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Overview

Case studies and simulations are excellent ways to practice critical thinking and problem solving in patient care in a safe space. These case-based assignments are designed to provide you with an opportunity to practice applying the theoretical knowledge you have acquired in a real-life scenario. Use this assignment to apply all the best practices that you have learned and be as thorough and detailed as you can.

In this course, we will be using an interactive simulation tool called iHuman to provide you with exposure to case study information. Through iHuman, you will have the opportunity to interact with a simulated patient to collect and analyze data much in the same way you would in real life. After collecting that data, you will use the iHuman platform to diagnose and develop a treatment plan. After completing the iHuman case, you will prepare a SOAP note to summarize and provide an overview of the simulated clinical experience. The SOAP note is a good tool to use in your practice, as it covers the areas of documentation that are considered vital in order to achieve the goals of treatment. You will be using SOAP notes (or something similar) frequently in your practice.

Instructions

Complete the iHuman case study assigned for the week. You will be working in the iHuman platform to complete the case. Follow the directions on logging in and navigating in iHuman. You will need to input your first and last name and email address to access the recording. Refer back to the iHuman Orientation for complete instructions on navigating in iHuman.

When working in iHuman, practice as if this were a real patient. For example, the platform allows you to ask many questions when taking a history. However, in reality, you will likely be limited in time. Practice setting yourself a time limit and work on being efficient in your clinical interview. While there is time for empathy, you do not want to distract from good clinical investigation.

In iHuman, review the specific instructions for the appropriate case. These instructions will help you understand the expectations of each case, as they may differ.

Once you have completed all the steps in iHuman, complete a SOAP Note (Word) for the patient you worked with. (Note: The template is meant to be a guide. You can change the formatting of your SOAP note if the table style does not work for you. Additionally, you can copy and paste what you have written in iHuman into your SOAP note if the content is appropriate.)

Your SOAP note should be no more than five pages long.

Use academic sources, cited in APA format, to support your rationale in your Assessment and Plan.

While items in iHuman may be auto-marked, your grade for this assignment is not based on how you perform within iHuman. The iHuman platform is merely an opportunity for you to interact with a simulated patient and gather data.

If you require technical support with the iHuman platform, use the iHuman Help Center to contact iHuman Technical Support directly. Technical support includes a malfunction of the platform; they will not be able to help with issues involving content!

Due: Facilitating group to post by Day 1; all other students post to discussion prompt by Day 3 and one other peer initial discussion prompt post by Day 6

Initial Post: Created by Facilitating Group ( I am not in the facilitating group)

This is a student-led discussion.

· 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 3. Your reply posts should include substantive reflection directed to the presenters.

· You are also expected to respond to at least two other peer’s initial discussion prompt posts.

Facilitating Group’s Post (to be replied)

Group Facilitated Discussion Plan: Pediatric and Adolescent Bipolar Disorder

Brandy L. Creasy, Deborah Penney, and Sharon Wallace

NURS664C Family Mental Health I

October 24, 2021

Introduction

This presentation is a collaboration of ideas and research synthesized to stimulate a lively discussion regarding pediatric-onset bipolar disorder (PBD) and adolescent-onset bipolar disorder (ABD). “Bipolar disorder in children and adolescents is characterized by recurrent episodes of elevated mood (mania or hypomania), which exceed what is expected for the child’s developmental stage and are not better explained by other psychiatric and general medical conditions” (Birmaher, 2020). In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 2013 p. 123), “bipolar disorders are separated from depressive disorders and placed between chapters on schizophrenia spectrum and other psychotic disorders in recognition of their place as a bridge between the two diagnostic classes in terms of symptomatology, family history, and genetics”.  

