use of Paxil because the pill increases the chance of suicidal actions and causes aggression in a child. Paxil is a strong medication and is highly addicting. Children have withdrawal symptoms only a few hours after taking the medication. When a child is presented to a Psychologist, it is the doctor’s job to prescribe pills that will help relieve the child's symptoms of bipolar. Every child is different, so finding the right pills can take years, and the procedure to finding these pills is similar to a guessing game. When a child undergoes a new medication they try one type of pill and if the medication doesn't work, doctors take the child off one pill and switch it with another. Some bipolar children have tried over 20 different types of medication in hopes of relief. Symptoms of these pills prescribed to bipolar children can sometimes give children side effects they must live with for the rest of their lives. Jacob, an 18- year -old living in Denver Colorado, is one of the many children who were diagnosed early with bipolar. He was put on Respidol, a pill for bipolar children that causes; drooling, ticks and excessive eating. Jacob developed a tick that makes his head roll every few seconds. He developed it as a toddler and still suffers from it today. Several other children develop ticks like twisting of the hair and tongue, creating bald spots and sores, muscle conversions and excessive blinking. Joseph Biederman is known for being the father of children with bipolar. After graduating Harvard, he went into the Psychiatric branch and began a study on children with symptoms similar to adults with bipolar. At the time bipolar in children was nonexistent until he linked their symptoms with the disease. Soon after Beiderman’s study the word was spread that several children were misdiagnosed and really suffered from was cases of bipolar. Numbers grew in bipolar children, yet the medication given was not accurate and caused children to overdose and die. Before 1997 only forty percent of medication that was given to children was accurately tested. Psychologists and doctors guessed on the proper dose to give a child, increasing overdoses in children. Bill Clinton saw the inaccuracy of the medication procedure and demanded that all medication given to children be tested. The results of some of the experiments showed that some of the medications the Psychologists were giving children did nothing for them. The medication did help adults, but because of the different brain functions of a child, the medication did nothing but cause side effects. When children between the ages two and four, are being treated for bipolar, their parents rarely look at what could be causing the symptoms besides bipolar. For instance, television is the father of manipulation and influence: it is one of the most popular ways to gain buyers or to jump- start a trend. Often after watching a movie or a show children play games where they role play the main characters for weeks. When parents let their children watch rated R movies, the movies set an example on how to act, and children follow it. A five- year -old girl named Jessica described to a Psychologist how she was going to kill her parents by cutting their throats. How did this idea come to Jessica in the first place? She was only five years old? The American Academy of Pediatrics (A.A.P) recommends that children under two shouldn't watch television at all. Even though parents say it’s not all right to hit, television says its okay to bite, kick, hit or scratch as long as you’re the good guy fighting the bad guy. How many children get mad at the siblings or parents and claim them to be the bad guy, such learned behavior causes children to act out because they believe its okay. Children are commonly mistaken that their naughty behaviors are from bipolar however it could be from influences such as television. One of the symptoms in bipolar children is sleep loss. Sleep loss can be linked to a number of aspects in a toddler’s life. A toddler’s want of independence or an increase in their motor ability can cause lack of sleep. Separation anxiety, allergies, and nightmares can cause sleep loss in a toddler as well. Another symptom is being hyper active. Being hyper active could be from a number of things besides being bipolar. For instance, children consume a large amount of sugar a day and because of the body ratio, they react to sugar right away becoming hyper. Sugar sneaks up on common house hold foods and causes children to be rowdy and hyper. Foods like tomato sauce, bread, crackers, barbecue sauce or Tropicana orange juice have high sugar content. Food coloring also causes hyper activity in small children. My own brother, Rocque, was given a specific diet after my mother refused to put him medication for A.D.H.D behaviors. The diet was very strict and he was forbidden to eat anything with red dye. Soon after his hyper activity decreased liked the nutritionist promised. Though some medications help with bipolar, not all do and there are a lot of risks that come with such medications. Children and their digestion systems are fragile: don’t follow a doctor’s lead the prescription blindly: ask questions, make sure medications are tested and are safe, and does not have any major side effects that will plague the child's life either. Furthermore, listen to your heart: a lot of people may say that your child is bipolar or has attention deficit disorder (A.D.D) Do not let their idea break your understanding of the child. Behaviors could be age, nutrition, TV or other common factors that cause the child to be hyper, tired or moody. Rebecca’s parents followed the doctors blindly. When asked what they thought about Rebecca being on ten pills a day, they said they trusted their doctor. Although it’s good to trust your doctor you should always question what your child is digesting or the child could end up like Rebecca. I wrote this paper for my college english class to bring a sense of curiousity to bipolar in children, I hope you enhjoyed my article. Chantel. — Preceding unsigned comment added by 63.230.64.18 (talk) 20:19, 6 December 2011 (UTC)

