Erin Jackson

January 14, 2016

Period 1
Annotated Source List
American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders 5th
ed. Washington D.C.: American Psychological Association, 18 May 2013. Web.
http://www.dsm5.org/Documents/Disruptive%20Mood%20Dysregulation%20Disorder
%20Fact%20Sheet.pdf
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a book psychiatrists
use to diagnose mood disorders and all other mental illnesses. The most recent edition, the DSM
V, was published in 2012 and contains illnesses they were not previously defined, like Disruptive
Mood Dysregulation Disorder (DMDD). Children who suffer this mood disorder are always
irritable and overreact disproportionately to what happened. These children also have very severe
temper outbursts, but they are not temper tantrums, as they are more severe and are never
controllable without treatment. There are requirements to be diagnosed with DMDD, such as the
patient has to have had symptoms for a minimum of a year and the symptoms have to be present
in two places such as at school and at home. Other things that have to present for somebody to be
diagnosed with DMDD are the person has to be between six and eighteen years old and there
have to be symptoms present before ten years old. The DSM V defined the illness out of
necessity. Many children with DMDD were being unsuccessfully treated because they were
diagnosed with Pediatric Bipolar Disorder. There are distinct differences between the two mood
disorders. Children with bipolar disorder have episodes of severe depression and
hypomania/mania. Defining DMDD allows children with this illness to be successfully treated
for their illness.
The DSM V is helpful in explaining different illnesses in detail. It describes
characteristics of the illness and why it is different from similar illnesses. It also references other
helpful sources and highlights why it was necessary for DMDD to be defined.
Aryal, Harral, Hill Et. Al. "Neurocognitive Function in Unmedicated Manic and Medicated
Euthymic Pediatric Bipolar Patients." The American Journal of Psychiatry 163.2 (2006):
286-93. The American Journal of Psychiatry. Feb. 2006. Web. 10 Nov. 2015.
<http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.163.2.286>.
Various experts conducted a study to test how the young bipolar brain works. They also
wanted to determine if there were differences between the unmedicated bipolar brain and the
brain function of children who were being medicated. In addition, they assessed whether
impaired brain function is displayed in between episodes. They often used the term
neurocognitive function to describe the results of the studies, meaning how the brain was
working and hormonal activity. Pediatric bipolar disorder can make it hard for somebody to
function normally in society. Some children may express classic symptoms like episodes of
mania and depression. Patients with pediatric bipolar disorder may have a hard time trying to
recover from their episodes. One difficulty that the experts encountered when assessing brain
function was brain activity is always changing in the developing mind. There is also the fact that
medications like mood stabilizers change how the brain works especially since children often

have to take more medicine than adults. They determined that pediatric bipolar disorder is linked
to a shorter attention span. It is also linked to a harder time remembering visual details as well as
words and space. Bipolar children may also have a hard time understanding social cues such as
knowing when it is appropriate to interrupt somebody, for example knowing when to ask
question, after the other person finishes making their point. They also noticed a lower IQ score in
children with bipolar disorder than in children who suffer from only depression.
This study was very helpful as it provided statistics for a meta analysis. It was also very
detailed and it provided details about the effectiveness of medication in treating children. It
mentioned how much medication children are taking, which seems like too much. It raises
questions about how to improve the efficiency and effectiveness of medication.
Asher, Jules, and Leibenluft. "Imaging Studies Help Pinpoint Child Bipolar Circuitry." National
Institute of Mental Health. U.S. Department of Health and Human Services, 8 Apr. 2010.
Web. 09 Nov. 2015. http://www.nimh.nih.gov/news/science-news/2010/imaging-studieshelp-pinpoint-child-bipolar-circuitry.shtml
Pediatric bipolar disorder is a rare illness that is often confused with other mental
illnesses. In some cases, children will display distinct episodes of mania and depression, but this
is not always the case. In fact, one symptom of many illnesses in chronic irritability. Experts
wonder whether children with chronic irritability should be diagnosed with bipolar disorder. Dr.
Leibenluft described a new symptom called severe mood dysregulation (SMD) which describes a
chronically irritable child who does not have cut and dry episodes. One way to diagnose pediatric
bipolar disorder is that children with bipolar disorder typically have a family history of the
illness. Both pediatric bipolar disorder and SMD seem to have symptoms similar to that of
Attention Deficit Hyperactivity Disorder (ADHD). All of the illnesses cause a difference in brain
activity and brain function. One difference is in the amygdala, a brain structure where emotions
and fear are processed. Children with bipolar disorder typically have a weaker connection
between the amygdalae and the other brain structures that handle emotion. Many children with
SMD and pediatric bipolar disorder have trouble reading facial expressions and emotions. To test
the difference in brain activity, the National Institute of Mental Health (NIMH) conducted a
study where they looked at brain activity through a MRI. They showed the children neutral faces
and looked at amygdala activity. They noticed that children with bipolar disorder surprisingly
have relatively normal amygdala activity while children with SMD had underactive amygdalae
and children with ADHD had overactive amygdalae.
This was helpful as it provided insight into the different symptoms of bipolar disorder. It
also helped clarify the differences between mental illnesses that could be confused for each other.
It makes it easier to determine what hormonal imbalances need to be treated and what
medication should be used.

