NURS6660 Week 8 Discussion: Pediatric Bipolar Depression Disorder Debate

Discussion: Pediatric Bipolar Depression Disorder Debate Some debate in the literature exists specific to whether or not bipolar disorder can be diagnosed in childhood. While some have anecdotally argued that it is not possible for children to develop bipolar disorder (as normal features of childhood confound the diagnosis), other sources argue that pediatric bipolar disorder is a fact. In this Discussion, you engage in a debate as to whether pediatric bipolar disorder is possible to diagnose. Learning Objectives Students will: Evaluate diagnosis of pediatric bipolar depression disorder Analyze consequences to diagnosing/failing to diagnose pediatric bipolar depression disorder To Prepare for the Discussion: The instructor will assign you a position for or against the issue of diagnosing pediatric bipolar depression disorder. Review the Learning Resources concerning the controversy over the diagnosis of pediatric bipolar depression disorder. Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit! By Day 3 Post: Write “for” or “against” in the subject line of your Discussion post. Based on the position you were assigned, justify whether or not pediatric bipolar depression disorder should be diagnosed. Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. Chapter 31, “Child Psychiatry” (pp. 1226–1253) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. “Bipolar and Related Disorders” “Depressive Disorders” Note: You will access this book from the Walden Library databases. Zeanah, C. H., Chesher, T., & Boris, N. W. (2016). Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 55(11), 990–103. Retrieved from. NURS6660 Week 8 Discussion: Pediatric Bipolar Depression Disorder Debate. http://www.jaacap.com/article/S0890-8567(16)31183-2/pdf Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication. Review the following medications: Seasonal affective disorder bupropion Bipolar depression Bipolar disorder amoxapine aripiprazole armodafinil asenapine bupropion carbamazepine fluoxetine iloperidone lamotrigine lithium lurasidone modafinil olanzapine olanzapine-fluoxetine combination quetiapine risperidone sertindole valproate (divalproex) ziprasidone alprazolam (adjunct) amoxapine aripiprazole asenapine bupropion carbamazepine chlorpromazine clonazepam (adjunct) cyamemazine doxepin fluoxetine flupenthixol fluphenazine gabapentin (adjunct) haloperidol iloperidone lamotrigine levetiracetam lithium lorazepam (adjunct) loxapine lurasidone molindone olanzapine olanzapine-fluoxetine combination oxcarbazepine paliperidone perphenazine pipothiazine quetiapine risperidone sertindole thiothixene topiramate (adjunct) trifluoperazine valproate (divalproex) ziprasidone zonisamide zotepine zuclopenthixol Bipolar maintenance Depression aripiprazole asenapine carbamazepine iloperidone lamotrigine lithium lurasidone olanzapine olanzapine-fluoxetine combination quetiapine risperidone (injectable) sertindole valproate (divalproex) ziprasidone agomelatine amisulpride amitriptyline amoxapine amphetamine (d) amphetamine (d,l) aripiprazole (adjunct) asenapine atomoxetine bupropion buspirone (adjunct) citalopram clomipramine cyamemazine desipramine desvenlafaxine dothiepin doxepin duloxetine escitalopram fluoxetine flupenthixol fluvoxamine iloperidone imipramine isocarboxazid ketamine lisdexamfetamine lithium (adjunct) l-methylfolate (adjunct) lofepramine lurasidone maprotiline methylphenidate (d) methylphenidate (d,l) mianserin milnacipran mirtazapine moclobemide modafinil (adjunct) nefazodone nortriptyline olanzapine paroxetine phenelzine protriptyline quetiapine (adjunct) reboxetine selegiline sertindole sertraline sulpiride tianeptine tranylcypromine triiodothyronine trazodone trimipramine venlafaxine vilazodone vortioxetine Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Optional Resources Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell. Chapter 62, “Bipolar Disorder in Childhood” (pp. 858–873) Chapter 63, “Depressive Disorders in Childhood and Adolescence” (pp. 874–892) NURS6660 Week 8 Discussion: Pediatric Bipolar Depression Disorder Debate.

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Pediatric bipolar depression disorder

Conservative estimates from quantitative data reveals that approximately 5% of the population suffers from disorders within the bipolar spectrum. The presence of these disorders among one parent would result in 22.5% risk of the children reporting the same disorder while the presence of these disorders among both parents would result in 62.5% risk of the children reporting the same disorder. The risk among identical twins being diagnosed with the same condition is 70% while the risk among fraternal twins and siblings is 20% (Stahl, 2014). Additional review of the disorders incidence among adults reveals that 60% had onset of the symptoms in their childhood or before they were 20 years of age, 30% experienced symptoms onset when less than 13 years of age while 40% experienced symptoms onset when between 13 and 18 years of age. Although the quantitative data makes it clear that pediatric bipolar disorder is a reality based on symptoms presentation among children, there are concerns about the validity and reliability of childhood diagnosis criteria. This is particularly true when it is considered that the condition is best addressed through early diagnosis and management to improve the patients’ quality of life in adulthood (Sadock, B., Sadock, V. & Ruiz, 2014). The present post discusses whether or not it is possible to discuss the disorder among children.

