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Latest comment: 3 years ago by Lfollet

Meeting Notes Lfollet (discusscontribs) 18:31, 28 October 2021 (UTC) Fixing link of above Lfollet (discusscontribs) 04:44, 3 November 2021 (UTC)Reply

Here is the short URL for the portfolio page: [[1]] https://w.wiki/UbG


The "Base Rates of PBD" table under Demographic Information is missing information in the "Best Recommended For" Column. --Ithaker (discusscontribs) 23:01, 1 February 2018 (UTC)Reply

"Psychometric Properties of Screening Measures" Table under Diagnosis is missing information in the "Parent General Behavior" row. --Ithaker (discusscontribs) 23:05, 1 February 2018 (UTC)Reply

Treatment contains parenthetical information which needs to be addressed and solidified. --Ithaker (discusscontribs) 23:06, 1 February 2018 (UTC)Reply


  • Put the things under gold standard diagnostic interviews on the main prescription phase page

Bipolar Chapter - Table 1

[edit source]
Recommended starter kits for assessing potential bipolar spectrum disorder
Tool Identified Patient Age
School Aged
(5 to 10 years old)
Adolescent
(11 to 18 years)
Parent About Youth Adult Client or Parent About Self
Anchor probability Very rare in general population Uncommon Uncommon Uncommon
Bipolar spectrum
benchmark
probability
~1% general
~5% clinical
(<1% bipolar I)
~4% general population
~10% clinical
Use age of youth to pick ~4% general population
~20% of clinical
Broad screen N/A (reading level) YSR, BASC, SDQ, or ASI CBCL, BASC, CSI, or SDQ YASR
Follow up measures PPDS (puberty)
N/A for self-report questionnaires (reading
level)
PPDS (puberty)
GBI-10M or 7 Up
PPDS (puberty)
PGBI-10M or CMRS10
FIRM
FIRM
HCL, BSDS, MDQ, or
ISS
Diagnostic Interview MINI-Kid MINI-Kid or MINI MINI MINI
Severity Interview: KMRS, KDRS
Rating Scale: None
(reading)
Interview: KMRS, KDRS
Rating Scale: GBI10M,
GBI10Da/Db
Interview: KMRS, KDRS
Rating Scale: PGBI10M,
PGBI10Da/Db
Interview: YMRS, HDRS
Rating Scale:
Altman
Global Functioning: CGAS (1 to 100) CGAS (1 to 100) CGAS (1 to 100) GAF
Quality of Life: Kiddy KINDL KINDL Parent KINDL QoL BSD
Sleep See Meltzer (2020) See Meltzer (2020) PGBI-Sleep
See Meltzer (2020)
Chronotype (SMEQ),
sleep problems (PSQI)
Mood change N/A Mood charting app Mood charting app Mood charting app

Note. Bipolar extremely rare before the age of 5; do not consider as a possible diagnosis except under highly extenuating circumstances.

Glossary: YSR = Youth Self Report (Achenbach & Rescorla, 2001); BASC = Behavioral Assessment Scale for Children (Reynolds & Kamphaus, 2015); SDQ = Strengths and Difficulties Questionnaire (Goodman, Ford, Simmons, Gatward, & Meltzer, 2003), ASI = Adolescent Symptom Inventory (Gadow & Sprafkin, 1997); CSI = Child Symptom Inventory (Gadow & Sprafkin, 1994); YASR = Young Adult Self-Report (Achenbach, 1997); PPDS = Petersen Pubertal Developmental Screen (Petersen et al., 1988); FIRM = Family Index of Risk for Mood disorders (Algorta et al., 2013); GBI = General Behavior Inventory (Depue et al., 1981); 7 Up = 7 Up (E. A. Youngstrom et al., 2013); PGBI-10M, 10Da, 10Db = 10 item forms of parent-reported GBI (E. A. Youngstrom, A. Van Meter, et al., 2018); HCL = Hypomania Checklist (J. Angst et al., 2010); BSDS = Bipolar Spectrum Diagnostic Scale (Ghaemi et al., 2005); MDQ = Mood Disorder Questionnaire (Hirschfeld et al., 2000); ISS = Internal States Scale (Bauer et al., 1991); MINI = Mini International Neuropsychiatric Interview (Sheehan et al., 1998); MINI-Kid = MINI for Children and Adolescents (Sheehan et al., 2010); KMRS = KSADS Mania Rating Scale (D. A. Axelson et al., 2003); KDRS = KSADS Depression Rating Scale (Demeter et al., 2013); YMRS = Young Mania Rating Scale (Young et al., 1978); HDRS = Hamilton Depression Rating Scale (Hamilton, 1967); CGAS = Children’s Global Assessment Scale (D. Shaffer et al., 1983); GAF = Global Assessment of Functioning (Hall, 1995); KINDL = quality of life scale (not an acronym) (Ravens-Sieberer & Bullinger, 2000); QoL.BSD = Quality of Life for Bipolar Disorder (Michalak et al., 2010); PGBI Sleep = sleep scale carved from parent GBI (Meyers & Youngstrom, 2008); SMEQ = Student Morningness-Eveningness Questionnaire (Košćec, Radošević-Vidaček, & Kostović, 2001); PSQI = Pittsburgh Sleep Quality Index (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989).