"Bipolar Disorder." NAMI: National Alliance on Mental Illness. NAMI, 2015. Web. 28 Sept.
2015. https://www.nami.org/Learn-More/Mental-HealthConditions/BipolarDisorder/Overview
The National Alliance of Mental Illness (NAMI) defines bipolar disorder as a lifelong
mental illness characterized by episodes of mania and depression. People with this illness
experience highs and lows that worsen over time when they are undiagnosed and not receiving
medical treatment. People start to experience the symptoms of bipolar disorder at an average age
of 25, however many people have symptoms earlier and later in life. Every year 2.9%, of people
are diagnosed with bipolar disorder and 83% of people have severe bipolar disorder. People who
suffer from this illness either experience mania or hypomania. When people are manic, they are
either very irritable and hostile or intensely happy. In this state, people make impulsive, poor
decisions because they are not able to think of the consequences. Mania conflicts with a persons
daily function. Hypomania is a less severe type of mania and people are still able to work and
handle everyday life. Bipolar depression can severely impact a persons ability to function.
However, it can range from being mild to very severe. Sometimes people experience feelings of
both states at the same time. This is known as mixed episodes. There are four types of bipolar
disorder. Bipolar I is when people have mania and depression and Bipolar II is when people have
hypomania and depression. Cyclothymia is less severe and people experience hypomania and
mild depression. The last type is bipolar disorder unspecified.
NAMI created a helpful source that introduced the different types of bipolar disorder. It
also helped explain the concept of mixed episodes. This source might assist someone who writes
an overview of the topic of bipolar disorder.
"Bipolar Disorder in Children and Adolescents." National Institute of Mental Health. U.S.
Department of Health and Human Services, 2012. Web. 8 Oct. 2015.
<http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-andadolescents/index.shtml>.
Bipolar disorder is a mood disorder that causes atypical mood changes, and it occurs in
children and adults. In fact, half of all people with bipolar disorder started having symptoms
before age 25. Bipolar disorder in children and people in their early teens is classified as early
onset. This type of bipolar disorder is often more severe because it causes more suicide attempts
than other forms of the illness. Many children with bipolar disorder suffer from other conditions
such as Attention Deficit Hyperactivity Disorder (ADHD), anxiety disorders (such as generalized
anxiety disorder and separation). Children with bipolar disorder may be at a higher risk for
developing alcoholism or other substance abuse disorders. Bipolar disorder may occur with other
mental illnesses. It is important for people with bipolar disorder to seek treatment so that they
can lead full and healthy lives. However, one challenge of treating children is that doctors have
to use studies are mainly based on adults. Doctors primarily use mood stabilizers and
antidepressants to treat bipolar disorder; when patients do not respond to mood stabilizers,
doctors may use anti-convulsion medications. It is also recommended that patients receive
psychotherapy in addition to medication.
The interesting booklet was helpful because it provided background information on
bipolar disorder in children. It provided variety by introducing the concept of treating children

using studies based on adults. It also summarized the difficulty of treating children with this
information.
Blanco, Laje, and Moreno et. al. "National Trends in the Outpatient Diagnosis and Treatment of
Bipolar Disorder in Youth." Journal of American Medical Association 64.9 (2007): n.
pag. JAMA Network. Web. 6 Jan. 2016.
<http://archpsyc.jamanetwork.com/article.aspx?articleid=482424>.
Bipolar disorder seems to becoming an increasingly common diagnosis. Experts
wondered if this was true and if so why. It may be that it is becoming more frequently diagnosed
or that it is becoming more common. The authors used the versions of National Ambulatory
Medical Care Survey (NACMS), which the National Center for Mental Health conducts every
year, from 1993 to 2003. Privately employed psychiatrists write about the demographics of the
patients they treated, and clinical, and treatment details of the office visits. The experts divided
the patients, who were diagnosed with bipolar disorder, by the medication used to treat them.
These groups included patients being treated with mood stabilizers, stimulants, antidepressants,
antipsychotics, and benzodiazepines. They also analyzed data on patients sex, race and age to
determine if there were trends in diagnosis. The experts found that there was an increase in both
children and adults seeking treatment for mental illness and being diagnosed with bipolar
disorder. Two thirds of patients were prescribed mood stabilizers. Anticonvulsant mood
stabilizers were given to patients the most. The study found that pediatric bipolar might have
been previously underdiagnosed. They also found that young patients may be more frequently
misdiagnosed because almost half were eventually diagnosed with another illness. Bipolar
disorder is being diagnosed more frequently, proving that there is a greater need for treatment.
The experts provided helpful information on the need for treatment. It provided
information about the demographics, such as ages, that are diagnosed with mood disorders. By
knowing the age group, doctors could determine what the proper hormonal balances should be
for the various ages. By knowing this doctors can determine which medication can help correct
hormonal imbalances.
Bressert, Steve. "An Introduction to Bipolar Disorder." Ed. John M. Grohol. Psych Central. N.p.,
30 Jan. 2013. Web. 23 Sept. 2015. <http://psychcentral.com/lib/an-introduction-tobipolar-disorder/>.
Bressert summarizes background information about bipolar disorder in an easy to
understand fashion. Bipolar disorder is characterized by its highs and lows which are medically
known as mania, or manic episodes, and depression, or depressive episodes. The cycling of the
episodes vary in different people. So people experience episodes for such a short time that they
do not suspect they have bipolar disorder. Mania is a symptom of bipolar disorder and it is when
people have an extremely high mood. These people experience extreme happiness, no need to
rest, are overactive, and have quick changing thoughts. These individuals also have depressive
episodes, where are they are really low, sad, hopeless, have no energy, are unhappy with things
they used to enjoy things they used to love. The cycling of bipolar disorder describes how often
episodes occur, how long they last and how far from apart each other they are. Most people with
bipolar disorder who experienced one episode of mania will experience it again. Also, 70 percent
of depressive episodes happen right before or after manic episodes. The goal of treatment is to

