Irritability and DSM-5 Disruptive Mood Dysregulation Disorder (DMDD): Correlates, predictors, and outcome in children

Size: px
Start display at page:

Download "Irritability and DSM-5 Disruptive Mood Dysregulation Disorder (DMDD): Correlates, predictors, and outcome in children"

Transcription

1 Irritability and DSM-5 Disruptive Mood Dysregulation Disorder (DMDD): Correlates, predictors, and outcome in children Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders National Institute of Mental Health, USA Clinical Associate Professor Georgetown University School of Medicine

2 No disclosures Travel paid by conference. Research supported by NIMH

3 Talk Outline A historical perspective on DMDD: irritability and pediatric bipolar disorder Longitudinal course and familial correlates of irritability DSM-5 Disruptive mood dysregulation disorder (DMDD) criteria Treatment

4 1. How happy are you to be here? 1. Ecstatic, what could be better? 2. Quite contented. 3. Pretty neutral. 4. Would prefer not to be. 5. Last place on Earth I want to be.

5

6 2. How common is the diagnosis of bipolar disorder in children? All are true except: 1. Vanishingly small in American clinics in /1000 visits in American clinics in % in US and non-us community samples % in US and non-us community samples /100,000 in US hospital discharges from /100,000 in UK hospital discharges from

7

8 Increase in diagnosis of BD in youth in US clinics Moreno et al, 2007

9 US-UK pediatric bipolar disorder hospital discharge rates, James et al, 2014

10 3. What are pathognomonic symptoms of pediatric bipolar disorder? 1. Very severe temper outbursts 2. Distinct change in mood from baseline 3. Particularly marked ADHD 4. Change in sleep, cognition, activity from baseline

11

12 DSM-5 Criteria for Manic Episode A. Distinct period of elevated, expansive, or irritable mood. present most of the day, nearly every day 1 week B. Symptoms (3, or 4 if irritable) occur at the same time as A and represent a noticeable change from previous behavior: (1) grandiosity (2) decreased need for sleep (3) pressured speech (4) flight of ideas, racing thoughts (5) distractibility (6) increased goal-directed activity, psychomotor agitation (7) excessive pleasurable activities

13 DSM-5 Criteria for Manic Epısode: Overlap with ADHD A. Distinct period of elevated, expansive, or irritable mood. present most of the day, nearly every day 1 week B. Symptoms (3, or 4 if irritable) occur at the same time as A and represent a noticeable change from previous behavior: (1) grandiosity (2) decreased need for sleep (3) pressured speech (4) flight of ideas, racing thoughts (5) distractibility (6) increased goal-directed activity, psychomotor agitation (7) excessive pleasurable activities

14 Should children with severe irritability and ADHD be considered to have a pediatric form of BD?

15 4. To answer the question Should children with severe irritability and ADHD be considered to have a pediatric form of BD? the most important thing to know is whether: 1. children with BD tend to also have symptoms of ADHD. 2. children with BD tend to have a family history of ADHD. 3. children with severe irritability develop manic episodes as they grow up. 4. children with severe irritability tend to have a family history of BD. 5. brain function differs between severely irritable children and those with BD.

16

17 5. When irritable children grow up, they are at risk for: 1. Mania or hypomania 2. Anxiety disorders 3. Unipolar depression 4. Psychopathy 5. Decreased education and income

18

19 Do irritable children develop manic episodes when they grow up? Community-based studies: Irritability in youth predicts anxiety, unipolar depression in adulthood Duration of follow-up: 3 to 20 years ODD has irritable and headstrong dimensions irritable predicts to depression (Stringaris and Goodman 2009, Rowe et al 2010, Burke et al, 2010) headstrong predicts to conduct disorder, antisocial personality Irritability in youth does not predict bipolar disorder in adulthood

20 Chronic irritability in youth predicts MDD, dysthymia, anxiety at f/u Children in the Community N Age at baseline Age at f/u ( ) MDD GAD Dysthymia 1.72 ( ) 1.81 ( ) Chronic irritability did not predict mania or Axis II Disorders. It was associated with decreased education and income. Stringaris et al, 2009

21 6. Which of the following is true about the heritability of irritability? 1. Irritability is about as heritable as bipolar disorder. 2. Irritable children tend to have strong family histories of bipolar disorder. 3. Irritability is about as heritable as anxiety disorders. 4. The longitudinal association between irritability and depression has a significant genetic component.

22

23 Do irritable children tend to have a family history of BD? LAMS (Longitudinal Assessment of Mania Study) Screened 2622 youth presenting for assessment 25% (N=235) met proxy criteria for DMDD Compared DMDD vs. non-dmdd in rates of BD in 1 st and 2 nd degree relatives Degree of familial loading for mania No analysis reached significance, even before correcting for multiple comparisons D Axelson, RL Findling, EA Youngstrom, et al (unpublished)

24 Genetics of irritability Twin studies show: Irritability is moderately heritable (~ ) Longitudinal association between irritability and depression/anxiety has a significant genetic component (41-74% of variance) Stringaris et al, 2012; Roberson-Nay et al, 2015a Gender differences in genetic influences Swedish twin sample (TCHAD) N=2490 Assessment waves: 8, 13, 16, 19y (Roberson-Nay et al, 2015b)

25 Irritability in Fragile Families and Child Well- Being Study N= 4898 families from 20 US cities, recruited at birth Irritability measure from CBCL Wiggins et al, 2013

26 Association between child irritability and maternal depression if mother depressed > 2x Auto-regressive cross-lag models show bidirectional relationship between maternal depression and child irritability. Wiggins et al, 2013

27 7. Which of the following children should receive the diagnosis of BD? 1. An extremely irritable child with ADHD. 2. An extremely irritable child without ADHD. 3. An extremely irritable child with a parent who has BD. 4. A child who experienced a distinct episode of mania.