Psych intensive (discusscontribs) 21:18, 5 August 2019 (UTC)Reply

Psych intensive (discusscontribs) 14:10, 29 July 2019 (UTC)Reply

Bipolar Chapter - Table 2

[edit source]
Criteria for Manic or Hypomanic Episode
A. A distinct period of abnormally and persistently elevated, expansive or irritable mood, clearly different from usual mood; increased energy

Duration: At least one week (unless treatment cuts it short) for mania; at least 4 days for hypomanic episode (though data suggest that two day periods are more common and still impairing)

B. During the mood episode, at least 3 of the following symptoms are also present to a significant degree

(4 or more if mood is mostly irritable):

  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep (such as feeling rested with only three hours of sleep)
  3. Pressured speech or more talkative than usual
  4. Flight of ideas or racing thoughts
  5. Distractibility
  6. Increased goal-directed activity or psychomotor agitation
  7. Excessive activities with a high risk for painful or damaging consequences
C. Mania: Causes marked impairment in school, at home, or with peers; may also require hospitalization to prevent harm to self or others; may also have psychotic features

Hypomania: An unequivocal change in functioning from typical for person when not symptomatic, observable by others; but not severe enough to cause marked impairment, and with no psychotic features.

D. Rule out symptoms due to physiological effects of a substance (including stimulant or antidepressant medication), or symptoms due to a general medical condition.

Adapted from DSM-5 (APA, 2013); ICD-11 (WHO, 2018); ISBSD Child Diagnosis Task Force (Youngstrom, Birmaher, & Findling, 2008).

Psych intensive (discusscontribs) 21:10, 5 August 2019 (UTC)Reply


Bipolar Chapter - Table 3

[edit source]
Definitions of Bipolar Disorder, Bipolar Spectrum Disorder, and Research Definitions of Pediatric Bipolar Subtypes
Definition (Source) Comment
Bipolar I
  • Requires lifetime presence of a manic episode (can be mixed)
    Mood disturbance duration of 7 days or until hospitalization
  • DSM: No requirement of depression – ever
  • ICD-10 required multiple episodes in order to be confident of diagnosis; only “provisional” with single episode, even in adults
Bipolar II
  • Requires lifetime combination of a major depressive episode and at least one hypomanic episode (of at least 4 days duration) (either can be mixed)
Cyclothymia

(DSM-IV-TR)

  • Technically not considered a type of “bipolar NOS” in DSM
  • Rarely diagnosed in children or adolescents in research or clinical settings
  • Many research groups lump cyclothymic disorder with Other Specified Bipolar and Related Disorders (e.g., B. Birmaher et al., 2006)
  • Difficult to disentangle from normal development, temperament, and comorbid conditions
  • Possible to diagnose reliably, and associated with significant impairment (Findling, Youngstrom, et al., 2005; A. Van Meter et al., 2013; A. Van Meter et al., 2011; Anna R. Van Meter et al., 2016)
Repeated hypomanias in the absence of lifetime mania or depression (DSM-5 – Other Specified Bipolar and Related Disorders [OSBRD])
  • Unlikely to be impairing enough to lead to treatment seeking; thus not seen clinically
  • Challenging to differentiate from normal behavior
Insufficient Duration of Mood Episodes

(DSM-5 OSBRD)

Leibenluft et al. (2003) further distinguish between cases with elated mood and/or grandiosity versus those with only irritability as mood disturbance; following Geller et al.