decrease the severity and frequency of different episodes. Another goal is to get the patients
mood as stable as possible. Bipolar disorder affects the victim by preventing them from having a
normal life, it also affects their relatives and loved ones.
This source was helpful because it gave an easy to understand introduction to bipolar
disorder. It described the different symptoms of the illness and also introduced the concept of
cycling, which is another way the illness varies in patients. It introduced new statistics that can
be used at a later date.
Carey, Benedict. "Troubled Children: The Diagnosis Maze--What's Wrong with a Child?..." New
York Times (New York, NY). Nov. 11 2006: A1+.SIRS Issues Researcher. Web. 03 Dec.
2015.
A thirteen old boy had several different diagnoses. At first, a psychiatrist, very quickly
told the boy, he had depression. The mother thought the boy was both to explosive and restless to
be depressed. He was given many different medications but they did not seem to work. He even
disappeared twice in two years, but doctors had a hard time recognizing his illness. There are
many people with stories like this boy. It can be hard to diagnose people who do not experience
the textbook symptoms of an illness. At times, different doctors do not agree on a diagnosis.
There is a lot of demand for child psychiatrists but there are still relatively few. So, other
professionals like family doctors, pediatricians, psychologists and social workers, will give their
opinions on what mental illness they think a child has. One very controversial issue is pediatric
bipolar disorder. Bipolar disorder is an illness that never used to be diagnosed in children until
relatively recent. Now, it is becoming an increasingly common diagnosis, although it is still a
rare illness. Some doctors argue that it is being underdiagnosed while some think that it is being
overdiagnosed. Children with pediatric bipolar say, that they are grateful for growing public
awareness. Some of its symptoms are similar to other illnesses, which makes the illnesses harder
to differentiate. All of this information can lead experts to question the validity of diagnosis and
treatment.
This article helped to identify some problems with the treatment of pediatric mental
illnesses. It also provided different stories, which will assist in providing examples. It also had a
very helpful section on bipolar disorder, which can contribute to analyzing other sources by
providing information on the validity of different articles.
Carlson, Ben, Dr., and Seattle Children's Hospital. Bipolar Disorder in Children. Youtube. N.p.,
26 Jan. 2009. Web. 14 Oct. 2015. <https://www.youtube.com/watch?v=9oOSBeaPWac>.
Pediatric bipolar disorder is a challenging illness for individuals and their loved ones.
Issues in mood regulation characterize the illness; it is more complex in children because of how
quick their cycling can be. Indicators of bipolar disorder in children include mood swings, acting
out, becoming more aggressive or destructive as well as acting more emotional. Pediatric bipolar
disorder is complicated because people displaying these symptoms may have another mental
illness or medical condition. Many children without these illnesses may also display these
symptoms, albeit to a lesser extent. Misdiagnosis may be a concern when trying to treat
somebody for a mental illness. Sometimes doctors may over diagnose patients, but other times
some professionals do not diagnose it enough or try to stay away from diagnosing a child with
bipolar disorder. Sometimes parents learn to manage their childrens behavior at home but

teachers notice the childs mood differences in school. Experts advise parents to actively engage
with their childs therapist and psychiatrists, and manage their childs behavior the best way they
know how. It might also be helpful to get a second opinion.
The news interview was very helpful because the doctor explained childhood bipolar
disorder in a very easy to understand way. It also started to explain how parents are involved in
their childs treatment, and how they learn how to manage their childrens behavior. This is
helpful because parents pay a large and important rule in their childs treatment.
Columbia Psych, and Moira Rynn, M.D. Pediatric Bipolar Disorder. Youtube. N.p., 17 Oct.
2012. Web. 8 Oct. 2015. <https://www.youtube.com/watch?v=bYB6N-fEWRc>.
People with Bipolar I disorder experience mania and depression. The symptoms can vary
among people. While, experiencing mania, children with bipolar disorder might need to sleep
less than usual but still feel awake and energized in the morning. People might also talk a lot
more than they normally do when having a manic episode. Although mania is often described as
a high and elevated mood, some people may seem unhappy and irritable. Many people report
having rushing ideas through their head and pursue many at once or go between different
projects. People also have grandiosity, which means they believe that they can do something
very unrealistic. In order to be diagnosed with a full manic episode, children have to experience
symptoms for a minimum of one week. People with bipolar disorder also experience depression.
Suffers describe themselves as sleeping too much, having trouble focusing and not having
energy. People can also experience mixed episodes, where they have symptoms of mania and
depression at the same time. Parents should talk to their childs pediatrician if they notice their
child has really changed their behavior from their usual state. Doctors are conducting a study on
lithium to test its effectiveness, safety, side effects as a mood stabilizer in children and
adolescents with bipolar disorder.
Dr. Rynn was explaining a study she did with Columbia Psychiatry and the New York
State Psychiatric Institute. The video was helpful as it introduced the concept of studies to find a
more effective treatment for children with bipolar disorder.
Correll, Hauser, Penzer et. al. "Type and Duration of Subsyndromal Symptoms in Youth with
Bipolar I Disorder Prior to Their First Manic Episode."Bipolar Disorders (2014): 478-92.
Wiley. Web. 10 Dec. 2015.
<http://onlinelibrary.wiley.com/store/10.1111/bdi.12194/asset/bdi12194.pdf?
v=1&t=ii102ni5&s=2f9ad0aeb035a80b1a0ec8869dfdc774cc268d7b>.
The people conducting this study researched warning signs of a manic episode, which if
identified, it could impact treatment by making it easier to diagnose and treat the illness. Early
identification would also give psychiatrists a better idea of what symptoms to treat. In addition,
knowing early warning signs could make treatment more effective because severe manic
episodes could be prevented. One already accepted warning sign is a family history of bipolar
disorder. There have not been many studies where experts assess a persons behavior before his
or her first manic episode. The ones that have been conducted identified depressed mood,
irritability, changes in sleeping habits, and being very sensitive as warning signs among lots of
other symptoms. For the study conducted in the article, the experts studied 52 people between
the ages of 7 and 21. All of these subjects had been diagnosed Bipolar I disorder. First, they

conducted interviews with the patients, and then, with the people who took care of them. Next,
these patients underwent more interviews where their behavior prior to their diagnosis was
assessed, using multiple choice questions to determine a subjects behavior before their first
manic episode. This study found that many people around a patient noticed changes in behavior
prior to their first manic episode. If warning signs are identified, it could result in treatment being
more effective
This study was helpful as it provided an idea of what symptoms need to be treated. It also
provided detailed information on the early warning signs of bipolar disorder. It contains multiple
references that could be used in a meta analysis.