28

29 Diagnosis given for the first time > age 6, < age 18 no preschoolers, no adult data DSM-5 DMDD Criteria Chronic, severe irritability Severe, recurrent temper outbursts > 3x week, on average Verbal and/or behavioral Developmentally inappropriate Mood between outbursts persistently irritable or angry most days, most of the day Irritability impairing in > 2 settings (home, school, peers) not at home only Present > 12 months chronic presentation 2 components of severe irritability Syndrome must onset before age 10 not adolescence

30 DSM-5 DMDD Overlap Criteria If child meets criteria for DMDD and ODD, diagnose only DMDD If child meets criteria for DMDD and ADHD, diagnose both Exclusions: Distinct (hypo)manic episode > 1 day Only present during episode of MDD not better explained by ASD, PTSD, separation anxiety

31 Common pitfalls in diagnosing DMDD Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation of provocation. Verbal outbursts MUCH more common than physical aggression The mood between outbursts is persistently irritably or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers) Modelled on criterion for depression Is the child generally grumpy? Cranky? Do you feel like you have to walk on eggshells? Accommodations

32 8. Which of the following were reasons for the creation of DMDD? 1. Severely irritable children may have been diagnosed with BD because there was no good home for them in DSM-IV. 2. The phenotype is very common. 3. These children are very ill and need more services than justified by the ADHD/ODD diagnoses. 4. Disruptive behavior disorders diagnoses don t do justice to their mood/anxiety symptoms. 5. Doctors diagnose these children as BD, won t prescribe stimulants or SRI s, and prescribe atypical antipsychotics instead. 6. Without a diagnosis, there aren t treatment trials.

33

34 Clinical Characteristics of Severe Mood Clinical Characteristics Dysregulation Age Age of onset Gender (% male) 65.2 % ADHD 86.1 % ODD 83.6 % Anxiety Disorders 66.7 Number medications Severe Mood Dysregulation (N=201) Children s Global Assessment Scale

35 9. For which of the following is there evidence suggesting possibly efficacy in chronic irritability? 1. Stimulants 2. SRI s 3. Atypical antipsychotics 4. Lithium 5. Psychotherapy

36

37 Few controlled clinical trials for irritability Medications Cuts across DSM diagnoses FDA indication: risperidone, aripiprazole for irritability in autism Psychotherapeutic interventions Treatments for other, related behaviors, syndromes Aggression Proactive vs. reactive aggression More specific treatments being developed

38 Irritability Treatment Algorithm

39 Meta-analysis of efficacy of stimulant Rx on overt and covert aggression Included 28 studies, total N=638 Effect size (Cohen s d) d= 0.84 for overt aggression (included rage attacks, irritability) d= 0.69 for covert aggression Connor et al, 2002

40 Irritability Treatment Algorithm

41 Rationale for prescribing SRI s in irritability Co-occurrence with anxiety and depression Some evidence in adults: anger attacks, PMDD Longitudinal and genetic associations with anxiety, depression More benign side-effect profile than atypical antipsychotics

42 SMD Lithium RCT: CGI-I Dickstein et al, 2009

43 Conclusions The diagnosis of BD should be reserved for children with history of distinct (hypo)manic episodes. Irritable children are at risk to develop anxiety and unipolar depressive disorders in adulthood. These longitudinal associations have a genetic component. DMDD should be used to diagnose severely irritable youth. Psychotherapy is likely to be important in the treatment of DMDD. Stimulants have a role in the treatment of youth with DMDD and ADHD. SRI s and atypical antipsychotic medications may also have a role in treating DMDD.

Treating Children with Anxiety and Bipolar Disorder. Ellen Leibenluft, M.D.

Treating Children with Anxiety and Bipolar Disorder. Ellen Leibenluft, M.D. Treating Children with Anxiety and Bipolar Disorder Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders Emotion and Development Branch National Institute of Mental Health National Institutes

More information

DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D.

DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D. DSM 5 AND DISRUPTIVE MOOD DYSREGULATION DISORDER Gail Fernandez, M.D. GOALS Learn DSM 5 criteria for DMDD Understand the theoretical background of DMDD Discuss background, pathophysiology and treatment

More information

PSYCHIATRIC DIAGNOSES. James R. (Bob) Batterson, MD Associate professor, UMKC School of Medicine

PSYCHIATRIC DIAGNOSES. James R. (Bob) Batterson, MD Associate professor, UMKC School of Medicine PSYCHIATRIC DIAGNOSES James R. (Bob) Batterson, MD Associate professor, UMKC School of Medicine 4 Key Diagnoses for the School Nurse 1. ADHD 2. Autistic Spectrum 3. Anxiety Disorders 4. Bipolar Disorder

More information

Bipolar disorder and severe irritability in youth: Diagnosis and treatment. Ellen Leibenluft, M.D.

