Sunday, August 11, 2013

9th Annual Mood Disorders Day in Stanford


Last month I attended the 9th Annual Mood Disorders Day in Stanford, here are a few highlights I thought you might me interested in. Please keep in mind that these are my interpretations of the information presented. For more complete information, I recommend you check out the following link which takes you to Stanford’s website where they have video and in some cases, slides posted for each of the presentations.

Stanford 2013 Presentations:
http://bipolar.stanford.edu/publications.html#Presentations

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Pediatric Mood Disorders Notes:

Presented by Kiki Chang, MD, Stanford
http://bipolar.stanford.edu/documents/7.ChangPediatricMoodDisorderUpdate.MoodDisorderDialogueDay13.pdf

Depression is often the first symptom of Bipolar Disorder in kids.
Bipolar starts with depression not mania.
1/2–2/3 of bipolar patients are labeled with bipolar BEFORE 18 years of age.
This is not an illness that begins in adulthood, it’s being diagnosed much earlier.

Rates of major depression in kids:
Preschool: 0.3%
Prepubertal: 1.8%
Adolescents: 4.7-8.9%

Children in preschool with depression have a higher family history of Bipolar Disorder. Bipolar switch rates in children with Major Depressive Disorder is 30%, adolescents 20%.

Symptoms of Depression:
• Somatic (Head/stomach ache)
• School refusal/separation anxiety
• Poor school performance
• Preoccupation with death or morbid themes
• New behavioral problems
( I have seen all of these symptoms in my two boys)

How depression is different in younger kids from older kids:

Prepubertal:
• More somatic/behavioral problems
• “I wish I were dead”
• Boredom
(Depression in kids does NOT look the same as in adults)

Adolescents:
• Acutely poor school performance
• Substance use
• Sleep/appetite changes
• Dangerous behavior/suicidal ideation

Age of onset of Bipolar Disorder:
14% Childhood (<12 years)
19% Late Adulthood (>30 years)
32% Early Adulthood (19–29 years)
36% Adolescents ( 13–18 years)

Notice the largest group are those between 13–18 years old.

kids can have short manic episodes, like 4 hours long, not days like adults. These episodes can be bipolar, a large percentage of them do get “full” Bipolar.

Comorbid Disorders with Bipolar Disorder in children and adolescents:

ADHD 49–87%
Substance abuse 8–39%
OCD 44%
Panic 19–26%
General Anxeity Disorder 19%
Social Anxiety 40%
Oppositional Defiant Disorder 75%
Conduct Disorder 12–41%

PANDAS:
Have you heard of PANDAS yet?
If your child’s symptoms were sudden and acute, you need to look into this!

This is acute onset of OCD, irritability, behavioral problems. Tics present in over 50% of cases. Other possible symptoms: frequent urination, dysgraphia, anorexia, sensory sensitivity, and cognitive impairment. Basically your kid was fine one day, they got an infection and what followed was a drastic and sudden change in your child’s behavior. Some of these kids are being diagnosed with bipolar disorder, but they do not have BP, but instead have a condition that was brought on by an illness such as Strep A infection. These kids typically don’t respond to psych meds. These cases are treated with short term medication like an antibiotic and these kids get better. If this fits your kid, contact Kiki Chang at Stanford, he’s currently doing research on this.

Currently Stanford’s research is looking into inflammation in the brain and it’s connection with Bipolar Disorder, depression, mania, anxiety, and even autism. They hope to find some answers on this path to explain the increase of all these illnesses in children.

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Psychotherapy Notes:

Presented by: Fennifer Nam, PhD, Stanford University 
https://mediaspace.stanford.edu/media/Mood+Dialog+Day+2013%3A+J.Nam-Psychotherapy+In+Mood+Disorders/0_905osu7g

The best treatment option for mood disorders is medication with therapy. When therapy is included, there are less days of depression and less hospitalization in patients.

There are different types of therapy. Such as:
1. Psycoeducation: Therapy that focuses on learning about the illness and how to manage it.

2. Cognitive Behavioral Therapy (CBT): Learn about what you’re thinking. What are your wrong thoughts that lead to bad actions. You work on recognizing wrong thoughts and work towards changing them.

3. Family Therapy: The entire family is in therapy together. This is important because patients do well when surrounded by support.

4. Dialectical Therapy (DBT): This is where you learn life skills. Pain will happen, here’s where you develop skills to cope.

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Alcohol/Substance Abuse Notes:

Anna Lembke, MD, Stanford Addiction Medicine Program
https://mediaspace.stanford.edu/media/Mood+Dialog+Day+2013%3A+A.Lembke%3A+Alcohol+Substance+Use+Disorders+And+Mood+Disorders/0_4a0qxzwe

Those with mood disorders have higher rates of substance abuse.

U.S. Population with Alcoholism = 15%
Bipolar Patients with Alcoholism = 75%

Most speculate that this is because those with bipolar disorder self-medicate.

Mood issues are worse if you use substances. Pot use in early teens creates a greater risk of having psychosis later in life.

There is a third element to this, the disease of addiction, if this runs in the family, risks are greater. You need to treat both mood disorder and addiction behaviors, you can’t treat both under one illness. For example, you can’t treat a person’s bipolar illness in a 12-step program, and you can’t treat their alcoholism in a psych ward. They need to be treated separately.

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Visit the Stanford presentation page for more presentations not reviewed above:
http://bipolar.stanford.edu/publications.html#Presentations





4 comments:

  1. Excellent! Thanks for the notes and links.

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  2. As always, you've done a fantastic job of re-capping the sessions at Stanford. I, too, felt Dr. Chang's excellent descriptions of the differences in how kids with bipolar disorder display depression and mania fit my girl perfectly. So great to see you there again, Mama Bear.

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    Replies
    1. I agree, it was nice to see a doctor acknowledge that there is a difference in kids and how his description describes our children. Love seeing you and your husband again, such a treat!

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