  • Common BSD presentation (D. A. Axelson et al., 2006; Findling, Youngstrom, et al., 2005)
  • Often high impairment (J. Angst et al., 2003)
  • May include cases with mood severity that would otherwise warrant a diagnosis of manic, mixed, or depressive state
  • May include mixed states with polarity shifts
  • Note that DSM-5 specifically added insufficient duration of cyclothymic “episode” as another prototype, with 6+ months as the duration in example
Insufficient Number of Manic Symptoms

Leibenluft et al. (2003) include “irritable hypomania” and “irritable mania” as another “intermediate” phenotype, even if accompanied by four or more other manic symptoms

  • More prevalent than bipolar I or II, both in adolescents (A. Van Meter et al., 2019) and adults (Moreira et al., 2017)
  • Possible to meet criteria with only nonspecific symptoms (e.g., irritable mood plus distractibility, high motor activity, and rapid speech)
  • Research designs typically have not documented episodicity of symptoms
  • High rates of impairment and service utilization (C. Galanter et al., 2003; Hazell, Carr, Lewin, & Sly, 2003)
Severe Mood Dysregulation (previously referred to as a “Broad Phenotype”) (Leibenluft et al., 2003 definition)
  • Research Criteria: Abnormal mood (anger or sadness) present at least half the day most days; accompanied by “hyperarousal” (insomnia*, agitation, distractibility, racing thoughts/flight of ideas; pressured speech, or social intrusiveness*); also shows increased reactivity to negative emotional stimuli compared to peers*; onset before age 12; duration at least 12 months; symptoms severe in at least one setting.
  • Rule outs: elated mood, grandiosity, or episodically decreased need for sleep; distinct episodes of 4+ days duration; meeting criteria for schizophreniform, schizophrenia, pervasive developmental disorder, or post-traumatic stress disorder; or meeting criteria for a substance use disorder in the past 3 months; or IQ<80; or symptoms are attributable to a medication or general medical condition.
  • Comments: The exclusion of episodicity and of several symptoms more specific to BSD both are intended to exclude bipolar cases. The inclusion of chronic presentations and sensitive but nonspecific symptoms are likely to include many cases with presentations that are not on the bipolar spectrum. This category may blend different etiologies and mechanisms as a result.

* Symptom is not part of DSM-IV or -5 criteria for mania.

Disruptive Mood Dysregulation Disorder (DMDD)
  • Fewer exclusions than the SMD research definition
  • Symptoms overlap entirely with ODD
  • DSM-5 put in “Depressive Disorders” chapter
  • ICD-11 did not add diagnosis; treats as ODD modifier (Evans et al., 2017)
  • We recommend conceptualizing as a disruptive behavior disorder and treating first with behavioral parenting oriented interventions, combined with careful assessment of response
  • Episodic presentation would suggest re-conceptualizing as a mood disorder
Bipolar Not Otherwise Specified – Research Criteria from “Course and Outcomes of Bipolar Youth” Study (NIMH R01 MH059929)

(Birmaher et al., 2006; Axelson et al., 2006)(Horwitz et al., 2010)

  • Requires “Core Positive” – presence of distinct period of abnormally elevated, expansive, or irritable mood
  • Minimum of 2 other “B criteria” symptoms if mood is mostly elated; at least 3 “B criteria” if irritable
  • Requires clear change from individual’s typical functioning (consistent with DSM-IV and ICD guidelines for hypomania)
  • Requires 4+ hours of mood within a 24 hour period to be counted as an index “day” of disturbance
  • Requires 4+ days at a minimum over the course of a lifetime to diagnose bipolar NOS; nonconsecutive days are acceptable.
  • Beginning to garner empirical support (Axelson et al., 2006)
  • Needs replication in other samples/research groups, but overlaps substantially with “insufficient duration” and “insufficient number of B criterion symptoms” definitions of Bipolar NOS
Child Behavior Checklist Proxy Diagnosis

(After Mick et al., 2003) Often operationally defined as parent-reported T-scores of 70+ on Aggressive Behavior, Attention Problems, and Anxious/Depressed scales.


NOT RECOMMENDED for clinical use (Althoff et al., 2010).