Bipolar disorder and severe irritability in youth: Diagnosis and treatment. Ellen Leibenluft, M.D. Bipolar disorder and severe irritability in youth: Diagnosis and treatment Ellen Leibenluft, M.D. Chief, Section on Bipolar Spectrum Disorders Emotion and Development Branch National Institute of Mental

More information

THINKING ABOUT SEVERE IRRITABILITY IN YOUTH

THINKING ABOUT SEVERE IRRITABILITY IN YOUTH 1 THINKING ABOUT SEVERE IRRITABILITY IN YOUTH Kenneth E. Towbin, M.D. Chief, Clinical Child & Adolescent Psychiatry Emotion & Development Branch NIMH, NIH, DHHS Talk Outline 2 Why study irritability? Pediatric

More information

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999

Feeling Moody? Major Depressive. Disorder. Is it just a bad mood or is it a disorder? Mood Disorders. www.seclairer.com S Eclairer 724-468-3999 Feeling Moody? Is it just a bad mood or is it a disorder? Major Depressive Disorder Prevalence: 7%; 18-29 years old; Female>Male DDx: Manic episodes with irritable mood or mixed episodes, mood disorder

More information

Disruptive Mood Dysregulation Disorder

Disruptive Mood Dysregulation Disorder The Center for Counseling Practice, Policy, and Research counseling.org/practice_briefs 703-823-9800 x324 Disruptive Mood Dysregulation Disorder Brandy L. Gilea Ph.D. and Rachel M. O Neill Ph.D., Walden

More information

ADHD vs. Bipolar Disorder Clinical Case Discussion

ADHD vs. Bipolar Disorder Clinical Case Discussion ADHD vs. Bipolar Disorder Clinical Case Discussion Rif El Mallahk, M.D. Allan Josephson, M.D. W. David Lohr, M.D. wdlohr01@louisville.edu September 19, 2014 Is ADHD overdiagnosed? Diagnostic practices

More information

3/17/2014. Pediatric Bipolar Disorder

3/17/2014. Pediatric Bipolar Disorder Pediatric Bipolar Disorder 1 Highlighted Topics 1. Review the current DSM-5 definition and criteria for bipolar disorder 2. Highlight major historical developments in the scientific understanding of bipolar

More information

Billy. Austin 8/27/2013. ADHD & Bipolar Disorder: Differentiating the Behavioral Presentation in Children

Billy. Austin 8/27/2013. ADHD & Bipolar Disorder: Differentiating the Behavioral Presentation in Children ADHD & Bipolar Disorder: Differentiating the Behavioral Presentation in Children Judy Goodwin, MSN, CNS Meadows Psychiatric Associates Billy Austin 1 Introduction Distinguishing between ADHD and Bipolar

More information

Assessment Strategies in Mood Disorders. Eunice Kim, Ph.D. Patricia Walshaw, Ph.D.

Assessment Strategies in Mood Disorders. Eunice Kim, Ph.D. Patricia Walshaw, Ph.D. Assessment Strategies in Mood Disorders Eunice Kim, Ph.D. Patricia Walshaw, Ph.D. KSADS-PL w Kiddie Schedule for Affective Disorders & Schizophrenia Present/Lifetime w Semistructured interview to assess

More information

BIPOLAR AFFECTIVE DISORDER IN CHILDREN AND ADOLESCENTS EPIDEMIOLOGY, DIAGNOSIS AND TREATMENT

BIPOLAR AFFECTIVE DISORDER IN CHILDREN AND ADOLESCENTS EPIDEMIOLOGY, DIAGNOSIS AND TREATMENT BIPOLAR AFFECTIVE DISORDER IN CHILDREN AND ADOLESCENTS EPIDEMIOLOGY, DIAGNOSIS AND TREATMENT George Davis, MD New Mexico Department of Children, Youth and Families DEFINITIONS BIPOLAR AFFECTIVE DISORDER

More information

Rosalie Greenberg, M.D. Child and Adolescent Psychiatrist Lorrie Baumann Director, NAMI NJ School Education Programs

Rosalie Greenberg, M.D. Child and Adolescent Psychiatrist Lorrie Baumann Director, NAMI NJ School Education Programs Helping Youth with Mental Health Disorders Rosalie Greenberg, M.D. Child and Adolescent Psychiatrist Lorrie Baumann Director, NAMI NJ School Education Programs Mental Illness is: Biologic disease Physical

More information

IRRITABILITY, PEDIATRIC MOOD DYSREGULATION. Kenneth E. Towbin, M.D. Chief, Clinical Child & Adolescent Psychiatry Emotion & Development Branch

IRRITABILITY, PEDIATRIC MOOD DYSREGULATION. Kenneth E. Towbin, M.D. Chief, Clinical Child & Adolescent Psychiatry Emotion & Development Branch 1 IRRITABILITY, PEDIATRIC BIPOLAR DISORDER & SEVERE MOOD DYSREGULATION Kenneth E. Towbin, M.D. Chief, Clinical Child & Adolescent Psychiatry Emotion & Development Branch NIMH, NIH, DHHS Talk Outline 2

More information

Mood Disorders. Ch. 6- Mood Disorders. What do you know about depression? True or false? Depression is not a common psychological disorder.

Mood Disorders. Ch. 6- Mood Disorders. What do you know about depression? True or false? Depression is not a common psychological disorder. Ch. 6- Mood Disorders OBJECTIVE: Depressive Disorders: Major depressive Disorder Post Partum Disorder Mood Disorders Mood disorders are a group of disorders involving severe and enduring disturbances in

More information

BIPOLAR DISORDER IN CHILDREN AND ADOLESCENTS: A REVIEW OF THE CURRENT KNOWLEDGE BASE

BIPOLAR DISORDER IN CHILDREN AND ADOLESCENTS: A REVIEW OF THE CURRENT KNOWLEDGE BASE BIPOLAR DISORDER IN CHILDREN AND ADOLESCENTS: A REVIEW OF THE CURRENT KNOWLEDGE BASE DSM Manic Episode Distinct period with abnormally and persistent elevated, expansive or irritable mood that lasts at

More information

Diagnosis and Treatment of Bipolar Disorder. Marissa Mariano-Mejia, M.D. Adult Psychiatrist July 2, 2016

Diagnosis and Treatment of Bipolar Disorder. Marissa Mariano-Mejia, M.D. Adult Psychiatrist July 2, 2016 Diagnosis and Treatment of Bipolar Disorder Marissa Mariano-Mejia, M.D. Adult Psychiatrist July 2, 2016 Points to Cover What is the defining characteristic of Bipolar Disorder? Bipolar I vs. Bipolar II