Removal of controversy section

Hi. I just blanked the controversy section which was recently added to this article. I did so because it wasn't addressing BD specifically but mental illness in general, and controversy sections of medical articles should be based on independent reviews of the controversy, rather than players such as CCHR and PsychRights. By all means significant players should be mentioned in the section if they are given similar significance in independent overviews of the controversy, but they themselves can't be used as the basis for the section. If there is a textbook chapter or academic journal review that gives (or tries to give) a non-partisan account of the controversy, that's the ideal source for such a section.

So, the content should be addressing controversies specific to bipolar disorder, and based on high quality independent (uninvolved third-party) sources. For an overview of ideal sources in Wikipedia articles see WP:RS, and for medical articles in particular see WP:MEDRS. --Anthonyhcole (talk) 10:56, 11 July 2012 (UTC)

Depression

BD in adults doesn't necessarily involve depressive episodes. This article repeatedly implies depressive episodes are a necessary symptom. I haven't followed the sources, or even read the entire article, and may not bother to. I just wanted to register my disquiet. --Anthonyhcole (talk) 11:18, 11 July 2012 (UTC)

Anthony's point is technically correct, but it is complicated. There are four main types of bipolar disorder recognized in DSM-5:

• Bipolar I (requires mania, no requirement of depression; however, only having mania and never getting depressed is quite rare from an epidemiological and clinical perspective)
• Bipolar II (requires a major depressive episode, plus a hypomanic episode, which distinguishes it from unipolar major depression)
• Cyclothymic disorder (requires one year or more of hypomanic and depressive symptoms in people under 18 years; 2 years of same for adults -- technically no major depressive episode during initial presentation, but could have substantial depressive symptoms)
• Other Specified bipolar and related disorder (formerly bipolar Not Otherwise Specified in DSM-IV) -- again, could have substantial depressive symptoms, but not meeting criteria for major depression.

Two things make emphasis on depression appropriate: (a) epidemiological and longitudinal studies both suggest that people with bipolar spend more time depressed than hypomanic or manic, and (b) these symptoms could be present in any bipolar condition and create more burden.

I will look at adding references to tertiary sources to clarify this later. Thanks for the point! Prof. Eric A. Youngstrom 15:23, 29 September 2014 (UTC) — Preceding unsigned comment added by Eyoungstrom (talk • contribs)

Additional material

Additional material on this topic has been contributed at [[Wikipedia talk:Artic les for creation/Pediatric Bipolar Disorder Portfolio]]. I have suggested that this material should be merged into this article or at least that possibility be discussed with the editors here before a new article is created. ~KvnG 21:31, 26 February 2014 (UTC)

Thanks for the review, Kvng - much appreciated! :)

My suggestion is to keep the page as it is (with multiple links to this page if viewers wanted additional information). My concern is that I created the page for clinicians as a quick reference page for gold-standard/up-to-date assessments in pediatric bipolar disorder (and their diagnostic validities). The purpose behind page that I created was to serve as a primer into leading them to read the relevant articles for the latest cutting-edge research on bipolar disorder assessments.

In my experience, clinicians do not want to trawl through an entire page full of irrelevant information (for their diagnostic purposes!) to obtain these critical values...