Pros:
  • Convenient to use for large sample studies
  • Avoids problems of rater training and anchoring effects

Cons:

  • Focuses on symptoms that are likely to be “shared” with other disorders at a genetic level
  • Items overlap with PTSD scale (You et al., 2017)
  • Prone to factors that might bias parent report
  • Does not capture diagnostically specific symptoms; instead concentrates on sensitive symptoms that might also have high false positive rate
  • Agreement with clinical or research-interview-derived (KSADS) diagnoses of bipolar spectrum might be modest (Althoff et al., 2010)

Psych intensive (discusscontribs) 21:13, 5 August 2019 (UTC)Reply


Bipolar Chapter - Table 4

[edit source]
Base rates of BSD in different clinical settings
Setting (Reference) Base Rate Demography Diagnostic Method
Rates of Bipolar Disorders in General Population 0.6% Bipolar I in youths age 5 to 18 Meta-analysis of epidemiological studies, 19 samples, N = 56,103 participants (A. Van Meter et al., 2019)
Rates of bipolar spectrum (I, II, cyclothymia, NOS) in general population 3.9% Bipolar spectrum in youths age 5 to 18 years Meta-regression estimate (A. Van Meter et al., 2019)
High school epidemiological
(Lewinsohn et al., 2000)
0.6% Northwestern USA high school KSADS-PL
Community Mental Health Center
(E. A. Youngstrom et al., 2005)
6% Midwestern Urban, 80% non-white, low-income Clinical interview & treatment
General Outpatient Clinic;
(Geller, Zimerman, Williams, Delbello, Frazier, et al., 2002)
6% to 8% Urban academic research centers WASH-U-KSADS
County Wards (DCFS)
(Naylor, Anderson, Kruesi, & Stoewe, 2002, October)
11% State of Illinois Clinical interview & treatment
Specialty Outpatient Service
(Biederman et al., 1996)
15-17% New England KSADS-E
Incarcerated adolescents
(Teplin, Abram, McClelland, Dulcan, & Mericle, 2002)
2% Midwestern Urban DISC
Incarcerated adolescents
(Pliszka et al., 2000)
22% Texas DISC
Acute psychiatric hospitalizations
in 2002-2003 – adolescents
(Blader & Carlson, 2007)
21% All of U.S.A. Centers for Disease Control survey of discharge diagnoses
Inpatient service
(Carlson & Youngstrom, 2003)
30% manic symptoms,
<2% strict BP I
New York City Metro Region DICA; KSADS
Acute psychiatric hospitalizations
in 2002-2003 – children
(Blader & Carlson, 2007)
40% All of U.S.A. Centers for Disease Control survey of discharge diagnoses
Psychiatric outpatient clinic
(Ghanizadeh, Mohammadi, & Yazdanshenas, 2006)
16-17% Iran K-SADS-PL (Farsi)
Inpatient and partial hospitalization programs at a psychiatric treatment center
(Pellegrini et al., 1986)
Mania (0%), hypomania (6%) Richmond, Virginia DISC

p Parent interviewed as component of diagnostic assessment; y youth interviewed as part of diagnostic assessment.

Note: KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia, PL = Present and Lifetime version, WASH-U = Washington University version, -E = Epidemiological version of the KSADS; DISC = Diagnostic Interview Schedule for Children; DICA = Diagnostic Interview for Children and Adolescents. Table modified from Wikiversity.