More information

Presentation and Assessment of Psychiatric Symptoms in Children and Adolescents with ASD

Presentation and Assessment of Psychiatric Symptoms in Children and Adolescents with ASD Presentation and Assessment of Psychiatric Symptoms in Children and Adolescents with ASD Andrea Witwer, PhD Nisonger Center The Ohio State University Objectives Obstacles in assessment of psychiatric symptoms

More information

Assessing for Depression

Assessing for Depression Assessing for Depression in your clinical counseling practice Deborah Legge PhD CRC LMHC http://www.influentialtherapist.com Poll Question Who are you? Clinical counselor in Private Practice Clinical Counselor

More information

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include: Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic

More information

ADHD and BIPOLAR DISORDER: Deciphering the Diagnostic Conundrum

ADHD and BIPOLAR DISORDER: Deciphering the Diagnostic Conundrum ADHD and BIPOLAR DISORDER: Deciphering the Diagnostic Conundrum Roberto Olivardia, Ph.D. Harvard Medical School roberto_olivardia@hms.harvard.edu Bipolar I Disorder 6 million people (18 and over) Statistics

More information

Symptoms and Spectrum of Bipolar Disorder

Symptoms and Spectrum of Bipolar Disorder Stahl s Illustrated Chapter 1 Symptoms and Spectrum of Bipolar Disorder This chapter introduces the symptoms of depression and mania as well as some symptoms commonly associated with bipolar disorder.

More information

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

More information

Chapter 7. Mood Disorders. An Overview of Mood Disorders

Chapter 7. Mood Disorders. An Overview of Mood Disorders Chapter 7 Mood Disorders An Overview of Mood Disorders Gross Deviations in Mood 2 Fundamental states: & Mania : The Low Major Depressive Episode The most commonly diagnosed & most severe depression Depressed

More information

CHILD AND ADOLESCENT BIPOLAR DISORDER: An Update from the National Institute of Mental Health

CHILD AND ADOLESCENT BIPOLAR DISORDER: An Update from the National Institute of Mental Health CHILD AND ADOLESCENT BIPOLAR DISORDER: An Update from the National Institute of Mental Health Research findings, clinical experience, and family accounts provide substantial evidence that bipolar disorder,

More information

Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome

Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome Dr. May Lam Assistant Professor, Department of Psychiatry, The University of Hong Kong Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome a mental state in

More information

MCPS Special Education Parent Summit

MCPS Special Education Parent Summit MCPS Special Education Parent Summit May 17, 2014 Rockville High School 2100 Baltimore Road Rockville, MD 20851 When ADHD Is Not ADHD: ADHD Look-Alikes and Co-occurring Disorders David W. Holdefer MCPS

More information

PSYCHIATRY FOR PCPs BIPOLAR DISORDER

PSYCHIATRY FOR PCPs BIPOLAR DISORDER PSYCHIATRY FOR PCPs BIPOLAR DISORDER David A Harrison, MD, PhD Assistant Professor Dept of Psychiatry & Behavioral Sciences University of Washington School of Medicine Mood Disorders: Diagnosis & Treatment

More information

Mood Disorders. 1. Major Depressive Disorders 2. Dysthymic Disorder 3. Bipolar Disorder Bipolar I disorder Bipolar II disorder 4. Cyclothymic Disorder

Mood Disorders. 1. Major Depressive Disorders 2. Dysthymic Disorder 3. Bipolar Disorder Bipolar I disorder Bipolar II disorder 4. Cyclothymic Disorder Mood Disorders 1. Major Depressive Disorders 2. Dysthymic Disorder 3. Bipolar Disorder Bipolar I disorder Bipolar II disorder 4. Cyclothymic Disorder 1. Major Depressive Disorders Introduction Major depressive

More information

NIH Public Access Author Manuscript J Am Acad Child Adolesc Psychiatry. Author manuscript; available in PMC 2010 December 9.

NIH Public Access Author Manuscript J Am Acad Child Adolesc Psychiatry. Author manuscript; available in PMC 2010 December 9. NIH Public Access Author Manuscript Published in final edited form as: J Am Acad Child Adolesc Psychiatry. 2010 April ; 49(4): 397 405. Pediatric Bipolar Disorder Versus Severe Mood Dysregulation: Risk

More information

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1 What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated

More information

Since the 1960s there has been a steady increase of youths being referred for mental health

Since the 1960s there has been a steady increase of youths being referred for mental health ODD AND MDD 1 Since the 1960s there has been a steady increase of youths being referred for mental health services due to aggressive, acting out, and disruptive behavior patterns (Achenback & Howell, 1993,

More information

Bipolar Disorder. Bipolar vs. Depression. Treating Mental Health Patients with Substance Abuse Disorders

Bipolar Disorder. Bipolar vs. Depression. Treating Mental Health Patients with Substance Abuse Disorders Treating Mental Health Patients with Substance Abuse Disorders Daniel Headrick, MD Pacific Coast Recovery Center 31872 Coast Highway Laguna Beach, CA 866 633-6787 Bipolar vs. Depression Himasiri De Silva,

More information

B i p o l a r D i s o r d e r

B i p o l a r D i s o r d e r B i p o l a r D i s o r d e r Professor Ian Jones Director National Centre for Mental Health www.ncmh.info @ncmh_wales /WalesMentalHealth 029 2074 4392 info@ncmh.info Robert Schumann 1810-1856 Schumann's