EmpowerPlus. What It Is Like to Have Bipolar Disorder. Youtube. N.p., 18 Mar. 2011. Web. 19
Nov. 2015. <https://www.youtube.com/watch?v=vxhzMyzigqM>.
A bipolar patient sat down for an interview as an adult and explained his experience with
his illness, both as a child, teen and adult. He described it interestingly, as a fight between logic
and emotions, where emotions always win. He said he knew what to do, what made sense
logically, but he did not care. His emotions were running too high. He described first having
symptoms of depression when he moved to a new school and he did not speak English. He got
bullied and started to feel depressed. He noticed that he was still experiencing depression even
after he left the school. When he was 15, he started experiencing mania that was not severe, but
his brother noticed his strange actions and teased him for it. He also had severe anxiety
symptoms. He described himself as going from making everybody happy and making people
laugh to not wanting to talk to anybody at all because he was too depressed or too angry. When
he was a young adult, he noticed his illness affecting his body and he was not able to function.
He went to a physical therapist because of neck pain, but that did not work for a long time. He
then went to a psychiatrist at 23 years old and was initially diagnosed with the wrong illnesses:
depression and compulsive anxiety. He started experience very severe mania. The second time he
went to the psychiatrist, he was manic and diagnosed with bipolar disorder. Initially, he was
happy about the diagnosis because he realized the way he was feeling was not his fault. His
psychiatrist tried to put on him on medication five different times but they all had side effects,
such as making him incredibly tired. After all of the obstacles he faced, he found a medication
that worked. His story is similar to a lot of other patients and needs to be heard.
This was helpful as it was a first person account. It put emotion into the illness and it
helped make it seem extremely important. It was a detailed description of how a person feels
when he or she experiences the symptoms and also exposed a greater need to improve treatment.
Healy, David. "The Latest Mania: Selling Bipolar Disorder." PLOS Medicine 3.5 (2006): n. pag.
PLOS Medicine. Web. 14 Jan. 2016.
<http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030185>.
The article starts by detailing a commercial about bipolar disorder. The commercial
showed a girl with bipolar disorder who was experiencing both mania and depression. It claimed
that a bipolar patient is usually diagnosed with depression because he or she generally does not
seek treatment during their manic episodes, when he or she is feeling very good. The commercial

advertised bipolarawareness.com, a now inactive website. A pharmaceutical company who

makes a drug for bipolar disorder ran the website. This can been seen as an example of the
phenomenon known as disease mongering. This could lead to people seeking offices visits and
being incorrectly diagnosed. Consequently, it could lead to some patients taking medication
unnecessarily. The article then goes on to talk about what medications were being used to treat
bipolar disorder and the changes. In the 1950s, patients experiencing bipolar depression started
being given antidepressants and those who were experiencing mania were either given lithium or
antipsychotics. A drug company, Abbott Laboratories, popularized the term, mood stabilizer,
when they got a license to produce the anticonvulsant, sodium valproate. Bipolar disorder was
first described in Diagnostic Statistical Manual in 1980. Today patients are being more
frequently diagnosed with bipolar disorder and need medicine for it.
This article was helpful as it provided useful information on how to find more credible
studies and the history of bipolar disorder. Looking back at bipolar disorder, can help experts
identify problems with treatment in the past and improving treatment in the future It also
provided information about how drug companies affect the treatment of bipolar disorder.
Jovinelly, Joann. Bipolar Disorder and Manic Depressive Illness. New York: Rosen Publishing
Group, 2001. Print. Coping with.
Jovinelly discussed the different treatments options available for bipolar disorder.
Medications are prescribed to correct the brain activity and hormonal imbalance. Sometimes, it
can take multiple medications and multiple trials to find an effective treatment for a patient.
Mood stabilizers are most commonly used for treating bipolar disorder. Around thirty years ago,
lithium used to be the only mood stabilizer available. Recently, many new ones have been
developed. It can take several weeks for mood stabilizers to start working. Psychiatrists may
prescribe adjunctive medications to treat certain symptoms, like insomnia. Lithium is still a very
commonly used mood stabilizer, but it requires patients to be closely monitored. Patients usually
have to take multiple blood tests because too much lithium can be fatal. Other mood stabilizers
include valproate, known under the brand name divalproex, and carbamazepine, known as
tegretol. Antidepressants are another treatment option. Patients have to take antidepressants for
several weeks before they brain chemistry starts to change. Some medications may increase
serotonin, norepinephrine and dopamine. Bipolar disorder is a severe illness that requires
treatment.
This book was incredibly helpful as it detailed the different treatment options available
for bipolar disorder. It also detailed how it changes the brain chemistry and which hormones
might need to be corrected. This is helpful as it details what medications can affect which
neurotransmitters, by regulating brain activity, patient will start to feel better.
Kaplan, Stuart L. "Mommy Am I Really Bipolar?." Newsweek. 27 Jun. 2011: n.p. SIRS Issues
Researcher. Web. 19 Oct. 2015.
Kaplan presents an interesting argument concerning the diagnosis of bipolar disorder in
children. He argues that pediatric bipolar disorder is extremely over diagnosed and thinks that, in
fact, hundreds of thousands children are incorrectly diagnosed and therefore mistreated. In the
1990s, once manic-depressive disorder was renamed to bipolar disorder, doctors began
diagnosing it in children. Kaplan, a child psychiatrist noticed at a conference that many of his