Psych intensive (discusscontribs) 21:19, 5 August 2019 (UTC)Reply

Psych intensive (discusscontribs) 16:55, 29 July 2019 (UTC)Reply

Bipolar Chapter - Table 5

[edit source]
Red flags that should trigger thorough evaluation of possible BSD
Red Flag Description References
Early onset depression Variously described as onset before age 15, or pre-pubertal (A. Duffy et al., 2009; Hillegers et al., 2005; Kowatch, Youngstrom, et al., 2005; E A Youngstrom & Algorta, 2014)
Psychotic features True delusions or hallucinations occurring in the context of mood (Kowatch, Youngstrom, et al., 2005; Anna R. Van Meter et al., 2016)
Episodic aggressive behavior
(including high parent reports
of externalizing behavior)
Not specific to bipolar, but most bipolar cases will show this; more episodic should trigger evaluation to rule out (D. Axelson et al., 2012; Hunt et al., 2009)
Family history of BSD Five-fold increase in risk for 1st degree relative;
2.5x for 2nd degree or “fuzzy” bipolar
(Algorta et al., 2013; Fristad et al., 2012; Hodgins et al., 2002)
Atypical depression Hypersomnia (vs. insomnia), increased appetite and weight gain (vs. decreased), decreased energy, and interpersonal rejection sensitivity (Benazzi & Rihmer, 2000; B. Birmaher et al., 1996)
Early onset of puberty Puberty doubles or triples risk of mood disorder. Early onset depression may be more likely to follow a bipolar course. (Peper & Dahl, 2013; Ullsperger & Nikolas, 2017)
Sleep disturbance Especially decreased sleep without fatigue, or combined with increased energy. Need to differentiate from insomnia with depression, or passive staying up with electronics (Algorta et al., 2013; Allison G Harvey, 2008; Perez Algorta et al., 2018; Phelps, 2008)

Psych intensive (discusscontribs) 15:41, 29 July 2019 (UTC)Reply

Bipolar Chapter - Table 6

[edit source]
Feature comparison of measures that are free to use, including discriminative performance (English versions all available on Wikipedia)
Adult About Self (including parent about self)
Feature MDQ BSDS HCL
Length
Maximum
15 20 32
Shortest
12 19 16
Reading Levela 7.3 10.0 7.2
Languages 13+ b 7+ c 18+ d
Projected d 1.00 1.05 0.95
Projected AUC

(95% CI)

.76

(.68 to .83)

.77

(.69 to .84)

.75

(.67 to .82)

Sensitivity at Sp=.9 .41 .43 .38
DiLR+ 4.1 4.3 3.8
Time Frame Lifetime Lifetime Lifetime
Teen About Self Any Mood
Feature MDQ GBI-10M 7 Up GBI-10Da
Length
Maximum
15 79 79 79
Shortest
12 10 7 10
Reading Levela 7.3 11.1 11.1 11.1
Languages 13+b 25+e 4+e 25+ e
Projected d .40 .43 .36
Projected AUC

(95% CI)

.61

(.54 to .67)

.62

(.58 to .67)

.60

(.56 to .65)

.66

(.62 to .70)

Sensitivity at Sp=.9 .20 .22 .20 .23
DiLR+ 2.0 raw 9+ 2.2 raw 19+ 2.0 raw 11+ 2.3 raw 16+
Time Frame Lifetime Past year Past year Past year
Parent About Youth Any Mood
Feature PGBI-10M CMRS FIRM PGBI-10Da
Length
Maximum
79 21 1 page grid 79
Shortest
10* 10* 1 page 10*
Reading Levela 11.1 6.5 17.6 11.1
Languages 25+e 5f 2g 25+e
Projected d 1.30 .87 .47 1.30
Projected AUC

(95% CI)

.82

(.80 to .84)

.73

(.66 to .80)

.63

(.54 to .72)

.82

(.80 to .84)

Sensitivity at Sp=.9 .47 .21 .28 .52
DiLR+ 4.7 raw 15.5+ 2.1 raw 12+ 2.8 raw 8+ 5.2 raw 10+
Time Frame Past Year Lifetime Lifetime
(family history)
Past year

Estimates based on saturated regression model for studies from 2000 and later, with 2016 as reference year (Youngstrom, Egerton, et al., 2018).

aFlesch-Kincaid Grade Level, estimated on the combination of instructions and items.

bMDQ available in English, Spanish, Chinese, Danish, Dutch, Farsi/Persian, Finnish, French, German, Italian, Japanese, Korean, Portuguese.

cBSDS available in English (US & UK), Arabic, Chinese, Japanese, Korean, Persian, Portuguese, Spanish.

dHCL available in English, Arabic, Croatian, Danish, Dutch, Flemish, French, German, Greek, Hungarian, Italian, Japanese, Polish, Portuguese (Portuguese & Brazilian), Russian, Spanish, Turkish.

eGBI available in English, Spanish, Portuguese, Korean in full length and 7 Up-7 Down versions; available in 20 other languages for 10-M and 10-Da versions.

fCMRS available in English, Spanish, Chinese, Arabic, Portuguese.

gFIRM available in English and Spanish.