More information

NQF-Endorsed Behavioral Health Measures. Title Description Steward

NQF-Endorsed Behavioral Health Measures. Title Description Steward 0003 Bipolar Disorder: Assessment for Diabetes Percentage of patients treated for bipolar disorder who are assessed for diabetes within 16 weeks after initiating treatment with an atypical antipsychotic

More information

Psychiatric Disorders

Psychiatric Disorders Psychiatric Disorders Learning about the brain from diagnosis to treatment Tedi Asher Harvard Medical School Talk overview Part I: Defining psychiatric disorders Part II: Biological underpinnings of depression

More information

Bipolar Disorder. Dr Leon Rozewicz FRCPsych MRCP MRCGP Consultant Psychiatrist Medical Director Priory Hospital North London

Bipolar Disorder. Dr Leon Rozewicz FRCPsych MRCP MRCGP Consultant Psychiatrist Medical Director Priory Hospital North London Bipolar Disorder Dr Leon Rozewicz FRCPsych MRCP MRCGP Consultant Psychiatrist Medical Director Priory Hospital North London Consultant telephone: 020 89205606 Secretary email: dianeking@priorygroup.com

More information

Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder

Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder Originally Published 1997 Revised, JAACAP, 2007, lead authors are Jon McClellan, MD Robert Findling,

More information

Bipolar Disorders. Poll Question

Bipolar Disorders. Poll Question Bipolar Disorders American Counseling Association DSM-V Webinar Series July 10, 2013 Dr. Todd F. Lewis, Ph.D., LPC, NCC The University of North Carolina at Greensboro Poll Question Who are you? Clinical

More information

Depressive Disorder in DSM-5

Depressive Disorder in DSM-5 Depressive Disorder in DSM-5 Gary G. Gintner, Ph.D., LPC Louisiana State University Baton Rouge, LA gintner@lsu.edu Who are you? Poll Question Clinical counselor in Private Practice Clinical Counselor

More information

PTSD In Early Childhood: DSM-5 and Beyond

PTSD In Early Childhood: DSM-5 and Beyond PTSD In Early Childhood: DSM-5 and Beyond Annual Meeting of the North Carolina Psychiatric Association September 27, 2014 Charles H. Zeanah, M.D. Section of Child and Adolescent Psychiatry Departments

More information

BIPOLAR DISORDER. Dr. Norman Costigan Department of Psychiatry Alberta Health Services

BIPOLAR DISORDER. Dr. Norman Costigan Department of Psychiatry Alberta Health Services BIPOLAR DISORDER Dr. Norman Costigan Department of Psychiatry Alberta Health Services Clinical Professor Faculties of Family Medicine and Psychiatry The University of Alberta 1 1 DSM 5 - Modified Major

More information

Part 1: Depression Screening in Primary Care

Part 1: Depression Screening in Primary Care Part 1: Depression Screening in Primary Care Toni Johnson, MD Kristen Palcisco, BA, MSN, APRN MetroHealth System Objectives Part 1: Improve ability to screen and diagnose Depression in Primary Care Increase

More information

This chapter discusses disorders characterized by abnormalities of mood: namely, Mood Disorders

This chapter discusses disorders characterized by abnormalities of mood: namely, Mood Disorders CHAPTER 1 Mood Disorders Description of mood disorders The bipolar spectrum Can unipolar depression be distinguished from bipolar depression? Are mood disorders progressive? Neurotransmitters and circuits

More information

How to Recognize Depression and Its Related Mood and Emotional Disorders

How to Recognize Depression and Its Related Mood and Emotional Disorders How to Recognize Depression and Its Related Mood and Emotional Disorders Dr. David H. Brendel Depression s Devastating Toll on the Individual Reduces or eliminates pleasure and jo Compromises and destroys

More information

ADHD Child and Adolescent Clinical Guideline

ADHD Child and Adolescent Clinical Guideline ADHD Child and Adolescent Clinical Guideline ADHD Concern Identified Hyperactive, Impulsivity. Severity and of symptoms. functional impairment rating scales, m amily HX ADHD Diagnosis Only? Develop Treatment

More information

Mood Disorders: The Ups and the Downs

Mood Disorders: The Ups and the Downs Mood Disorders: The Ups and the Downs Melissa Goelitz, MD NAMI Wisconsin Conference April 30, 2016 What is a depressive episode? Mood Changes An overly long period of feeling sad or hopeless Loss of interest

More information

BY www.health24.com http://www.health24.com/medical/condition_centres/777-792-807-1647,23534.asp 1 WHAT IS BIPOLAR DISORDER? Bipolar disorder, also known as manic depression, is a mood disorder characterised

More information

Child & Adolescent Anxiety: Psychopathology and Neuroscience

Child & Adolescent Anxiety: Psychopathology and Neuroscience bbrfoundation.org Child & Adolescent Anxiety: Psychopathology and Neuroscience Daniel S. Pine, M.D. Chief, Child & Adolescent Research Mood & Anxiety Disorders Program National Institute of Mental Health

More information

Asperger syndrome or Asperger's syndrome or Asperger disorder is an autism spectrum disorder that is characterized by significant difficulties in

Asperger syndrome or Asperger's syndrome or Asperger disorder is an autism spectrum disorder that is characterized by significant difficulties in Tanvir Singh, MD Asperger syndrome or Asperger's syndrome or Asperger disorder is an autism spectrum disorder that is characterized by significant difficulties in social interaction, along with restricted

More information

Screening for Mental Illnesses at DOCS Health Fairs

Screening for Mental Illnesses at DOCS Health Fairs Screening for Mental Illnesses at DOCS Health Fairs Depression, Anxiety & Substance Abuse Screening Presented by: Stefania Prendes-Alvarez Mental Health The World Health Organization defines mental health

More information

Bipolar Disorder in Adults Evidence Based Practice

Bipolar Disorder in Adults Evidence Based Practice Bipolar Disorder in Adults Evidence Based Practice Questions from Module A 1) To diagnose a hypomanic episode, the period of persistently elevated, expansive, or irritable mood must last at least days.