Will be happy to listen to opinions from other editors! Thanks so much! Ongmianli (talk) 22:36, 26 February 2014 (UTC)

Please be aware that Wikipedia is not intended to be a forum for cutting edge research. We prefer to source material from WP:SECONDARY as opposed to WP:PRIMARY sources as primary sources tend to encourage original research. ~KvnG 23:10, 26 February 2014 (UTC)

Thanks again for the quick turnaround, KvnG! Perhaps I misspoke: by "cutting edge", I meant the latest scientific articles that have been published in respected journals. The purpose is so that clinicians can refer to the 'gold standard' published research. Does that make more sense?? Ongmianli (talk) 20:31, 27 February 2014 (UTC)

I have transferred my material that was rejected as an article into this page. Would appreciate anybody's feedback on my edits! Ongmianli (talk) 01:41, 28 September 2014 (UTC)

These look like excellent additions to the page around evidence-based assessment. I will go over them carefully in the coming weeks, and add citations to secondary sources. I changed gold to "gold" to reflect that semi-structured interviews are also imperfect, consistent with how Spitzer, Garb, Fristad, and others describe them. Thanks for all the work on this! Prof. Eric A. Youngstrom 12:47, 29 September 2014 (UTC)

Need help with editing reference page, and multiple duplicates of information on page

A bunch of information on assessment has been added (together with an exhaustive reference list), but I was unable to collapse the reference page together. Would appreciate any help!

There's also quite a bit of duplicate information. Would be good to clean it up! Ongmianli (talk) 01:59, 28 September 2014 (UTC)

@Kvng:

Disruptive Mood Dysregulation Disorder

Hi, I just wanted to add a sentence to the section that talks about Disruptive Mood Dysregulation Disorder (DMDD). In my abnormal psychology textbook I was reading about the disorder and I just wanted to add some information to this page that will specify when a child should be diagnosed with DMDD. With the addition of this information it might be a little more clear on how to differentiate the disorder from Bipolar disorder. Jamiewolfee (talk) 19:57, 5 December 2014 (UTC)

Primary source text removed

Please see WP:MEDRS. The following is either off-topic, overly detailed, based on very old or primary sources or both, in the wrong article, unencyclopedic, or all of the above. Please cite new text to recent secondary reviews; there are plenty of them. SandyGeorgia (Talk) 09:26, 8 January 2015 (UTC)

