Psychiatric Illness and Sleep in Children and Adolescents
Mark A. Richardson, Norman R. Friedman in Clinician’s Guide to Pediatric Sleep Disorders, 2016
There are two primary types of bipolar disorder, Bipolar I disorder and Bipolar II disorder. The clinical course of Bipolar I disorder is characterized by the occurrence of one or more episodes of mania. Bipolar II disorder is characterized by one or more episodes of hypomania. Mania and hypomania differ by degree, with mania associated with marked impairment in functioning, need for hospitalization, and often psychosis (6). Otherwise, the diagnostic criteria are the same (Table 5). Decreased need for sleep (e.g., feeling rested after only two to three hours of sleep) is a major symptom of mania and hypomania and is one of the primary symptoms suggested to best discriminate bipolar disorder from attention-deficit/hyperactivity disorder (ADHD) in prepubertal children and early adolescents. One study found approximately 40% of children with mania presenting with a dramatically decreased need for sleep (19). Children and adolescents who are manic, much like manic adults, will not show evidence of tiredness or fatigue during the day, despite decreased or absent sleep. On the contrary, manic individuals will demonstrate increased energy and goal-directed behavior during the day. In some individuals, decreased need for sleep can be the first symptom to signal an episode of mania (3). Recognition and treatment of this decreased need for sleep may subvert the development of a full-blown episode of mania and the associated sequelae such as psychosis, danger to self or others, and hospitalization.
Mood and Anxiety Disorders
Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews in Co-occurring Mental Illness and Substance Use Disorders, 2022
Research has suggested that there is a greater genetic propensity involved in bipolar I disorder than there is a uni-polar depressive disorder, with 8% to 10% of those with a first-degree blood relative with bipolar I disorder developing it (Plomin et al., 2008; Willcutt & McQueen, 2010). The monoamine hypothesis for bipolar disorder suggests that if deficiencies in serotonin and norepinephrine contribute to the development of depressive disorders, then increased norepinephrine contributes to the manic phase of bipolar disorder (Goodwin & Jamison, 2007), while increased dopamine affects symptoms of hyperactivity, grandiosity, and euphoria (Goodwin & Jamison, 2007). These same symptoms can be seen in those who use drugs like cocaine and amphetamines and demonstrate manic symptoms. Elevated cortisol levels are found in those with bipolar disorder and have been also found in the HPA axis due to abnormalities in thyroid functioning in those clients (Goodwin & Jamison, 2007).
Inventory Resources and Risks for Recovery
Sandra Rasmussen in Developing Competencies for Recovery, 2023
This is not a geographical cure. My name is Deborah H; I am a single 33-year-old software engineer. I am alcohol and drug-free for four years. My Bipolar I disorder is managed effectively. I received a job promotion and am moving cross-country with my parent company. I found an in-network psychiatrist who kept me on Abilify. I am now met with a mental health counselor to continue my overall recovery work. Together we reviewed my personal assets and liabilities. I have four years continuous recovery and reasonable stability of my bipolar disorder. I am highly motivated to grow in my recovery. Even though I planned the move and “feel ready” for the change, we identified personal, professional, and social stress and risks to manage. My apartment complex has a gym and pool. I am walking distance from a temple. I plan to participate in online recovery meetings until I am more comfortable around the city. The counselor suggested a focus on self-care and work as priority goals: “keep it simple.” I scheduled sessions with the mental health counselor every two weeks for the next three months. I am cautiously optimistic about me, my recovery, and my future.
Bipolar depression: the clinical characteristics and unmet needs of a complex disorder
Published in Current Medical Research and Opinion, 2019
Roger S. McIntyre, Joseph R. Calabrese
Bipolar disorder is a chronic and complex mood disorder that is characterized by an admixture of manic (bipolar mania), hypomanic and depressive (bipolar depression) episodes, with significant subsyndromal symptoms that commonly present between major mood episodes1. Ranked among the leading causes of worldwide disability2, bipolar I disorder has been consistently associated with significant medical and psychiatric comorbidity, premature mortality, high levels of functional disability and reduced quality of life3. The essential feature of bipolar I disorder requires the occurrence of at least one fully syndromal lifetime manic episode, although depressive episodes are common4. Bipolar II disorder requires the occurrence of at least one hypomanic episode and one major depressive episode; it is no longer considered a milder form of bipolar disorder as it is associated with considerable time spent depressed and with functional impairment that accompanies mood instability4. Bipolar disorder with mixed features is a complex presentation in which a mood episode from either the manic or depressive pole is complicated by the presence of subsyndromal but clinically significant symptoms from the opposite pole. Patients with bipolar depression have greater morbidity and mortality than patients with bipolar mania, with depressed patients having a higher risk of suicide, interepisode panic attack and psychosis5.
The Rapid Mood Screener (RMS): a novel and pragmatic screener for bipolar I disorder
Published in Current Medical Research and Opinion, 2021
Roger S. McIntyre, Mehul D. Patel, Prakash S. Masand, Amanda Harrington, Patrick Gillard, Susan L. McElroy, Kate Sullivan, C. Brendan Montano, T. Michelle Brown, Lauren Nelson, Rakesh Jain
A multidisciplinary group of 6 mental health and psychometric experts then participated in two modified Delphi consensus panels. During Panel 1 (pre-panel online activity and web conference [30 April 2019]), participants reviewed the identified concepts and ranked them in order of the ones that would best identify patients with a diagnosis of MDD who may instead have bipolar I disorder. During Panel 2 (pre-panel online activity and in-person or web conference [20 May 2019]) participants further refined the reduced concept list developed during Panel 1 proceedings and again ranked them by their potential to differentiate patients with bipolar I disorder from those with MDD. Patient-friendly item wording, and specific thresholds (e.g. age of depression onset, number of episodes) and variations (e.g. comorbidities, family history) were explored and determined for draft screening tool items. All decisions related to item reduction and selection were made based on a consensus from the majority of participants (i.e. at least 4 of 6). A pool of bipolar I disorder screening tool items were drafted for subsequent qualitative evaluation.
Advances in the psychopharmacotherapy of bipolar disorder type I
Published in Expert Opinion on Pharmacotherapy, 2021
Ahmad Sleem, Rif S. El-Mallakh
Only randomized clinical trials published in the English language literature from January 2015 through current were reviewed. Only PubMed was queried with the keywords ‘((bipolar disorder) AND treatment) AND randomized.’ We included randomized controlled trials (RCTs) and observational studies discussing pharmacological treatment and having patients with bipolar I disorder in the study population. We excluded review articles, non-pharmacological studies, comorbidities treatment studies, and studies dealing exclusively with type II bipolar illness, but included some meta-analyses if they contributed to the discussion. The initial review excluded studies based on the title. The remaining articles then underwent a review of abstract. Identified articles were then read for content and included in the output tables (Tables 1–3). The discussion was then synthesized from the tables with additional background data added for clarification.
Related Knowledge Centers
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