Naela Aslam, Kimberly Barber & Rhonda Williams

Initial interview

General screeners

Specific screeners
Diagnostic interview

Diagnosis

1.Be

open to the possibility of encountering PBD.

2.Use

screening instruments broad and specific.

3.Be

alert to mood shifts during testing.

Youngstrom et al. (2005); Jerkins et al. (2011)

General screeners

General Screeners
Medical Assessment:

Medical or general medical conditions that could attribute for the symptoms:
Exposure to virus or bacterium

Endocrine changes
Neurological diseases Reactions to medication or illegal drugs

Baroni et al. (2009); Maniscalco & Hamrin (2008); Youngstrom (2007)

General Screeners
Cognitive:
WISC

D-KEFS /NEPSY
CMS / WRAML Impairments in: sustained & selective attention, verbal/visual working & short-term memory, verbal/visual recognition, long-term recall, planning, set-shifting, verbal fluency, cognitive control, language, general academic performance

Academic:
WIAT

PPVT / EVT
Burdick et al. (2007); Gogos et al. (2010); Youngstrom (2007)

General Screeners
Social / Emotional / Behavioural:
BASC

Minnesota Multiphasic Personality Inventory 2 (MMPI-2)

General Behavior Inventory (GBI) Parent General Behavior Inventory (Short form) Child Behaviour Checklist (CBCL)

CBCL: High score on Externalizing scale Parent T-scores of 70+ on aggressive behaviour, attentional problems and anxiousdepressed subscales
Bagby et al. (2005); Giles et al. (2007); Maniscalco & Hamrin (2008)

Specific screeners

Specific Screeners
Young Manic Rating Scale (YMRS)
Mood Disorder Questionnaire Bipolar Inventory Symptoms Scale (BISS)
Child Mania Rating Scale

Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS)

Maniscalco & Hamrin (2008); Gonzalez (2008)

Keep in Mind.
General Screeners help to rule out
Specific Screeners help to rule in Parent report measures identify PBD better Checklists and mood rating scales should not be used in isolation.

Jerkins et al. (2011); Youngstrom (2007)

4.

Gather a detailed family history.

5.
6. 7.

Establish a reasonable base rate.

Use nomogram to increase accuracy. Gather additional information about handle symptoms. Involve collateral informants in the process.
Youngstrom et al. (2005); Jerkins et al. (2011)

8.

Diagnostic interview

Diagnostic Interview
Semi-structured should focus on questions that explore:

Family factors

Genetics

Mood states

Rapid cycling

Mixed states

Manic Depressive

Youngstrom et al. (2005); Youngstrom (2007)

Diagnostic Interview
Family History: Strong genetic/hereditary factors Help determine family strengths and challenges Challenges to comprehensive family history Indirect interviews are prone to reporter bias Asking whether someone in the family has been diagnosed with BD isnt enough

Jerkins et al. (2011); Youngstrom et al. (2005); Youngstrom (2007)

Can have parents complete it about themselves

http://www.dbsalliance.org/pdfs/MDQ.pdf
Jerkins et al. (2011); Youngstrom et al. (2005); Youngstrom (2007)

estimate of the chance that a child may have PBD.

initial risk estimate + familial factors= probability of PBD

highly recommended because its quick, accurate, requires no computation, allows for direct estimation of the PPV, and it is highly flexible use of nomogram decreases clinical judgement errors and the overdiagnosis of PBD

Jerkins et al. (2011); Youngstrom (2007)

Mood States
Gather lifetime history of mood states

Less likely to seek treatment for hypomanic or manic states

More likely to seek treatment during the depressive stage of PBD Assessment should include measures of both depressive and manic/hypomanic symptoms

Jerkins et al. (2011); Youngstrom et al. (2005); Youngstrom (2007)

Rapid Cycling
More frequent relapses into mood states when a person has at least 4 distinct mood episodes per year

Switch in polarity of mood may often occur within the course of a single episode (even within a day)

Jerkins et al. (2011); Youngstrom et al. (2005); Youngstrom (2007)

Mixed States
Symptoms of mania and major depression within the same episode
Must be adequate number and duration of symptoms to meet criteria for both major depression and mania Oscillating mixed states Black mania
Jerkins et al. (2011); Youngstrom et al. (2005); Youngstrom (2007)

Questions
Do you get moody? Tell me about the times you get moody Do you get easily annoyed? Give me some examples of what annoys you. Do you think that you are difficult to get along with? Do you feel sad? Tell me about feeling sad. When do you feel the best during the day? When do you feel the worst during the day?

Sattler & Hoge, (2006)

Diagnostic Interview
Structured interview is a comprehensive and objective assessment that focuses on symptoms identified within the diagnostic criteria of the DSM IV-TR.
Structured Diagnostic Interview for Parents Anxiety and Mood Mini-International Neuropsychiatric Interview (MINI) Diagnostic Interview Schedule for Children

McConaughy (2005); Youngstrom et al. (2005)

Questions
Has your child developed any of the following for at least a 2 week period of time? Depressed or irritable mood most of the day nearly every day for the last 2 weeks yes no dont know Fatigue of loss of energy nearly every day yes no dont know During the week or more that your child showed this abnormal and persistent mood, did you notice any of the following to be persistent and/or occurring to an abnormal or significant degree? Showed a decrease need for sleep; for instance, he/she stated that he/she felt rested after only 3 hours of sleep yes no dont know Skipped from one idea to another in speech, as if his/her ideas were flying rapidly yes no dont know

McConaughy (2005)

Diagnosis

9.

Extend the window of assessment. key constructs during treatment.

10. Assess

11. Be

a critical consumer of the literature and stay current.

Youngstrom et al. (2005); Jerkins et al. (2011)

Handle Symptoms
Pressured speech Racing thoughts

grandiosity

Hypersexuality

Elevated mood

Handle
symptoms

Change in moods and cycling

Youngstrom (2007); Youngstrom et al. (2005)

How PBD differs from Unipolar Depression:

It may be an episode of bipolar depression if Early or acute onset of depression Atypical features Lethargy, hypersomnia, increased appetite or weight gain, rejection sensitivity Recurrent depressive episodes Family history of BD
Youngstrom (2007)

How PBD differs from ADHD:

It may be an episode of bipolar disorder if Higher novelty seeking Lower reward dependence behaviour Lower persistence Less self-direction and cooperation Manic symptoms

Maniscalco & Hamrin (2008); Youngstrom (2007)

How PBD differs from Schizophrenia:

Schizophrenia has
Similar cognitive functioning deficits as PBD More severe deficits in neurocognitive domains Severely impaired emotion recognition

Nieto & Castellanos (2011)

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