peers were excited about the new diagnosis. As a result, psychiatrists started telling hundreds of
kids they had bipolar disorder when it had rarely been diagnosed in children before. While
Kaplan had noticed fads in the illnesses being diagnosed, he had never seen such an extreme
number of patients being diagnosed with one illness. One example he cites is a psychiatrist who
was too quick to diagnose a two-year-old patient and her siblings with pediatric bipolar disorder.
In actuality, the patients were being abused and were fed medicine to keep them sedated.
Pediatric bipolar disorder is different than the illness in adults because children have symptoms
that are typical behaviors like always being angry while adults have distinct episodes. Therefore,
it is hard to differentiate between bipolar disorder and anger management issues. Opposition
Defiant Disorder (ODD) and Attention Deficit Hyperactivity Disorder (ADHD) can also be
mistaken for pediatric bipolar disorder.
This article was helpful as it provided a unique perspective on the illness. It provided a
more complex argument, which will be helpful in research projects, and it provided useful
information. It forces the readers to think in a different way and provided interesting facts and a
new logic.
Leach, Hannah. "Do You Understand the Bipolar Spectrum?" Psych Central. N.p., 2015. Web. 22
Oct. 2015. <http://psychcentral.com/blog/archives/2013/08/21/do-you-understand-thebipolar-spectrum/>.
There are various forms of bipolar disorder. These illnesses are called bipolar spectrum
disorders or bipolar affective disorders. The disorders do not run in order from most severe to
least severe. Although some people may perceive bipolar I disorder as the worst because it
causes mania. In fact, any person who has experienced at least one manic episode is diagnosed
with bipolar I disorder. Mania is when people feel very high. They may have racing thoughts,
hallucinations and are not able to function in daily life. People with this type of bipolar can have
depressive episodes ranging from mild to severe. The next illness on the bipolar spectrum is
bipolar II disorder. People who have this disorder experience hypomania, a milder form of mania
where people are able to function in everyday life, and depression. People with this form of the
illness are the most likely to attempt and complete suicide because they experience depression
more often than people with bipolar I disorder. Cyclothymia and bipolar disorder not otherwise
specified the milder forms of the illness, but their effects can be just as bad as the other types.
This article comes from a blog, but scholarly articles support its claims. The article
helped explain differences in the illnesses on the bipolar spectrum. It was helpful as it provided a
information on bipolar affective disorders in more detail than other sources.
Madan, Vishal, and Matthew Sachs. "Electroconvulsive Therapy in Children and Adolescents."
American Academy of Child and Adolescent Psychiatry (2013): n. pag. American
Academy of Child and Adolescent Psychiatry. AACAP Ethics Committee, 1 Jan. 2012.
Web. 16 Dec. 2015.
<https://www.aacap.org/App_Themes/AACAP/docs/member_resources/ethics/in_wo
rkplace/Sachs_Maadan_Electroconvulsive_Therapy_in_children_and_adolescents.pdf>.
Electroconvulsive therapy (ECT) is used when no other treatment is working. ECT
involves a patients brain signals being changed through electrical waves. Historically, Dr. Bour
Heuyer first used ECT in the 1940s on French teenagers with a variety of mental illnesses. Dr.

Lauretta Bender brought it to the U.S. in 1947. She claimed that 98% of her patients saw an
improvement in what was then known as childhood schizophrenia. This is a controversial
treatment with lots of ethical questions. When considering this treatment doctors consider four
things: autonomy, making sure the patient gets a say in their treatment,beneficence, what is best
for the patient, non-maleficence, making sure the patient is not hurt, justice making sure that
treatments are given equally and fairly. For ethical reasons, doctors prefer to use other methods
of treatment and not a lot of research has been done on it. The studies that have been conducted
found an 80% response rate for mania and a 63% response rate for depression. Currently child
and adolescent psychiatrists are not well informed on the issue. In fact, 53% of child
psychiatrists have minimal knowledge on the issue, and 75% of psychiatrists did not feel
comfortable giving a second opinion, meaning evaluating a patient they are not treating and
making sure them symptoms are severe enough to undergo ECT. 52% felt it was not safe in
children and 26% thought the same in adolescents. Some states have an age requirement on the
procedure, varying from 12 to 18. ECT can be necessary, despite the complicated ethics, when no
other treatment is working.
This article was helpful as it provided information on the complicated ethics of ECT. It
also provides evidence such as statistics that could be used in a paper. Finally, it also provides
information on the effectiveness of different treatment options, which could be used in an
argument. This treatment raises questions about the effectiveness of ECT and whether it should
be used more often and how it compares to medication.
McClure, Snow, Treland et. al. "Deficits in Social Cognition and Response Flexibility
in Pediatric Bipolar Disorder." American Journal of Psychiatry162.9 (2005): 1644-51.
American Journal of Psychiatry. Web. 19 Nov. 2015.
<http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.9.1644?url_ver=Z39.882003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed>.
Various experts collaborated in an experiment to determine if pediatric bipolar has effects
on a patients social life. They wanted to test different brain structures that affect how vulnerable
somebody is. They were testing patients who met all of the criteria for being diagnosed with
pediatric bipolar disorder. Their measures of social cognitive function included how well a
person knows how to behave in a certain situation and how flexible his/her responses are. Social
cognition is how well a person can use both verbal and nonverbal language, read and interpret
facial expressions and other nonverbal social cues and understand what a person is verbally
saying. Response flexibility is how well a person is able to motorly respond and change between
not being able to do something and successfully completing a task. The experts used the social
pragmatic judgement subtest on the euthymic patients, those experiencing manic symptoms at
the time, and the control group. They found both groups with bipolar disorder performed lower
on the social cognition test. Particularly, they had a difficult time recognizing different facial
expressions. Patients did not have social cognitive deficits before they started experiencing
symptoms of bipolar disorder.
The experts informed people about consequences of bipolar disorder that are not talked
about often. They conducted in depth research about how pediatric bipolar affects different
aspects of a patient's life. Knowing how a patient interacts with a patient and why can really help
with treatment. It hints at why the patients hormones are imbalanced and determining which
medication can help.