Bipolar spectrum disorders are differentiated from other affective and psychotic disorders based on the existence of episodes of mania and/or hypomania. According to the APA (2013, p. 124), a manic episode is identified when a person experiences an “abnormally and persistently elevated, expansive, or irritable mood” with an equally abnormal and persistent “increase in activity or energy” for almost all day, every day, for a week; and during the mood disturbance, three to four (with irritable mood) of the following symptoms are observed: 1) grandiosity, 2) a decreased need for sleep, 3) increased talkativeness, or pressured speech, 4) racing thoughts or flight of ideas, 5) increased distractibility, 6) increased goal directed activity or agitation and energy, and 7) increased involvement in dangerous or risky activities and behaviors in appropriate for current age and developmental stage (APA, 2013, p. 124). The mood episode should a) be severe enough to impact the individual’s ability to function socially and academically (occupationally for adults) or include psychotic features; b) behaviors are abnormal in comparison to developmental level and typical presentation for the client, and c) the client’s presentation is not better explained by the existence of another condition or due to an exogenous substance (APA, 2013, p. 124). The APA (2013, pp. 124-125) indicates that hypomania is identified when the previously identified symptoms of mania are present for four days instead of seven, though symptoms are not severe enough to adversely impact the individual’s social or academic functioning.

Screening for Mood Disorders. Children and adolescents with mood disorders may present to a primary care or psychiatric outpatient setting and describe having an emotional problem (Meadow-Oliver & Yearwood, 2021). Following up a chief complaint of an emotional problem, when a mood disorder is consistent with history and symptoms, includes screening for depression and suicide-risk (Meadow-Oliver & Yearwood, 2021). The United States Preventive Services Task Force (USPSTF) recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years (Siu & U.S. Preventative Task Force, 2016). The USPSTF (2013) indicates the evidence is not sufficient to support suicide-risk screening in adolescents who do not have a psychiatric disorder (O’Connor, Gaynes, & Burda, et al., 2013, April). Limited data exists on screening instruments in younger populations (U.S. Preventive Services Task Force, 2016). However, it is reasonable to conduct opportunistic screening (U.S. Preventive Services Task Force, 2016). 

PHQ-A and BDI-II. The Patient Health Questionnaire for Adolescents (PHQ-A) (Johnson, Harris, Spitzer & Williams, 2002) and the primary care version of the Beck Depression Inventory have been studied most for use with pediatric populations (U.S. Preventive Services Task Force, 2016). The 9-item PHQ-A was the first instrument validated to assess anxiety, eating, mood, and substance use disorders with adolescents in an outpatient setting (Johnson, Harris, Spitzer & Williams, 2002). The PHQ-A has a sensitivity of 75%, a specificity of 92%, and an overall accuracy of 89% for any psychiatric disorder (Johnson, Harris, Spitzer & Williams, 2002). Johnson, Harris, Spitzer, and Williams (2002) also provided the sensitivity, specificity, and overall accuracy data for each disorder assessed by the PHQ-A (e.g., anxiety, GAD, any mood disorder, etc.). The Severity Measure for Depression – Child Aged 11-17 was adapted from the PHQ-9 and the PHQ-A (APA,) The Beck Depression Inventory has been widely used to screen for depression in the general population (Steer & Clark, 1997). The Beck Depression Inventory-II was modified to include the symptoms of agitation, concentration difficulty, worthlessness, and loss of energy (Steer & Clark, 1997).

Screening for Bipolar Disorder. Bipolar disorder is challenging to diagnose due to symptoms that overlap with other disorders (Jenkins, et al., 2012). Pediatric bipolar disorder is described as a “high-stakes condition” (p. 3) and indicate that the diagnosis of bipolar disorder in pediatric populations has been reported to range from missed diagnosis to overdiagnosis. Screening instruments recommended for bipolar disorder include the Mood Disorder Questionnaire for Adolescents (MDQ-A) and the Child Bipolar Questionnaire (CBQ). The MDQ-A was adapted from the adult version of the Mood Disorder Questionnaire (MDQ). The MDQ-A is a 13 item yes/no questionnaire about having symptoms of mania for a week or more, with sensitivity and specificity of 38% and 73% (Wagner, Hirschfeld, & Emslie, 2006). The sensitivity and specificity for the parental version of the MDQ-A was reported to be 72% and 81%, and the teacher/friend version of the MDQ-A was reported to be 38% and 74% (Pavuluri, 2007; Wagner, Hirschfeld, & Emslie, 2006). However, Miguez, et al. (2013) reported the test-retest reliability of the MDQ-A self-report was moderate (kappa = 0.66) and agreement between the MDQ-A and parent version was poor (kappa = 0.07). The Kappa statistic is used to measure inter-rater reliability with a range from -1 to 1+ (McHugh, 2012). The finding related to the parent and adolescent version, whereas if 0.07 indicates agreement, then 0.93 would indicate a large amount of disagreement (McHugh, 2012). 

