Talk:Evidence-based assessment/Bipolar disorder in youth (assessment portfolio)

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

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 (discuss • contribs) 23:01, 1 February 2018 (UTC)

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

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

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

Bipolar Chapter - Table 1

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 (discuss • contribs) 21:18, 5 August 2019 (UTC)

Psych intensive (discuss • contribs) 14:10, 29 July 2019 (UTC)

Bipolar Chapter - Table 2

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): Inflated self-esteem or grandiosity Decreased need for sleep (such as feeling rested with only three hours of sleep) Pressured speech or more talkative than usual Flight of ideas or racing thoughts Distractibility Increased goal-directed activity or psychomotor agitation 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 (discuss • contribs) 21:10, 5 August 2019 (UTC)

Bipolar Chapter - Table 3

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 (discuss • contribs) 21:13, 5 August 2019 (UTC)

Bipolar Chapter - Table 4

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 (discuss • contribs) 21:19, 5 August 2019 (UTC)

Psych intensive (discuss • contribs) 16:55, 29 July 2019 (UTC)

Bipolar Chapter - Table 5

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 (discuss • contribs) 15:41, 29 July 2019 (UTC)

Bipolar Chapter - Table 6

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 (discuss • contribs) 21:15, 5 August 2019 (UTC)

Bipolar Chapter - Table 7

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 (discuss • contribs) 21:16, 5 August 2019 (UTC)

Bipolar Chapter - Table 8

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 (discuss • contribs) 21:17, 5 August 2019 (UTC)

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

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