Mental Health America. National Mental Health Association, 2015. Web. 30 September 2015
<http://www.nmha.org>

The National Mental Health Association (NMHA) has been in existence since 1909 and
its goal is to help people with mental illnesses live their best lives possible. They also try to help
people with treatment and intervene as early as possible in their B4Stage4 initiative. One of
their goals is to educate people and they provide general information on many mental illnesses,
including multiple mood disorders. They have several programs that try to advocate for mental
health, including a national awareness month. NMHA also finds it helpful for people to share
their stories about mental illnesses and provides a safe space for people to do so. One interesting
tab in the website is the newsroom. It leads to different categories such as press releases, news,
and a newsletter called The Bell. The website also gives different tips on how to face and
conquer mental illness. It explains why their mission is important by describing why maintaining
good mental health is essential. It also discusses how to handle stress in different settings. It
provides people with several resources in order to assist with their treatment. It also explains
different ways people can volunteer and help raise awareness about mental health.
The professional organization, NMHA supplies several different articles that provide
background information on multiple mental illnesses, which can be useful in the beginning
stages of research. It can also assist in finding different experts on mood disorders who can
contribute knowledge to different research projects. It also provides some insight into different
treatment options and describes some symptoms patients need to display in order to be diagnosed
with specific types of mental illnesses.
"Mood Disorders." World of Health. Gale, 30 September 2013. Science in Context. Web. 7 Sept.
2015.
The article provides current and valuable information on mood disorders, including
different types of mood disorders that the most recent editions of DSM focus on, like major
depressive disorder, dysthymia and bipolar disorder. It explains what defines a mood disorder,
stating that all victims of mood disorders suffer some type of depression. In addition, World of
Health explains that there are two different categories of mood disorders. One type is unipolar
meaning those where victims only have some type of depression like dysthymia and major
depressive disorder. The other category of mood disorders is bipolar meaning those with two
extremes. People who have these illnesses feel extremely high or extremely low. Dysthymia is
feeling down for a very long time, at least one year. In addition, the feeling of being mildly

depressed can last somebodys entire life. Major depressive disorder can be life threatening and
involves people feeling extremely hopeless, sad, tired and other negative feelings. People who
are depressed can also have suicidal thoughts. Bipolar disorder involves depression and mania or
hypomania. Mania is feeling extremely high meaning happy and it also involves rapid thoughts,
delusions, and the inability to make good decisions. The article also details how mood disorders
can be treated, through different types of therapy and medicine. As well as how they are
diagnosed, through observing the patient and their symptoms and family history.
This article was found on database meaning it was evaluated. It was also updated in 2013 making
the information up to date. In addition, the source provides credible background information on
the complex topic of mood disorders and what is done to treat them and diagnose them. It
provided descriptions mood disorders making it easier to narrow the topic.
Roux, Susan L. "Overview of Mood Disorders in Children." University of Rochester Medical
Center. Rochester, 2015. Web. 10 Sept. 2015.
<https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=90&ContentID=P01634>.
Roux focused on explaining mood disorders in children and teenagers. This article states
that in order for a mood disorder to be defined as such, there has to be some form of depression.
Although this is the case for adults as well, symptoms can be different in children and teenagers,
which makes mood disorders more burdensome to diagnose in people under eighteen years of
age. It also described several symptoms that are common in children and adolescents like feeling
really guilty, losing or gaining weight and trying to complete suicide. It also explains what is
known about the causes of mood disorders. Currently no expert is completely sure on what
causes mood disorders because there are multiple factors in developing mood disorders.
Scientists believe that mood disorders are caused by the imbalance of neurotransmitters in the
brain. Neurotransmitters are chemicals in the brain released to control various feelings and
mood. Mood disorders that are commonly diagnosed in children include disruptive mood
dysregulation disorder, dysthymia and major depression.
The article assists in confirming and supporting different sources while also providing
background insight into mood disorders. This source provided very useful background
information. It also helped readers get grounded in their research in order to help focus their
topic.
Schwartz, Lori. Personal interview. 8 Jan. 2016.
Dr. Schwartz is a psychiatrist who works outpatient at The Center for Eating Disorders at
Sheppard Pratt. She says that the best part of her job is knowing she is able to help children feel
better. She discussed both the illnesses she treats, the medications she uses and why she uses
them. She mentioned that pediatric bipolar disorder is rare because to be diagnosed with Bipolar
I disorder, there has to be a full manic episode. When a person is mani, he or she does not
typically seek treatment because he or she feels very good. A patient usually gets help when he or
she is depressed and feeling very low. She said that antidepressants could induce mania in
vulnerable people. When a patient seeks treatment, he or she has to undergo a full psychiatric
evaluation. After the patient is diagnosed, in collaboration with the patient and their family, the
psychiatrist comes up with an individual treatment plan based on the most severe symptoms. She

mentioned that she is hesitant to use antipsychotics but will use them, in combination with a
mood stabilizer, when a patients symptoms are so severe that he or she needs a medication to
start working immediately. Once the mood stabilizers start to work, she tries to wean her patients
off the antipsychotics. However, some patients respond better to a low dose of antipsychotics,
rather than a mood stabilizer. She evaluates how the medication is working through follow up
visits where she can observe the patient and ask about the symptoms. If the medication is not
working, she will try a higher dose, when she maxes out a medication, reach the maximum dose,
she will try a different medicine in another category. Each patient requires a different treatment
plan.
This interview was extremely helpful because it provided evidence for some claims
about different medications. It also challenged some other claims, like antipsychotics being the
best treatment plan. Dr. Schwartz provided very good information that would make a paper and
final product better and provided facts about treating bipolar disorder.
The Center for Advancement of Children's Health at Columbia University. Bipolar Disorder.
Mental Health Information for Teens. Ed. Karen Belliner. 2nd ed. Detroit: Omnigraphics,
2006. 101-08. Print. Teen Health.
Bipolar disorder is a mental illness where people experience two serious extremes, mania
and depression. It is not an unusual diagnosis because an estimated two million Americans
suffering from this condition. Most people will start experiencing episodes when they are either
in their late teens or young adulthood. Sometimes doctors do not recognize that a person has
bipolar disorder and as a result a person could suffer for a very long time. In addition, some
experts disagree on whether children should be diagnosed based on the same criteria as adults.
Psychiatrists mainly use information on adults to guide their treatment of children and
adolescents. This creates a problem because psychiatrists have to estimate appropriate doses of
medications. Some of these medications, like the mood stabilizer, lithium, are extremely toxic. A
dose that is too high could be deadly, so patients on this medication have to take several blood
tests. It is also not guaranteed that medications that work well in adults will be effective in
treating children. In addition, there is some speculation that antidepressants can increase the
likelihood of a manic episode, if not used with a mood stabilizer. There is also some speculation
that stimulant medications can increase the severity of mania. In conclusion, treatment could be
more effective if doctors had more studies based on children.
This book chapter was useful because it provided additional evidence that antidepressants are not
necessarily the most effective medication. By discussing the problem with using studies based on
adults to treat children, it can help form a revised hypothesis. It also discussed different mood
stabilizers, which can help in determining the most effective way to treat bipolar disorder.
U.S. National Institute of Mental Health. Atypical Antipsychotic More Effective than Older
Drugs in Treating Childhood Mania, but Side Effects Can Be Serious. By Coleen Labbe.
NIMH, 11 Jan. 2012. Web. 21 Dec. 2015. <http://www.nimh.nih.gov/news/sciencenews/2012/atypical-antipsychotic-more-effective-than-older-drugs-in-treating-childhoodmania-but-side-effects-can-be-serious.shtml>.
A new category of medication, atypical antipsychotics, is being used to treat bipolar
disorder in children. More patients taking risperidone, an atypical antipsychotic, experienced a