The Child Bipolar Questionnaire (CBQ) is an illustrated 65-item behavioral online assessment reported to have a sensitivity of 62.8%, specificity of 61.5% and positive predictive value of 82.8% (Papolos, et al., 2004). The CBQ includes the 65 highest ranked symptoms and behaviors from the DSM-IV symptom criteria for mania, major depression, and comorbid conditions (Miguez, et al., 2013). The CBQ screens for bipolar disorder and the disorders comorbid to bipolar disorder including “mania, major depression, separation anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, oppositional defiant disorder, conduct disorder, and attention deficit disorder” (The Child Bipolar Questionnaire, The Bipolar Child, n.d.). The CBQ is available in English and Spanish and is written at an 8th grade reading level (Papolos, Cockerham, & Hennon, n.d.). The CBQ can be completed on-line, and parents can request the results of the assessment to share with their mental health care provider for a fee.

A study comparing the MDQ-A and CBQ, conducted by Miguez, et al. (2013) showed that only 8 of 76 patients, ages 13-18 met the K-SADS-PL diagnostic criteria for BD, when screened with the MDQ-A and CBQ. The researchers reported, with respect to the to the K-SAD-PL, the sensitivity and specificity for the MDQ-A as 75% and 57.4% and 50% and 73.5% for the CBQ (Miguez, et al, 2013).

More Screening Tools and Information to Consider. In a study of adults in an in-patient setting, researchers showed that the MDQ and the McLean Screening Instrument (MSA) for borderline personality disorder (BPD) differentiated between bipolar disorder (BD) and (BPD) (Palmer, et al., 2021). The MDQ-A has been validated in adolescents. The McLean Screening Instrument for Borderline Personality Disorder (MSI) has been shown to be valid in adolescents in one study (Noblin, Venta & Sharp, 2014). Research is needed to confirm validity of the MSI in adolescents and to ascertain whether screening with both tools might differentiate between BD and BPD in adolescents.

Additional instruments to consider include the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure – Child 11-17, the DSM-5 Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure-Child 6-17, or the Level 2 – Mania – Child 11-17 (Altman Self-Rating Scale Mania Scale [ARSM]), developed and adapted from the Adult ARSM. As well, the interwoven relationship between biological, psychological, and social factors that come together across time, and in any given moment, make assessing and predicting suicide risk immensely complex (Fonseca-Pedrero & Pérez de Albéniz, 2020). Appendix A. Suicide Risk Screening Instruments Table 1 includes 13 instruments, complete with information about whether the instrument is self-administered or administered by the clinician, number of items, estimated time to administer, range of score, target behavior or purpose, target user, time frame assessed, and data specific to validation of the instrument. Six suicide-risk screening instruments, included in Table1, have been identified for use with children and adolescents (O’Connor, Gaynes, Burda, et al., 2013). To access the screening instruments, go to: https://www.ncbi.nlm.nih.gov/books/NBK137742/?report=reader. Revisions to the USPSTF screening recommendations for depression and suicide-risk in children and adolescents are in progress. A few final notes to share the Paykel suicide scale was recently validated in the Spanish language (Fonseca-Pedrero & Pérez de Albéniz, 2020), and the ASQ instrument, a tool specific to use in the pediatric Emergency Department (Horowitz, et al., 2012), can be accessed at https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials .Online Resources

Discussion Prompt and Response Instructions

Peers are asked to read each prompt and reply to three out of the seven questions (in red). Please number the question as it corresponds with the initial post

.