Perhaps, one of the major issues with pediatric bipolar depression disorder is its accurate diagnosis. On one hand, an accurate diagnosis requires that the symptoms be presented for ten years. On the other hand, every year that the condition is left untreated result in a 10% reduced likely for the patient fully recovery following treatment. Besides that, the disorders clinical and phenomenological presentation differs between adults and children. This is unfortunate since the Diagnostic and Statistical Manual of Mental Disoders-5 (DSM-5) that is currently in use only presents the adult criteria for diagnosis, which is not of much use when diagnosing children (Sperry, 2016). Speaking from a developmental perspective, pediatric populations are yet to achieve physical, neurocognitive and emotional maturity thus presenting a challenge when conducting a diagnosis. NURS6660 Week 8 Discussion: Pediatric Bipolar Depression Disorder Debate. Besides that, it is normal for children who are less than ten years of age to prominently present changeable, unstable and labile moods that could be misinterpreted when diagnosing the condition. In addition, pediatric populations find it difficult to verbalize their symptoms and emotions, which could have different meanings when considering the patient’s stage of development. Also, there is a high rate of comorbid disorders in the bipolar spectrum that have overlapping symptoms and conditions, which make it more difficult to conduct a diagnosis among children (American Psychiatric Association, 2013).

It is evidence that the presentation of pediatric bipolar depression disorder is atypical when compared to bipolar depression disorder incidence among adults. To address these differences and ensure accurate diagnosis of the condition among children, there is need to follow a four step-process. The first step is to have the families keep daily logs of the child prior to the psychological/psychiatric evaluation. This should occur at least one month to the evaluation. The logs keep track of the child’s temper tantrums in terms of triggers, duration, intensity and frequency. In addition, they track sleep, energy, activity level and mood. The second step is to review the child’s past medical records to include medical history in terms of blood work, toxin screen, brain scan and EEG. The third step is to interview the child while noting family history of bipolar spectrum disorders. The interview would also identify the cardinal symptoms of the disorder that include hyper-sexuality, psychosis, reduced need for sleep, racing thoughts, grandiosity and elated mood. In addition, the interview looks into the aggression levels and intensity of mood irritation, while assessing safety issues. The final step involves discussing the diagnosis impression with the child’s family, while the particular impression was selected, and provide reassurance for treatment (Stahl, 2014).

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It is important to note that pediatric bipolar depression disorder presentation occurs as rapid changes in behavior and mood. This atypical presentation of the disorder is linked to the developmental differences in the expression of symptoms as well as the evolving nature of the disorder among children. This is an important point to consider since it has prognostic and treatment implications as the symptoms severity and mood fluctuations increase over time. Given this awareness and the information presented in this discussion, it is clear that pediatric psychiatric personnel should be more familiar with the diagnosis of the condition through practice since the condition occurs among children while its diagnosis do not follow the classic adult presentation. This would also require that the psychiatric personnel be less reliant on DSM-V criteria since it is based on adult symptoms that do not necessarily match pediatric symptoms for the disorder (Sperry, 2016). In this respect, it can be accepted that pediatric bipolar depression disorder is possible to diagnose since its presentation and symptoms differ from adults, although the diagnostic accuracy would depend on the clinicians’ familiarity and comfort levels, as well as frequency of conducting diagnosis among children. NURS6660 Week 8 Discussion: Pediatric Bipolar Depression Disorder Debate.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5^th ed.). Washington, DC: Author.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry (11^th ed.). Philadelphia, PA: Wolters Kluwer.

Sperry, L. (2016). Handbook of diagnosis and treatment of DSM-5 personality disorders: assessment, case conceptualization, and treatment (3^rd ed.). New York, NY: Routledge.

Stahl, S. M. (2014). Prescriber’s guide: Stahl’s essential psychopharmacology (5^th ed.). New York, NY: Cambridge University Press.

Zeanah, C. H., Chesher, T., & Boris, N. W. (2016). Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 55(11), 990–103. Retrieved from http://www.jaacap.com/article/S0890-8567(16)31183-2/pdf . NURS6660 Week 8 Discussion: Pediatric Bipolar Depression Disorder Debate.