remission of symptoms than patients taking lithium, a mood stabilizer, and divalproex sodium,
an anticonvulsant mood stabilizer. Patients on risperidone experienced more severe metabolic
side effects. The subjects of this study were 290 children that had previously untreated bipolar 1
disorder. Their mania was either treated with risperidone, lithium or divalproex sodium. The
results showed that 68.5% of children taking risperidone had their manic symptoms improved, as
compared to 36.5% of children taking lithium, and only 24% of participants taking divalproex
sodium. In addition, only 15.7% of participants had to stop taking risperidone as opposed to 26%
on divalproex sodium and 32.2% on lithium. However, patients on risperidone experienced a
greater weight gain. Patients on risperidone gained seven pounds, while participants taking
lithium gained three pounds and patients on divalproex sodium gained nearly four pounds.
Patients on risperidone were also more likely to experience increased cholesterol and diabetes.
This press release will help support on an argument on the most effective way of treating
pediatric bipolar disorder. It also helped explain negative side effects of bipolar medication. The
press release of a study could be used as evidence in a paper. If a patients symptoms are so
severe that he or she needs something to work immediately, antipsychotics would be better.
However, antipsychotics have more side effects and psychiatrists need to weigh the risks with the
benefits.
U.S. National Institute of Mental Health. Mental Health Medications. NIMH, Jan. 2016. Web. 16
Jan. 2016.
<http://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149867>.
Mental illnesses may require medication, talk therapy and sometimes brain stimulation
therapy. Three categories of medications that are commonly used to treat bipolar disorder include
antidepressants, mood stabilizers and antipsychotics. All of these medications are used to help
regulate brain activity. Antidepressants are used to treat depressive episodes in bipolar patients.
The most popular type of antidepressants is serotonin reuptake inhibitors (SSRIs). Medications
such as fluoxetine and sertraline fall under this category. This type of medication works by
increasing serotonin to help patients feel better. Another category of antidepressants is serotonin
and norepinephrine reuptake inhibitors (SNRIs) that work by increasing serotonin and
norepinephrine levels. Bupropion is another antidepressant which increase dopamine and
norepinephrine levels. These types of antidepressants are newer and have less side effects than
the older ones. It usually takes several weeks for antidepressants to work. Side effects can
include weight gain, diarrhea, nausea, and sleepiness. Antipsychotics are used to treat mania and
psychosis. Newer antipsychotics are known as atypical while older ones are known as typical.
They generally work more quickly than mood stabilizers and antidepressants. Antipsychotics
help stop hallucinations and treat psychosis. It can take up to six weeks for the medication to
start working fully. They have many possible side effects such as include sleepiness, digestive
symptoms, weight gain, seizures, low white blood cell count and blurred vision. Mood stabilizers
are commonly used to treat bipolar disorder and work by changing brain activity and balancing
hormones. Side effects can include rashes, irregular heartbeat, and frequent urination among
other symptoms.
This article provided useful information on the the different subcategories of the
medications used to treat bipolar disorder. It also provided different information about how the
different medications work. It also clarified the side effects and risks associated with the different

types of medications. This was helpful as it provided information about which medication affects
which hormones, which can help a patient be treated more effectively.

U.S. National Institute of Mental Health. Study Sheds Light on Medication Treatment Options for
Bipolar Disorder. By Coleen Labe. NIMH, 28 Mar. 2012. Web. 03 Dec. 2015.
<http://www.nimh.nih.gov/news/science-news/2007/study-sheds-light-on-medicationtreatment-options-for-bipolar-disorder.shtml>.
The National Institute of Mental Health (NIMH) is conducting a study called The
Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). From 1998 to
2005, they tested people who are out of the hospital and some of their subjects had multiple
mental illnesses. At a cost of 26.8 million dollars, the program studied different aspects of
treatment like medication and therapy. One piece of revolutionary data the study found that when
patients are on mood stabilizers, antidepressants work just as well as the placebos. Bipolar
depression is significantly harder to treat than unipolar depression. This is a problem as people
with bipolar disorder generally experience more depressive episodes than manic ones. As a
result, many psychiatrists will use antidepressants to treat bipolar disorder in addition to mood
stabilizers. Some experts think that antidepressants can possibly trigger manic episodes. This can
make experts consider both the positives and negatives of using both mood stabilizers. The study
found that 27% of patients on the placebo had at least an eight-week remission of symptoms
while only 24% of people on antidepressants did not have symptoms. Ten percent of both groups
experienced manic symptoms. This showed while antidepressants may not necessarily trigger,
mania, they are not very effective in treating bipolar symptoms.
This press release was very helpful as it had a new perspective on the use of antidepressants,
which can help in writing a revised hypothesis. It also highlights problems with the current
treatment of bipolar disorder. It is a part of a larger study, which has different useful information.
Also, it can make it easier to find journal articles.
Wang, Shirley S. "The Long Battle to Rethink Mental Illness in Children." Wall Street Journal
[New York] 18 Oct. 2012: n. pag. Wall Street Journal. Web. 17 Sept. 2015.
<http://www.wsj.com/articles/SB10000872396390444273704577633412579112188>.
The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM), the DSM V includes descriptions of illnesses that were never defined before. One
example of a new illness defined after heated debate is Disruptive Mood Dysregulation Disorder
(DMDD). Many people who have this illness were diagnosed with pediatric bipolar disorder and
were being unsuccessfully treated for it and overmedicated. These illnesses are similar but they
have distinct differences. Children with bipolar disorder have episodes of depression and suffer
episodes of either mania or hypomania. However, children with DMDD do not have distinct
episodes but are always irritable. Friends and family of children with this mood disorder are very