Prompt #1: Screening for Bipolar Disorder, Depression,

Beck updated the Beck Depression Inventory IA to the Beck Depression Inventory II after the American Psychiatric Association updates to the DSM-IV. Read the article by Beck et al, to discover the specific reason for updating the Beck Depression Inventory. The DSM-V was last updated in 2013. Schmit and Balkin (2014) examines the differences between the measures and language of instruments and the DSM-V. Please note questions 1-3 are related to prompt #1

Question 1: As a clinician using instruments to screen and diagnose clients, will it be important to determine if the instrument you select is consistent with the diagnostic criteria of the DSM-V? 

Question 2: Have you used any of the instruments identified by Schmit and Balkin (2014) in the article, Evaluating emerging measures in the DSM-5 for counseling practice, recently? If so, which one(s)? Compare the instrument to the DSM-V. What did you discover?

Question 3: Considering that few validated screening instruments are available for use with adolescents (U.S. Preventive Services Task Force, 2016) and that other screening instruments may not be consistent with the DSM-V, how might the findings from the Diagnostic stability in children and adolescents with bipolar disorder, by  Laursen, M. F., Licht, R. W., Correll, C. U., Kallehauge, T., Christensen, A., Rodrigo-Domingo, M., & Nielsen, R. E. (2020) be explained?  Do the factors associated with risk of diagnostic change resonate with findings in the U.S.? 

Resources. Please review the following resources related to prompt #1. 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Beck, A.T., Robert A. Steer, Roberta Ball & William F. Ranieri (1996) Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients, Journal of Personality Assessment, 67:3, 588-597. https://doi.org/10.1207/s15327752jpa6703_13

Laursen, M. F., Licht, R. W., Correll, C. U., Kallehauge, T., Christensen, A., Rodrigo-Domingo, M., & Nielsen, R. E. (2020). Diagnostic stability in children and adolescents with bipolar disorder, a nationwide register-based study. International Journal of Bipolar Disorders, 8(1), 1–10. Note: A PDF of this publication can be downloaded at https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-020-0179-3

Schmit, E.L. & Balkin, R.S. (2014). Evaluating emerging measures in the DSM-5 for counseling practice. The Professional Counselor, 4(3), 216-331. http://tpcjournal.nbcc.org. Note:  This publication can be accessed at http://tpcjournal.nbcc.org  via the upper left tab Articles, and then to Volume 4, Issue 3, p. 216-331. 

 

Prompt #2: Bipolar Symptoms, Comorbidity, and Misdiagnosis in PBD and ABD Populations

According to the APA (2013), Birmaher, (2020), and Boland et al. (2021), a significant portion of the pediatric bipolar disorder (PBD) population will have another co-occurring mental health disorder, like an anxiety disorder (40-66%), attention deficit hyperactivity disorder (ADHD, 50%), oppositional defiance disorder (ODD, 40%), conduct disorder (CD, 30%), substance use disorders (SUDs 20-30%), autism spectrum disorders (ASDs), obsessive compulsive disorder (OCD), or posttraumatic stress disorder (PTSD). In addition, Birmaher (2020) indicates that patients with PBD are also more likely to be overweight or obese and have one or more chronic medical conditions/diagnoses.

Question #4 What treatment, psychopharmacological, psychotherapeutic, or both, would you provide to an eleven-year old female patient diagnosed with Bipolar Type 1 with a BMI of 28.4 (Height 5’3”, weight 105 pounds) who is experiencing auditory hallucinations, and has a family history of Diabetes Mellitus Type 2 and heart disease?

Question #5 For this prompt, knowing what you know about the difficulty in diagnosing PBD due to overlapping of symptoms with other pediatric psychiatric disorders, briefly identify how you would rule out comorbid psychiatric conditions in PBD clients?