Note. AUC = Area Under Curve from receiver operating characteristic analysis; estimate assumes parametric distribution. Sensitivity for specificity = .90 uses same assumptions. DiLR+ is the diagnostic likelihood ratio associated with scoring above the threshold attached to a specificity of .90; note that this might not be the most discriminating region of performance on a given test. The Wikiversity pages have more details, including multi-level likelihood ratios. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

Psych intensive (discusscontribs) 21:15, 5 August 2019 (UTC)Reply


Bipolar Chapter - Table 7

[edit source]
Symptoms and associated features of BSD based on meta-analysis
Symptom Sensitivity to
BSDa
Specificity to
BSD
Features
Suggesting BSD
Features Suggesting
Other Diagnoses
Recommendation
Handle Symptoms (High Specificity)
A.1. Elated, expansive, euphoric mood Mweighted= 64%
(95% CI:
53 to 75%)
19 studies
High Extreme, causes impairment, situationally inappropriate, extreme duration Transient, more responsive to redirection, more situationally driven Substance abuse Highly specific feature – Presence helps rule in diagnosis. Assess even though family may not consider it part of presenting problem
A.2. Irritable mood 77%
64 to 88%)
17 studies
Low Irritability in context of other mood symptoms; high versus low energy irritability Chronic oppositional behavior in absence of changes in mood or energy; Might be unipolar depression Assess via collateral informant – self report underestimates. If collaterals deny irritability, effectively rule out BSD because of high sensitivity. Embed in context of changes in mood & energy
B.1. Grandiosity 57%
(44 to 69%)
19 studies
Moderately high – much lower if conduct disorder included Episodic quality, and should fluctuate with mood. Periods of grandiosity contrasted with low self-esteem, worthlessness More chronic, arrogant, not associated with mood is suggestive of CD/APD or adolescent overconfidence

Substance abuse

Worth emphasizing, but probably not specific enough to elevate to required feature. Fluctuations a key feature in discerning from CD/APD.
Increased Energy 79%
(61 to 93%)
8 studies
Highest sensitivity in meta-analysis
Low for “high energy” – which is also common in ADHD; episodic periods of high energy would be more specific to mood disorder Higher if ask about fluctuation or change; low if ask about chronic (b/c common feature with ADHD) Chronic high motor activity Need to assess as change in functioning from youth’s typical behavior. Episodic quality is more specific to bipolar. Focus on energy versus motor activity for self-report (2002); change in motor activity for collaterals.
Nonspecific Symptoms (in Descending Order of Sensitivity to BSD)
Pressured Speech 63%
(49 to 77%)
18 studies
Unclear. Carlson (Carlson, 2002) raises issue of expressive language problems; but not evaluated yet in published samples Episodic quality, change from typical for youth; set against slowed or impoverished speech during depression Chronically “chatty” or talkative more suggestive of ADHD Emphasize changes from typical functioning embedded in shifts of mood or energy
Racing Thoughts 61%
(45 to 76%)
15 studies
Good if embed in mood context Ask about imagery as well as words Distinguish from expressive language disorder

Substance abuse, meds

Decreased need for sleep 56%
(46 to 67%)
19 studies
High if framed as decreased need, not insomnia. Low if just focus on trouble falling asleep. High energy, actively engaged in activities, does not miss sleep the next day Decreased sleep due to stimulant use (ADHD), use of substances or medications; difficulty falling asleep with unipolar depression (versus decreased need for sleep). Depressed persons want to sleep, but cannot Emphasize decreased need for sleep, as distinct from difficulty falling asleep (particularly due to stress or rumination). High energy, little diminution of energy despite decreased sleep
Mood swings/lability 76%
(55 to 95%)
6 studies
High – based on PGBI, CBCL, Conners items Frequent, intense, with periods of long duration May be induced by substance abuse, medications, medical/neurological illnesses, borderline personality traits, disruptive disorders Parent report highly sensitive. BSD unlikely if parent denies. Specificity appears promising, based on multiple scales. Conceptualize as mixed state with volatile mood.
Hypersexuality 32%
(23 to 42%)
12 studies
High – typically either pediatric BSD or sexual abuse Hypersexuality not characteristic, embedded in episodes of energy/mood; has pleasure-seeking quality Sexual Abuse—linked to trauma, perhaps more seductive/re-enacting quality than sensation-seeking;