More information

Mood (affective) disorders. Jana Hořínková Dept. of Psychiatry Masaryk University Brno

Mood (affective) disorders. Jana Hořínková Dept. of Psychiatry Masaryk University Brno Mood (affective) disorders Jana Hořínková Dept. of Psychiatry Masaryk University Brno MOOD DISORDERS Main feature: mood change in sense of decrease (depression) or elevation (mania) Definition of mood:

More information

Deconstructing the DSM-5 By Jason H. King

Deconstructing the DSM-5 By Jason H. King Deconstructing the DSM-5 By Jason H. King Assessment and diagnosis of depressive disorders and bereavement reactions In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),

More information

Drugs PSYCHOSIS. Depression. Stress Medical Illness. Mania. Schizophrenia

Drugs PSYCHOSIS. Depression. Stress Medical Illness. Mania. Schizophrenia Drugs Stress Medical Illness PSYCHOSIS Depression Schizophrenia Mania Disorders In preschool children imaginary friends and belief in monsters under the bed is normal (it may be normal in older developmentally

More information

Introduction to bipolar disorder

Introduction to bipolar disorder Introduction to bipolar disorder Bipolar I is when the individual experiences manic episodes when high as well as episodes of depression Bipolar II is when the individual experiences hypomanic episodes

More information

Personality Disorders

Personality Disorders Personality s The Good, the Bad and the Really, Really Ugly: Borderline and other Cluster B Personality s BY CHRIS OKIISHI, MD! Long standing! Often life long! Developmental origins! Genetic origins! Resistant

More information

Clinical features - Depression

Clinical features - Depression Mood CRS Formulation Depression The word depression is used to describe a variety of states ranging from normal unhappiness after a loss up to severe major depressive illness with physical and psychotic

More information

Medication for children with autism

Medication for children with autism Medication for children with autism James Scott Child & Adolescent Psychiatrist Royal Brisbane and Women s Hospital & The University of Queensland Centre for Clinical Research Murray 9 year old boy Autistic

More information

BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS

BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS The future of our country depends on the mental health and strength of our young people. However, many children have mental health problems

More information

Sleep Medicine and Psychiatry. Roobal Sekhon, D.O.

Sleep Medicine and Psychiatry. Roobal Sekhon, D.O. Sleep Medicine and Psychiatry Roobal Sekhon, D.O. Common Diagnoses Mood Disorders: Depression Bipolar Disorder Anxiety Disorders PTSD and other traumatic disorders Schizophrenia Depression and Sleep: Overview

More information

Bipolar and related disorders and depressive disorders in DSM-5

Bipolar and related disorders and depressive disorders in DSM-5 Should be cited as: Psychiatr. Pol. 2014; 48(2): 245 260 PL ISSN 0033-2674 www.psychiatriapolska.pl Bipolar and related disorders and depressive disorders in DSM-5 Dorota Łojko, Aleksandra Suwalska, Janusz

More information

Recognizing and Treating Depression in Children and Adolescents.

Recognizing and Treating Depression in Children and Adolescents. Recognizing and Treating Depression in Children and Adolescents. KAREN KANDO, MD Division of Child and Adolescent Psychiatry Center for Neuroscience and Behavioral Medicine Phoenix Children s Hospital

More information

Effects of Memantine in Autism

Effects of Memantine in Autism Effects of Memantine in Autism Amy Dixit, PGY-1 Erin Stenson, PGY-1 March 27, 2012 Key Features in Autism Impairment in reciprocal social interactions Poor eye contact, failure to develop peer relationships,

More information

Bipolar Disorder. Definition. Signs and Symptoms

Bipolar Disorder. Definition. Signs and Symptoms Bipolar Disorder NDSCS Counseling Services hopes the following information will help you gain a better understanding of bipolar disorder. If you believe you or someone you know is experiencing concerns

More information

Major Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions

Major Depressive Disorder (MDD) Guideline Diagnostic Nomenclature for Clinical Depressive Conditions Major Depressive Disorder Major Depressive Disorder (MDD) Guideline Diagnostic omenclature for Clinical Depressive Conditions Conditions Diagnostic Criteria Duration Major Depression 5 of the following

More information

Did Vincent van Gogh suffer from bipolar disorder? Results from an experts meeting (preliminary) Willem Nolen UMC Groningen

Did Vincent van Gogh suffer from bipolar disorder? Results from an experts meeting (preliminary) Willem Nolen UMC Groningen Did Vincent van Gogh suffer from bipolar disorder? Results from an experts meeting (preliminary) Willem Nolen UMC Groningen December 23, 1888 Ear incident Cuts off his ear and delivers it to a prostitute

More information

Moody Kids, Bipolar Disorder, and Medication Treatment Strategies. Learning Objectives. Mood Episodes. Irritability and Anger are Nonspecific Symptoms

Moody Kids, Bipolar Disorder, and Medication Treatment Strategies. Learning Objectives. Mood Episodes. Irritability and Anger are Nonspecific Symptoms Moody Kids, Bipolar Disorder, and Medication Treatment Strategies May 6, 2016 Dara Sakolsky, MD, PhD Associate Medical Director, STAR Clinic Assistant Professor of Psychiatry University of Pittsburgh Medical

More information

Oppositional Defiant Disorder and Conduct Disorder Treatment Guide

Oppositional Defiant Disorder and Conduct Disorder Treatment Guide Oppositional Defiant Disorder and Conduct Disorder Treatment Guide DSM V Criteria Diagnostic criteria for 313.81 Oppositional Defiant Disorder A. A pattern of angry, irritable mood, argumentative and defiant