Resources:  In addition to Boland et al.’s (2021) chapter on bipolar disorder, please review the following resources provided to identify comorbid disorders, overlapping symptoms, and possible methods of differentiating between the various bipolar and comorbidly occurring disorders.  

Birmaher, B. (2020). Pediatric bipolar disorder: Comorbidity. UpToDate. Retrieved October 22, 2021, from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/pediatric-bipolar-disorder-comorbidity/print?search=pediatric%20bipolar&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5

Boland, R. J., Verdun, M. L., & Ruiz, P. (2021). Kaplan & Sadock’s synopsis of psychiatry (12th ed). Chapter 6. Bipolar disorders. Wolters Kluwer.

Leibenluft, E. (2020). Chronic irritability in children is not pediatric bipolar disorder: Implications for treatment. Bipolar Disorders, 22(2), 195-196. https://doi/or/10.1111/bdi.12881

Roselle, A. (2019). Pediatric bipolar disorder: Onset, risk factors, and protective factors. Journal of psychosocial nursing & Mental Health Services, 57(9), 32-37. https://doi.org/10.3928/02793695-20190531-03 

 

Prompt #3: Treatment Planning for the 12-year-old with Bipolar 1

According to McClellan et al. (2007), and Fristad and MacPherson (2014), pharmacotherapy is the first line therapeutic intervention, with psychotherapy an essential adjunctive measure. Bipolar disorder in children and adolescents can often go undiagnosed in favor of conduct disorder, antisocial personality disorder, and even schizophrenia. 

Question #6: What would be the course of treatment for a twelve-year-old child diagnosed with Bipolar 1.  Would you recommend pharmacotherapy or psychotherapy or both and why? 

Question #7: If treated with pharmacotherapy, what would be the first line choice and why? If psychotherapy is added, what would it be and would it include family-centered therapy? and why?

Resources. After reading Boland et al.’s (2021) chapter on bipolar disorders, review the following provided resources. 

Axelson, D. (2021). Pediatric bipolar disorder:  Overview of choosing treatment UpToDate. Retrieved 10/24/21, from Pediatric bipolar disorder: Overview of choosing treatment – UpToDate

Boland, R. J., Verdun, M. L., & Ruiz, P. (2021). Kaplan & Sadock’s Synopsis of Psychiatry (12th ed). Chapter 6. Bipolar Disorders. Wolters Kluwer. 

Hanging indent not maintained

 References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association Publishing. 

American Psychological Association. (2020, June). Patient health questionnaire (PHQ-9 & PHQ-

2). American Psychological Association. https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health

Axelson, D. (2021). Pediatric bipolar disorder:  Overview of choosing treatment. UpToDate.        Retrieved October 24, 2021, from Pediatric bipolar disorder: Overview of choosing treatment – UpToDate

Birmaher, B. (2020). Pediatric bipolar disorder: Comorbidity. UpToDate. Retrieved October 18, 2021, from https://www-uptodate-           com.regiscollege.idm.oclc.org/contents/pediatric-bipolar-disorder-comorbidity/print?search=pediatric%20bipolar&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5

Boland, R. J., Verdun, M. L., & Ruiz, P. (2021). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer. 

Fonseca-Pedrero, E., & Pérez de Albéniz, A. (2020). Assessment of suicidal behavior in adolescents: The Paykel suicide scale. Psychologist Papers, 41(2), 106-115. https://doi.org/10.23923/pap.psicol2020.2928  

Fristad, M. A., & MacPherson, H. A. (2014). Evidence-based psychosocial treatments for child and adolescent bipolar spectrum disorders. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 43(3), 339–355. https://doi.org/10.1080/15374416.2013.822309

Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., . . . Pao, M. (2012). Ask suicide-screening questions (ASQ): A brief instrument for the pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 166(12), 1170-1176. https://doi.org/10.1001/archpediatrics.2012.1276 