Extended commentary
The following discussion has been closed. Please do not modify it.
Demographic Information This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Base Rates of PBD in different clinical settings Setting Reference Base Rate Demography Diagnostic Method National Comorbidity Survey-Adolescent (NCS-A) Kessler et al., 2012 3.0% All of U.S.A. Composite International Diagnostic Interview (CIDI) 3.0 Community Epidemiologic Samples Van Meter, Moreira, & Youngstrom, 2011 1.2% U.S.A., Netherlands, U.K., Spain, Mexico, Ireland, New Zealand Structured and semi-structured diagnostic interviews Inpatient Services/Diagnoses Holtmann et al., 2008 0.3% All of Germany International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Community Sample Olino et al., 2012 2.9% Oregon LIFE, SCID, DSM-IV Inpatient Service Carlson & Youngstrom, 2003 30% manic symptoms, <2% strict BP I New York City Metro Region DICA; KSADS KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia, PL = Present and Lifetime Version, LIFE = Longitudinal Interval Follow-Up Evaluation, DICA = Diagnostic Interview for Children and Adolescents Likelihood Ratios Likelihood ratios (also known as likelihood ratios in diagnostic testing) are the proportion of cases with the diagnosis scoring in a given range divided by the proportion of the cases without the diagnosis scoring in the same range. The table below shows area under the curve (AUCs) and likelihood ratios for potential screening measures for pediatric bipolar disorder. It should be noted that all studies used some version of a K-SADS interview by a trained rater, combined with review by a clinician to establish consensus. Likelihood Ratio Comments Larger than 10, smaller than 0.10 Frequently clinically decisive Ranging from 5 to 10, 0.20 Helpful in clinical diagnosis Between 2.0 and 0.5 Rarely result in clinically meaningful changes of formulation Around 1.0 Test result did not change clinical impressions at all "LR+" refers to the change in likelihood ratio associated with a positive test score, and "LR-" is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. On the other hand, likelihood ratios larger than 10 or smaller than 0.10 are frequently clinically decisive, 5 or 0.20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation. Area under Curve (AUCs) and Likelihood Ratios for PBD Potential Screening Measures Screening Measure Cut-off scores (LR+/LR-) Likelihood Ratios (LR+/LR-) Population Area under curve (AUC) and Sample Size Citation CBCL Externalizing T-Score Above 81, below 54 4.3/0.04 Bipolar spectrum vs. all other diagnoses 0.78 (N=324) Youngstrom, Findling, Calabrese et al., 2004 CBCL Attention, Aggressive, Anxious/Depressed T-Score (Parent) Above 60, less than 60 4.67/0.5 Bipolar spectrum vs. all other diagnoses 0.81 (N=101) Meyer et al., 2009 TRF Externalizing T-Score Above 77, less than 46 3.8/0.25 Bipolar spectrum vs. all other diagnoses 0.70 (N=324) Youngstrom, Findling, Calabrese et al., 2004 Youth Self Report (YSR) Externalizing T-Score Above 77, less than 49 3.0/0.31 Bipolar spectrum vs. all other diagnoses 0.71 (N=324) Youngstrom, Findling, Calabrese et al., 2004 Parent General Behavior Inventory (P-GBI) (Hypomanic/Biphasic Section) Above 49, below 9 9.2/0.06 Bipolar spectrum vs. all other diagnoses 0.84 (N=324) Youngstrom, Findling, Calabrese et al., 2004 Parent Mood Disorder Questionnaire (P-MDQ) Above 6, below 9 4.64/0.17 Bipolar spectrum vs. all other diagnoses 0.84 (N=819) Wagner et al., 2006 Conners' Abbreviated Parent Questionnaire Above 8, less than 3 5.21/0.31 Bipolar spectrum vs. ADHD 0.85 (N=150) Henry et al., 2008 Child Mania Rating Scale (Brief) (Brief CMRS-P) Above 10/not reported 10.5/0.17 Bipolar spectrum vs. ADHD 0.85 (N=150) Henry et al., 2008 Child Mania Rating Scale (Full) (Full CMRS-P) Above 20, not reported 13.7/0.19 Bipolar spectrum vs. ADHD 0.91 (N=150) Henry et al., 2008 Child Bipolar Questionnaire (CBQ-P) not reported 25.3/0.25 Bipolar spectrum vs. all other diagnoses 0.74 (N=497) Papolos et al. (2010) Clinically Significant Change Benchmarks with Common Instruments and Mood Rating Scales Listed below are clinically significant change benchmarks of common screening instruments used for pediatric bipolar disorder. Measure Subscale Cut-off scores Critical Change (unstandardized scores) Benchmarks Based on Published Norms A B C 95% 90% SEdifference Beck Depression Inventory BDI Mixed Depression 4 22 15 9 8 4.8 CBCL T-scores (2001 Norms) Total 49 70 58 5 4 2.4 Externalizing 49 70 58 7 6 3.4 Internalizing n/a 70 56 9 7 4.5 Attention Problems n/a 66 58 8 7 4.2 TRF T-scores (2001 Norms) Total n/a 70 57 5 4 2.3 Externalizing n/a 70 56 6 5 3.0 Internalizing n/a 70 55 9 7 4.4 Attention Problems n/a 66 57 5 4 4.8 YSR T-scores (2001 Norms) Total n/a 70 54 7 6 3.3 Externalizing n/a 70 54 9 8 4.6 Internalizing n/a 70 54 9 8 4.8 Benchmarks Based on Bipolar Spectrum Samples Gracious et al., 2002 Young Mania Rating Scale - Parent (Full) n/a 5.2 22.1 14.4 4.3 3.6 2 Young Mania Rating Scale - Parent (Brief) n/a 6.8 27.4 17.5 5 4.2 2.5 Carlson & Youngstrom, 2003 Teacher-Completed Teacher Self-Control Rating Scale n/a 32.4 110.6 72.6 11.6 9.7 5.75 Inpatient Global Rating Scales n/a 1.9 90.7 50.8 15.7 13.2 7.21 Cooperberg, 2002 Young Mania Rating Scale (Clinician Rated) n/a 6 2 2 12 10 6.2 Child Depression Rating-Revised (CDRS-R) n/a n/a 40 29 8 7 4 Parent GBI Hypomanic/Biphasic 7 19 15 8 7 4.2 Depression n/a 18 13 7 6 3.6 Adolescent GBI Hypomanic/Biphasic n/a 32 19 8 7 4.4 Depression n/a 47 27 10 9 5.2

Sources

References