More information

A PROSPECTIVE STUDY OF SEVERE IRRITABILITY IN YOUTHS: 2- AND 4-YEAR FOLLOW-UP

A PROSPECTIVE STUDY OF SEVERE IRRITABILITY IN YOUTHS: 2- AND 4-YEAR FOLLOW-UP Research Article DEPRESSION AND ANXIETY 00:1 9 (2014) A PROSPECTIVE STUDY OF SEVERE IRRITABILITY IN YOUTHS: 2- AND 4-YEAR FOLLOW-UP Christen M. Deveney, Ph.D., 1 Rebecca E. Hommer, M.D., 2, Elizabeth Reeves,

More information

The Clinical Presentation of Mood Disorders. Bob Boland MD

The Clinical Presentation of Mood Disorders. Bob Boland MD The Clinical Presentation of Mood Disorders. Bob Boland MD 1 The Clinical Presentation of Mood Disorders 2 Concentrating On Depression Major Depression Mania Bipolar Disorder (Manic-Depression) For the

More information

Gene Griffin, J.D., Ph.D. Northwestern University Feinberg School of Medicine January 9, 2012

Gene Griffin, J.D., Ph.D. Northwestern University Feinberg School of Medicine January 9, 2012 Gene Griffin, J.D., Ph.D. Northwestern University Feinberg School of Medicine January 9, 2012 I. Prevalence of Mental Illness in Older Youth in Child Welfare II. Child Trauma III. Mental Health and Child

More information

Not All That Swings Is Bipolar: Diagnosis and Treatment of Borderline Personality Disorder

Not All That Swings Is Bipolar: Diagnosis and Treatment of Borderline Personality Disorder Not All That Swings Is Bipolar: Diagnosis and Treatment of Borderline Personality Disorder Michael D. Jibson, MD, PhD Professor of Psychiatry University of Michigan Disclosure In the past 12 months I have

More information

A Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood.

A Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood. Bipolar disorder Bipolar (manic-depressive illness) is a recurrent mode disorder. The patient may feel stable at baseline level but experience recurrent shifts to an emotional high (mania or hypomania)

More information

Disruptive behaviour disorders Oppositional defiant disorder (ODD) / Conduct disorder (CD)

Disruptive behaviour disorders Oppositional defiant disorder (ODD) / Conduct disorder (CD) Disruptive behaviour disorders Oppositional defiant disorder (ODD) / Conduct disorder (CD) Professor Alasdair Vance Head, Academic Child Psychiatry Department of Paediatrics University of Melbourne Royal

More information

Childhood Rage: Diagnosis and Treatment Strategies for Severe Mood Dysregulation - Part 2: Diagnosis and Treatment

Childhood Rage: Diagnosis and Treatment Strategies for Severe Mood Dysregulation - Part 2: Diagnosis and Treatment Liberty University DigitalCommons@Liberty University Faculty Publications and Presentations Center for Counseling and Family Studies 2013 Childhood Rage: Diagnosis and Treatment Strategies for Severe Mood

More information

Bipolar Disorder. When people with bipolar disorder feel very happy and "up," they are also much more active than usual. This is called mania.

Bipolar Disorder. When people with bipolar disorder feel very happy and up, they are also much more active than usual. This is called mania. Bipolar Disorder Introduction Bipolar disorder is a serious mental disorder. People who have bipolar disorder feel very happy and energized some days, and very sad and depressed on other days. Abnormal

More information

Management of Attention Deficit/Hyperactivity Disorder (ADHD) How the Pharmacist Can Impact Care

Management of Attention Deficit/Hyperactivity Disorder (ADHD) How the Pharmacist Can Impact Care Management of Attention Deficit/Hyperactivity Disorder (ADHD) How the Pharmacist Can Impact Care POSTTTEST/RATIONALE Case I The parents of a boy, 4 years of age ask the pharmacist for consultation about

More information

Child psychiatry and DSM-5

Child psychiatry and DSM-5 Child psychiatry and DSM-5 Dr. Natalie Grizenko Associate Professor, McGill University Medical Director Child and Adolescent Psychiatry at the Douglas Mental Health University Institute Child psychiatry

More information

Depression Remission at Six Months Specifications 2014 (Follow-up Visits for 07/01/2012 to 06/30/2013 Index Contact Dates)

Depression Remission at Six Months Specifications 2014 (Follow-up Visits for 07/01/2012 to 06/30/2013 Index Contact Dates) Description Methodology Rationale Measurement Period A measure of the percentage of adults patients who have reached remission at six months (+/- 30 days) after being identified as having an initial PHQ-9

More information

Towards Developing a Manual for Residential Treatment Centers to Support Individuals with an FASD and Their Families

Towards Developing a Manual for Residential Treatment Centers to Support Individuals with an FASD and Their Families Towards Developing a Manual for Residential Treatment Centers to Support Individuals with an FASD and Their Families Presented By Dr. Pamela Gillen University of Colorado Anschutz Medical Campus and Dan

More information

Autism Spectrum Disorder: Latest in Prevalence, Diagnosis and Interventions

Autism Spectrum Disorder: Latest in Prevalence, Diagnosis and Interventions Autism Spectrum Disorder: Latest in Prevalence, Diagnosis and Interventions Muhammad Waqar Azeem, MD, DFAACAP, DFAPA Chair, Department of Psychiatry Sidra Medical & Research Center DISCLOSURES: NONE n

More information

Improving the Recognition and Treatment of Bipolar Depression

Improving the Recognition and Treatment of Bipolar Depression Handout for the Neuroscience Education Institute (NEI) online activity: Improving the Recognition and Treatment of Bipolar Depression Learning Objectives Apply evidence-based tools that aid in differentiating

More information

Preferred Practice Guidelines. Behavioral Health Screening, Assessment and Treatment

Preferred Practice Guidelines. Behavioral Health Screening, Assessment and Treatment Preferred Practice Guidelines Behavioral Health Screening, Assessment and Treatment This guideline is based in part on the following: American Academy of Pediatrics. ADHD: Clinical Practice Guideline for

More information

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe,

More information

CHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014. 2014 MVP Health Care, Inc.

CHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014. 2014 MVP Health Care, Inc. CHAPTER 5 MENTAL, BEHAVIOR AND NEURODEVELOPMENT DISORDERS (F01-F99) March 2014 2014 MVP Health Care, Inc. CHAPTER 5 CHAPTER SPECIFIC CATEGORY CODE BLOCKS F01-F09 Mental disorders due to known physiological

More information

What are Mood Disorders?

What are Mood Disorders? What are Mood Disorders? Chapter 8 Class Objectives What is Bipolar Disorder? How does this differ from Unipolar Mood Disorder? How do Mood Disorders develop? How are Mood Disorders treated? What do you

More information

Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders

Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders Welcome New Employees Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders After this presentation, you will be able to: Understand the term Serious

More information

Treating Mood and Anxiety Disorders in Children & Adolescents

Treating Mood and Anxiety Disorders in Children & Adolescents Treating Mood and Anxiety Disorders in Children & Adolescents Daniel S. Pine, MD Section on Development & Affective Neuroscience Disclosures: Conflicts Sources of Research Support National Institute of

More information

Bipolar Disorder: Advances in Psychotherapy

Bipolar Disorder: Advances in Psychotherapy Bipolar Disorder: Advances in Psychotherapy Questions from chapter 1 1) Which is characterized by one or more major depressive episodes with at least one hypomanic episode in which the patient s functioning

More information

Bipolar Disorder: Fact Sheet and Criteria for Diagnosis

Bipolar Disorder: Fact Sheet and Criteria for Diagnosis Bipolar Disorder: Fact Sheet and Criteria for Diagnosis Formerly known as manic-depressive disorder, bipolar disorder is a brain disorder that results in extreme fluctuations in mood, energy, and activity

More information

SAMPLE. Manic Episode: Description DSM-IV-TR

SAMPLE. Manic Episode: Description DSM-IV-TR Manic Episode: Description A Manic Episode involves a period of one week or longer in which the prevailing mood is abnormally and persistently elevated, expansive, or irritable and during which at least

More information

Bipolar Disorder Discovery Series. Facts, Insights & Perspectives Dr. Andrea J. Levinson, MD MSc FRCPC Head: Early Intervention Clinic CAMH

Bipolar Disorder Discovery Series. Facts, Insights & Perspectives Dr. Andrea J. Levinson, MD MSc FRCPC Head: Early Intervention Clinic CAMH Bipolar Disorder Discovery Series Facts, Insights & Perspectives Dr. Andrea J. Levinson, MD MSc FRCPC Head: Early Intervention Clinic CAMH Bipolar Llll Disorder Discovery Series Acknowledgements The Mood

More information

Bipolar Disorder and Substance Use Disorder

Bipolar Disorder and Substance Use Disorder Bipolar Disorder and Substance Use Disorder 1) A person is diagnosed with bipolar I disorder after having at least one manic episode and one depressive episode in an alternating pattern. The episodes must

More information

Healthy Family Tool Kit

Healthy Family Tool Kit Adolescent Depression Awareness Program During three 45-minute sessions or two 90-minute sessions, students will learn to identify the symptoms of depression, understand the process of medical decision

More information

MOLINA HEALTHCARE OF CALIFORNIA

MOLINA HEALTHCARE OF CALIFORNIA MOLINA HEALTHCARE OF CALIFORNIA MAJOR DEPRESSION IN ADULTS IN PRIMARY CARE HEALTH CARE GUIDELINE (ICSI) Health Care Guideline Twelfth Edition May 2009. The guideline was reviewed and adopted by the Molina

More information

Neurodevelopmental Disorders, Disruptive, Impulse Control and Conduct Disorder (DSM 5)

Neurodevelopmental Disorders, Disruptive, Impulse Control and Conduct Disorder (DSM 5) Neurodevelopmental Disorders, Disruptive, Impulse Control and Conduct Disorder (DSM 5) Matthew Soulier, MD Paula Wadell, MD Scott Summers, MD, PhD UC Davis Department of Psychiatry CONCENTRATION IRRITABILITY

More information

Management of depression in young people

Management of depression in young people Management of depression in young people A guide for primary care health professionals For young people not in immediate danger of suicidal behaviour, management of major depressive disorder is likely

More information

AUTISM SPECTRUM DISORDER TEMPLATE IMPRESSIONS AND RECOMMENDATIONS ALL AGE VERSION

AUTISM SPECTRUM DISORDER TEMPLATE IMPRESSIONS AND RECOMMENDATIONS ALL AGE VERSION AUTISM SPECTRUM DISORDER TEMPLATE IMPRESSIONS AND RECOMMENDATIONS ALL AGE VERSION SUMMARY: PtName is a XX-year-old boy/girl who came to the clinic to [restate chief concern and problem behaviors]. Today,

More information

Summary of Treating Early Onset Schizophrenia by Jon McLellan, MD

Summary of Treating Early Onset Schizophrenia by Jon McLellan, MD Summary of Treating Early Onset Schizophrenia by Jon McLellan, MD Schizophrenia is a neurodevelopmental disorder characterized by severe disruptions in thought, perceptions and behavior. Early onset schizophrenia

More information