Jenkins, M. M., Youngstrom, E. A., Youngstrom, J. K., Feeny, N. C., & Findling, R. L. (2012). Generalizability of evidence-based assessment recommendations for pediatric bipolar disorder. Psychological assessment24(2), 269–281. https://doi.org/10.1037/a0025775

Johnson, J. G., Harris, E. S., Spitzer, R. L., & Williams, J. B. (2002). The patient health questionnaire for adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. The Journal of Adolescent Health 30(3), 196–204. https://doi.org/10.1016/s1054-139x(01)00333-0 

Laursen, M. F., Licht, R. W., Correll, C. U., Kallehauge, T., Christensen, A., Rodrigo-Domingo, M., & Nielsen, R. E. (2020). Diagnostic stability in children and adolescents with bipolar disorder, a nationwide register-based study. Springer Science and Business Media LLC. https://doi.org/10.1186/s40345-020-0179-3 

Leibenluft, E. (2020). Chronic irritability in children is not pediatric bipolar disorder: Implications for treatment. Bipolar Disorders, 22(2), 195-196. https://doi/or/10.1111/bdi.12881

McClellan, J., Kowatch, R., & Findling, R. L. (2007). Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 107–125. https://doi.org/10.1097/01.chi.0000242240.69678.c4

Meadows-Oliver, M. & Yearwood, E.L. (2021). Mood dysregulation disorders. Child and adolescent behavioral health (2nd ed.). Wiley Blackwell. 

Miguez, M., Weber, B., Debbané, M., Balanzin, D., Gex-Fabry, M., Raiola, F., Barbe, R. P., Vital Bennour, M., Ansermet, F., Eliez, S., & Aubry, J. M. (2013). Screening for bipolar disorder in adolescents with the mood disorder questionnaire-adolescent version (MDQ-A) and the child bipolar questionnaire (CBQ). Early Intervention in Psychiatry7(3), 270–277. https://doi.org/10.1111/j.1751-7893.2012.00388.x ed

Noblin, J. L., Venta, A., & Sharp, C. (2014). The Validity of the MSI-BPD Among Inpatient Adolescents. Assessment21(2), 210–217. https://doi.org/10.1177/1073191112473177 

O’Connor E., Gaynes, B., Burda, B.U., et al. (2013, April). Screening for suicide risk in primary care: A systematic evidence review for the U.S. preventive services task force. Rockville (MD): Agency for Healthcare Research and Quality (US); (Evidence Syntheses, No. 103.) https://www.ncbi.nlm.nih.gov/books/NBK137744/?report=reader

Palmer, B. A., Pahwa, M., Geske, J. R., Kung, S., Nassan, M., Schak, K. M., Alarcon, R. D., Frye, M. A., & Singh, B. (2021). Self-report screening instruments differentiate bipolar disorder and borderline personality disorder. Brain and behavior11(7), e02201. https://doi.org/10.1002/brb3.2201

Papolos, D.F., Cockerham, M. & Hennon, F.J. (2004.). The child bipolar questionnaire (CBQ): A screening instrument for juvenile-onset bipolar disorder [PDF]. https://www.bpchildresearch.org/pdf/CBQ_Development.pdf

Pavuluri M. (2007). Parental report version of the Mood Disorder Questionnaire for adolescents has good sensitivity and specificity for diagnosing bipolar disorder in psychiatric outpatient clinics. Evidence-Based Mental Health10(1), 9. https://doi.org/10.1136/ebmh.10.1.9

Roselle, A. (2019). Pediatric bipolar disorder: Onset, risk factors, and protective factors. Journal of Psychosocial Nursing & Mental Health Services, 57(9), 32-37. https://doi.org/10.3928/02793695-20190531-03 

Schmit, E.L. & Balkin, R.S. (2014). Evaluating emerging measures in the DSM-5 for counseling practice. The Professional Counselor, 4(3), 216-331. http://tpcjournal.nbcc.org

Siu, A.L. & U.S. Preventative Task Force. (2016). Screening for depression in children and adolescents: U.S. preventive services task force recommendation statement. Annals of Internal Medicine, 164(5), 360-367. www.annals.org.