pornography exposure; actual sex

Insensitive to BSD, so absence not informative. Highly specific: Presence should trigger careful assessment of BSD and abuse (recognize that they could co-occur)
Distractibility 74%
(61 to 85%)
17 studies
Low – ADHD, unipolar, anxiety, PTSD, and low cognitive functioning all show this, too Higher if ask about change from typical, embed in context of mood Chronic problems much more suggestive of ADHD or neurological impairment Probably important to assess via collateral instead of self-report. High sensitivity could make negative collateral helpful at ruling out bipolar.
Poor judgment 61%
(45 to 76%)
17 studies
Moderate Episodic, embedded in mood/energy Impulsive or accident-prone, clumsy Episodic, sensation-seeking may be most specific presentation
Flight of Ideas 54%
(42 to 66%)
12 studies
Moderate (Speech problems again) substance abuse, medication-induced
Increased sociability/people-seeking/overfamiliarity

(ICD10, p. 113); Added to WASH-U KSADS;

41%
(27 to 56%)
7 studies
Unknown Could be the positive affect, could be sensation seeking Needs investigation

a Sensitivity estimates from Van Meter, Burke, Kowatch, et al. (2016) meta-analysis.

Psych intensive (discusscontribs) 21:16, 5 August 2019 (UTC)Reply

Bipolar Chapter - Table 8

[edit source]
Clinically Significant Change Benchmarks with Common Instruments and Mood Rating Scales


Measure

Cut Scores* Critical Change

(Unstandardized Scores)

Minimally
Important
Difference
(MID)
d ~.5
A B C 95% 90% SEdifference
Benchmarks Based on Published Norms
CBCL T-Scores (2001 Norms)
Externalizing 49 70 58 7 6 3.4 5
Internalizing n/a 70 56 9 7 4.5 5
Attention Problems n/a 66 58 8 7 4.2 5
TRF T-Scores (2001 Norms)
Externalizing n/a 70 56 6 5 3.0 5
Internalizing n/a 70 55 9 7 4.4 5
Attention Problems n/a 66 57 5 4 2.3 5
YSR T-Scores (2001 Norms)
Externalizing n/a 70 54 9 8 4.6 5
Internalizing n/a 70 54 9 8 4.8 5
Benchmarks Based on Outpatient Samples
PGBI-10Ma 1 9 6 6 5 3.2 3
CMRS 10b -- 6 4 5 4 2.3 2
PGBI-10Daa -- 7 4 6 5 3.0 3
PGBI-10Dba -- 7 4 6 5 2.9 3
AGBI-10Mc -- 14 7 6 5 3.1 3
AGBI-10Dac -- 18 7 6 5 3.2 3
AGBI-10Dbc -- 16 7 6 5 2.9 4
7 Upc -- 8 4 4 4 2.2 3
7 Downc -- 12 5 5 4 2.3 3
KMRSb 19 19 19 3 3 1.6 3
KDRSb 12 19 18 5 4 2.4 3
CDRS-R Totala -- 24 22 6 5 2.9 5
YMRS Totala 4 3 3 3 3 1.8 3

* “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.
The outpatient samples use all cases with BSD for the clinical reference group for mania measures, and any mood disorder as the reference for depression measures.

aData from (E. A. Youngstrom, A. Van Meter, et al., 2018).

bData from (E A Youngstrom et al., 2005).

cData from (Eric A. Youngstrom, Halverson, Youngstrom, Lindhiem, & Findling, 2018).

Psych intensive (discusscontribs) 21:17, 5 August 2019 (UTC)Reply

Table 6. Multilevel DiLR for Short Forms, Using 10M to Predict Bipolar Spectrum Disorders, and 10da and 10db to Predict Any Mood Disorder

[edit source]
Table 6. Multilevel DiLR for Short Forms, Using 10M to Predict Bipolar Spectrum Disorders, and 10da and 10db to Predict Any Mood Disorder
Risk Change Label 10M for Bipolar 10Da for Any Mood 10Db for Any Mood
Score Range DiLR Score Range DiLR Score Range DiLR
Very Low 0-2.59 .07 0-1.99 .25 0-1.99 .22
Low 2.6-6.99 .41 2-5.99 .71 2-5.99 .71
Neutral 7-10.99 1.44 6-9.99 1.85 6-10.99 2.69
High 11-17.99 2.39 10-14.99 4.52 11-14.99 5.64
Very High 18+ 5.38 15+ 8.80 15+ 8.09