Psychiatric Times - Category 1 Credit |
To earn AMA PRA Category 1 Credit(s)™: Read the article "The State of the Evidence on Pediatric Bipolar Disorder" from the December 2009 issue of Psychiatric Times, complete the posttest and the evaluation. (Note: A score of at least 70% must be achieved in order to be awarded credit.) The posttest will be scored instantly and results will be shown onscreen. Please make a copy of your test results for your continuing education records. After submitting the activity evaluation, you may then print a Statement of Credit for your records. |
You must keep your own records of this activity. Copy this information and include it in your continuing education file for reporting purposes.
CME LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
CME LLC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
CME LLC is approved by the California Board of Registered Nursing, Provider No. CEP12748, and designates this educational activity for 1.5 contact hours for nurses.
The American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 Credits™ toward recertification requirements.
The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credits™ from organizations accredited by the ACCME.
Sponsored by CME LLC for 1.5 Category 1 credits.
Original release date 12/09. Approved for CME credit through December 2010.
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Educational Objectives
After reading this article, you will be familiar with:
• The pathophysiology of pediatric bipolar disorder (PBD)
• Assessment tools and measures
• Treatment options
• Comorbidities
Who will benefit from reading this article?
Psychiatrists, child and adolescent psychiatrists, psychologists, primary care physicians, nurse practitioners, and other health care professionals. To determine whether this article meets the continuing education requirements of your specialty, please contact your state licensing and certification boards.
Pediatric bipolar disorder (PBD) is a serious psychiatric illness that impairs children’s emotional, cognitive, and social development. PBD causes severe mood instability that manifests in chronic irritability, episodes of rage, tearfulness, distractibility, grandiosity or inflated self-esteem, hypersexual behavior, a decreased need for sleep, and behavioral activation coupled with poor judgment. While research in this area has accelerated during the past 15 years, there are still significant gaps in knowledge concerning the prevalence, etiology, phenomenology, assessment, and treatment for PBD.
This article briefly summarizes the scientific evidence that has contributed to our understanding of this disorder. The research literature in the areas of prevalence, etiology, pathophysiology, assessment, diagnosis, and treatment is reviewed.
Prevalence of PBD
Unfortunately, there are still no authoritative data on the prevalence of PBD: estimates depend on whether the disorder is defined as a narrow or broad phenotype.1 Children with the narrow phenotype fit symptom criteria for a bipolar disorder diagnosis as defined by DSM-IV-TR, whereas children with the broad phenotype experience serious mood dysregulation and associated symptoms but may not meet symptom number or duration criteria defined by the narrow phenotype.
One community study showed a lifetime prevalence of bipolar disorder of 1% in youths aged 14 to 18 years, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).2,3 However, Brotman and colleagues4 found the lifetime prevalence of severe mood dysregulation to be 3.3% in children aged 9 to 19 years from an epidemiological study sample. These findings indicate that a high percentage of the population may experience symptoms consistent with the broad phenotype of PBD.
Retrospective studies of adults with bipolar disorder have reported that as many as 60% experienced symptoms before age 20 years and 10% to 20% reported symptoms before age 10 years.5-7 It remains unclear, however, how subthreshold symptoms in childhood relate to adult-onset bipolar disorder, as well as whether there is continuity between the childhood-onset presentation and the more classic presentation of adult bipolar disorder.
Geller and colleagues8 showed continuity in both disorder presence and nature of symptoms in children with bipolar I disorder who were observed for 8 years into adulthood. The findings from their study indicate that the unique symptom presentation of early-onset bipolar disorder continues into adulthood for these children.
Despite a lack of knowledge on exact prevalence and the continuity or overlap between childhood-onset and adult-onset presentations, the psychosocial and interpersonal effects of PBD (whether broad or narrow phenotype) on patients and their families is devastating. A community study showed that PBD is associated with substantial impairment in social (66%), family (56%), and school (83%) functioning.2 PBD has been associated with behavioral problems in school, low grades, having few or no friends, frequent teasing, poor social skills, poor sibling relationships, and parent-child relationships characterized by frequent hostility and conflict.9,10