cautious because the victims of DMDD can be explosive. The victims of this disorder also have
severe fits of temper that are out of their control. Experts were inspired to define a new illness
because many patients with similar symptoms that were being mistreated and over medicated
because they were diagnosed pediatric bipolar disorders. However, some experts were hesitant to
add a new disorder to the DSM V because of reasons like the fear of defining it incorrectly or
some thought that the illnesses defined in the DSM IV were sufficient. There was also concern
about how to best treat the illness and what medicine to use. Some experts were worried about
over medicating patients.
This article was helpful in explaining the differences between the DSM IV and the DSM
V. It also provided insight into why it is necessary to update the DSM and define new illnesses.
In addition, it assists readers in understanding DMDD and why it was defined and what is being
done to treat it. Wang also effectively described the differences between pediatric bipolar
disorder and DMDD.
"What Are Bipolar Disorders?" What Are Bipolar Disorders? American Psychiatrist, 2015.
Web. 05 Oct. 2015. <http://www.psychiatry.org/patients-families/bipolardisorders/what-are-bipolar-disorders>.

Bipolar disorder is a mental illness in which a person suffers from depression and some
type of mania (either hypomania or a full manic episode). Depression is when a person feels
extremely low, sad and hopeless and they have to display at least five symptoms for a minimum
of two weeks. In order to be diagnosed with depression, people have to experience a loss of
passion for things they used to love, feel extremely low, sad, hopeless, or severely doubt their
self-worth. Mania is when people are extremely and dangerously high. People can either appear
exceedingly happy or irritable. Some common symptoms include: trying to get more done than
possible in a short period of time; feeling overly confident, and not being able to focus. People
usually experience their first episode mania at an average age of eighteen, but many people have
their initial manic episode episode earlier or later in life. Like any other illness some, people
have a greater chance of being diagnosed if they meet certain criteria. Environmental factors like
stress and family deaths can expose bipolar disorder in vulnerable people. One interesting
statistic is that 80-90% of people with bipolar disorder have a family member that suffers from
unipolar (depression) or bipolar mood disorder.
This article comes from a professional organization and their website can be used to help
find advisors for research projects. This article also provided background information on bipolar
disorder and described different treatments. This source also provided interesting statistics.
Wynn, Yewande. Personal interview. 21 Nov. 2015.
Wynn worked as a mental health counselor for many years. She first worked in a
childrens psychiatric hospital, as an intern. She then worked in an adult group home and
counseled impoverished people in Georgia. After working in the adult group home, she had a

valuable experience working in the only prison behavior modification unit in the country of its
time. She described an experience with a young patient who committed a heinous crime as a
teenager. This patient was both bipolar and schizophrenic and was convicted at eighteen years
old. She was in the intensive behavior modification unit around three times and worked very
hard each time. Wynn described this as a success story because her patient was able to function
in general population for around six months even though she did take her own life during a
manic episode. Her patient was stable, but did not realize it. She then described what bipolar
disorder looks like when patients first come in for treatment. She mentioned that there are major
changes in mood and energy. She also described the manic and depressive episodes. She
mentioned that the more manic a patient is, the easier he or she is to treat. She said both
medication and therapy, is largely trial and error. She also mentioned that a child being
diagnosed with bipolar disorder is rare because they often do not have major stressors in their
life.
This interview was extremely useful. It provided a new outlook on patients and treatment.
In addition, it provided useful information on the social implications of mental illness and how a
patients environment affects their treatment.

Yale, Kathleen. Depressive and Bipolar Disorders: Crash Course Psychology #30. Dir. Nick
Jenkins. Youtube. Google, 8 Sept. 2014. Web. 23 Sept. 2015.
<https://www.youtube.com/watch?v=ZwMlHkWKDwM>.

The video opens up by introducing Kay Redfield Jameson, a psychologist and author who
has bipolar disorder. In her book, she details how when she was manic she would do things
without thinking about the consequences like empty out her bank account and how she would fill
multiple journals with her rapid, racing thoughts. She also described how she would was
depressed and one time she attempted suicide by overdosing. She pioneered the treatment of
mood disorders with her work. However, there are still some people who misunderstand mood
disorders because they view them as something that can be cured in a day not as a serious illness.
People who have mood disorders have dangerously high highs and severely low lows.
Depression is a very common illness and in fact is the most cited reason for getting mental health
treatment. The Diagnostic and Statistical Manual of Mental Disorders states that people have to
experience at least five symptoms of depression for at least two weeks in order for them to be
diagnosed. Some symptoms include change in appetite and weight as well as experiencing less
interest in different things, being really tired, having a hard time concentrating and thoughts of
death and suicide. People with mood disorders have hormonal imbalances. When people have
mania they have dramatically increased norepinephrine, but when people have depression they
have low serotonin and norepinephrine levels.
This video is entertaining and informative and it provided background information on
mood disorders. It can contribute to a research project by giving a more scientific perspective,
one that focuses on hormones and how to improve hormone levels. In addition, other articles can
back up the claims this source makes.