David Miklowitz's blog

Groups for bipolar kids

A reader asked:


Do you know of any structured groups for children with bipolar disorder in the Los Angeles area?

Dr. Dave's reply:

There aren't many, I'm afraid.  Look at the website for the Depressive and Bipolar Support Alliance (www.dbsalliance.org) or the National Alliance on Mental Illness (www.nami.org). You can also search the www.bpkids.org site for support group listings.  Consider groups that focus on broader topics (for example, dialectical behavior therapy for teens with depression) rather than strictly bipolar disorder. Good luck!




Distinguishing Bipolar from ADHD

A reader asked:

What is the best method for distinguishing a non-extreme case of bipolar disorder from ADHD? My 12 year old daughter is diagnosed as ADHD, and is on Adderall which is somewhat helpfull. We have a maternal family history of bipolar II (mom) and I (grandmom). My daughter is displaying some bipolar symptoms, but nothing extreme. Our phsychiatrist is considering bipolar in addition to or instead of ADHD. He is considering adding Lamictal to Adderal or replacing Adderall with Lamictal, and suggested that her response to therapy may be the tie breaker in her diagnosis. Is this the best approach?

Dr. Dave:

Borderline personality and bipolar disorder

A reader asked:

"My 15-year-old daughter has signs of borderline personality disorder. I've heard that some people think this is related to bipolar. What do you think? And is BPD something you address at your clinic? Thanks."

Dr. Dave:

Borderline personality disorder is usually not diagnosed until adulthood.  Be wary of any diagnoses of borderline personality disorder among adolescents. Although teens may show behaviors that are similar to adults with borderline personality (e.g., inexplicable rages, self-cutting, jumping from one relationship to another, intolerance of being alone), often this is because there are underlying mood disorders (depression, bipolar disorder, dysthymia) that lead to these behaviors.  You'd want to make sure any underlying mood problems are treated before settling on the borderline diagnosis.

Diagnosis of 13-year old

A reader asked:

Our 13-year old daughter has signs of a mood disorder -- persistent anger, oppositionality, impulse control -- along with NLD and executive functioning problems, but her therapist does not believe she is bipolar because she is not hypersexualized.  When she was willing to take medication, Abilify seemed to help.  Given that there seems to be no consensus about the parameters of adolescent bi-polar disorder, I'm concerned that the therapist is giving that diagnosis short shrift.  Is she?

Dear reader,

Approaching teens about mood disorder

A reader asked:

how should i approach my daughter about the idea of mood disorder? i am not 100 percent sure if shes bipolar or if its teenage hormones? I want to research it with her but not sure how to start. any suggestions? symptons we see as a family is irregular sleep patterns, social problems, recklessness, spending problems, unrealistic ideas about most all decisions, lack of self-esteem. any help you can give would be great! thanks


Clinicians in Reno, Nevada

A reader asked:

I am trying to locate clinicians in the Reno area who are trained in FFT.
Also, need a psychiatrist (who is accepting patients) specializing in adolescent BD, familiar with current research on related psychopharmacology issues.
Patient is 16 yr. old female recently discharged from inpatient unit with provisional dx of
BD II. No luck tracking down good local resources so far. Ryst and Strange at U NV are not accepting new patients. Family can easily travel to Sacramento, or beyond if necessary. Would appreciate any leads you might offer. Thanks, Pam

9 Year Old with Family History of Bipolar Disorder

A reader asked: "If a 9 year old only exhibits more of the depressed mood part of cycle (symptoms of irritability especially among peers, crying outbursts, isolating) has a family history of bi-polar from mother's side 2 individuals, would an evaluation/intake still be warranted by your program? When do manic episodes typically begin in children?"


Group support for bipolar disorder

A reader sent in the question, "Is there any evidence that support groups help people with bipolar disorder?"

Good question! The short answer: yes.

There are only a handful of controlled studies on this issue, the best one being a study done in Spain by Francesc Colom and his colleagues at the University of Barcelona.  They found that people with bipolar disorder who participated in educationally-oriented groups run by therapists- in which every session involved tasks such as learning to identify early warning signs of relapse - did much better over 5 years than people who attended a support group that did not involve education about bipolar disorder.