Steer, R. A., & Clark, D. A. (1997). Psychometric characteristics of the beck depression inventory-II with college students. Measurement and Evaluation in Counseling and Development, 30(3), 128. Retrieved from https://www.proquest.com/scholarly-journals/psychometric-characteristics-beck-depression/docview/195609830/se-2?accountid=28844 

The Bipolar Child. (n.d.). The child bipolar questionnaire.  https://bipolarchild.com/assessment/

U.S. Preventive Services Task Force. (2016, March 15).  Screening for depression in children and adolescents: Recommendation statement. American Family Physician, 91(6), 506-508. https://doi.org/10.7326/M15-2957

Wagner, K.D., Hirschfeld, R.M.A., Emslie, G.J. (2006). Parental report version of the mood disorder questionnaire for adolescents has a good sensitivity and specificity for diagnosing bipolar disorder in psychiatric outpatient clinics. Journal of Clinical Psychiatry, 67, 827-830. 

Peer Post 1 (To be replied)

Week 12: Pediatric and Adolescent Bipolar Disorder

Jeffrey Pham

November 15, 2021

 

 

Dear Group 3,

 

I enjoyed your very creative and detailed presentation. Also, thank you so much for submitting it early on the discussion board so that it would enable us time to work on it. I have chosen question 4, 6 and 7, as instructed in your discussion prompt to select three out of the seven questions to respond to.

Question #4 What treatment, psychopharmacological, psychotherapeutic, or both, would you provide to an eleven-year old female patient diagnosed with Bipolar Type 1 with a BMI of 28.4 who is experiencing auditory hallucinations, and has a family history of Diabetes Mellitus Type 2 and heart disease?

 

An 11-year-old female exhibiting Bipolar Type 1 with psychosis (auditory hallucinations), would require a medication that can stabilize her mood and, at the same time, control her psychosis.  Given the patient’s BMI of 28.4 (overweight), family history of DM Type 2 and heart disease, psychopharmacotherapeutics must be selected carefully to avoid psychotropic that may exacerbate her weight gain and family history risk factors for cardiovascular and elevated blood sugar issues.  Since she has bipolar type 1 with psychotic features, antipsychotic would be considered to prevent excessive dopamine to bind to the D2 receptors of the mesolimbic pathway, though in general, this drug classification is considered to carry a risk for metabolic syndrome, which includes weight gain, elevated blood sugar, hyperlipidemia, and cardiovascular risk profile (Stahl, 2017).  Compared to other antipsychotic, Abilify carries the least profile for metabolic syndrome (Lieberman, 2004). Though Abilify may have a minimal risk of metabolic syndrome when compared to other antipsychotic, such as Zyprexa, it is always pertinent to monitor for weight changes when a client is on antipsychotic as there is a risk profile with metabolic syndrome with all antipsychotics (Stahl, 2017; Lieberman, 2004).  Abilify would be justified for this patient because of the minimal risk of metabolic syndrome and indication to treat psychosis and mood instability (Stahl, 2017). According to Kirino (2014), Abilify can be safely prescribed to children and adolescents and it has considerably less side effects when compared to other antipsychotics, such as weight gain, sedation, extrapyramidal syndrome and hyperprolactinemia.  Adjunctive therapy with psychotherapeutic, such as DBT, has evidenced to enhance treatment for clients who have bipolar (Washburn et al., 2011).

 

Question #6: What would be the course of treatment for a twelve-year-old child diagnosed with Bipolar 1.  Would you recommend pharmacotherapy or psychotherapy or both and why? 

Question #7: If treated with pharmacotherapy, what would be the first line choice to treat bipolar 1 and why? If psychotherapy is added, what would it be and would it include family-centered therapy? and why?

Responding to both questions six and seven: The first-line choice course of treatment for pediatric bipolar 1 depends on the client’s prominence or comorbid symptoms.  Just as in question 4, the client would benefit more from …