The REACH Institute
...The REsource for Advancing Children's Health |
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Bipolar Disorder Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness, and children who have it may suffer needlessly for years or even decades. For those afflicted with the illness, it is extremely distressing and disruptive, and like other serious illnesses, bipolar disorder is also hard on other family members and friends. Family members of children with bipolar disorder often have to cope with serious behavioral problems and the lasting consequences of these behaviors. Signs and symptoms of mania include discrete periods of:
Signs and symptoms of depression include discrete periods of:
It may be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many people call "the blues," then normal mood, then hypomania (a mild form of mania), and then mania. Some children with untreated bipolar disorder have repeated depressions and only an occasional episode of hypomania (bipolar II). In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single "mixed" bipolar state. The diagnosis of bipolar disorder in children and adolescents can be difficult. At present, it is not clear whether different criteria should be used to make the diagnosis in youngsters than in adults. For example, some experts have suggested that a mood state of continuous, rapidly changing mood states and irritability (but without euphoria, grandiosity, or discrete manic episodes) constitute the more typical manifestations of bipolar disorder in pre-pubertal children. However, this issue remains unresolved because of the lack of the necessary longitudinal research studies showing that such children in fact do show the more typical signs of bipolar disorder in adolescence or adulthood. Perhaps in part because of its different manifestations in children and youth, manic-depressive illness is often not recognized by the patient, relatives, friends, or even physicians. An early sign of manic-depressive illness may be hypomania--a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior. Sometimes, hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong. Recognition of the various mood states is essential so that the child who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease, which include destruction of personal relationships and suicide. In its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, poor school or work performance, or Attention-Deficit/Hyperactivity Disorder. If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.
WHAT CAUSES BIPOLAR DISORDER?Bipolar disorder tends to run in families and is believed to be inherited in many cases. Despite vigorous research efforts, a specific genetic defect associated with the disease has not yet been detected. There are however, several theories being tested. Cellular/Molecular. There are hypotheses that certain cells and/or molecules in the brain and a change in their activity cause the extreme highs and low associated with bipolar disorder. These theories involve studying specific chemical elements such as NA-, K-, -ATPase and guanine neucleotide binding proteins. Genetic. Through twin studies and family studies (and even adoption studies), Bipolar disorder has shown strong hereditary tendencies. This is particularly true of early onset bipolar disorder. Neurological. Brain imaging studies have suggested a correlation between structural abnormalities in the brain and having bipolar disorder. These abnormalities include a decrease in size of the medial temporal lobe and reduced total cerebral volume. Psychological, Social, Environment. There are few studies concerning the impact of psychological, societal or environmental influences on bipolar disorder. Most studies that have been done are based on the theory of the mania being a defensive or compensatory reaction to severe depression. There is little evidence to support the notion that social or psychological factors "cause" bipolar disorder. However, some recent evidence suggests that social and environmental factors can be involved in triggering an episode.
DIAGNOSISBipolar illness can be diagnosed in children under age 12, although it is not common in this age bracket. It can be confused with attention deficit/hyperactivity disorder, so careful diagnosis is necessary. Bipolar disorder involves cycles of mania and depression. Clinically, a patient is diagnosed as either Bipolar I Disorder or Bipolar II Disorder. Bipolar I Disorder is broken up into six subcategories. In the diagnosis of this disorder, whether Bipolar I or Bipolar II, the mental health practitioner must establish that the manic episode does not more accurately fit the criteria for schizoaffective disorder, or is not related to schizophrenia, schizopherniform disorder, delusional disorder, or another psychotic disorder Bipolar I Disorder Bipolar II Disorder
Books for Further ReadingMondimore, F. M. Bipolar Disorder : A Guide for Patients and Families Johns Hopkins Univ Pr., 1999. Papolos, D and Papolos, J. The Bipolar Child : The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder Broadway Books, 1999 Shafij, M and Shafij, S. L. (ed) Clinical Guide to Depression in Children and Adolescents . Amer Psychiatric Pr, 1991. Carlson, T. The Life of a Bipolar Child Benline Pr, 2000. Scientific PublicationsGreil W, et al. "Lithium versus carbamazepine in the maintenance treatment of bipolar II disorder and bipolar disorder not otherwise specified." Int Clin Psychopharmacol. 1999 Sep;14(5):283-5. Greil W, et al. "The comparative prophylactic efficacy of lithium and carbamazepine in patients with bipolar I disorder.." Int Clin Psychopharmacol. 1999 Sep;14(5): 277-81. Mendlewicz J, et al. "Short-term and long-term treatment for bipolar patients: beyond the guidelines." J Affect Disord. 1999 Sep;55(1):79-85. Review. Cassano GB, et al. "The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology." J Affect Disord. 1999 Aug;54(3):319-28. Review. Robb AS. "Bipolar disorder in children and adolescents." Curr Opin Pediatr. 1999 Aug;11(4):317-22. Review.
On the Webhttp://www.nimh.nih.gov/publicat/bipolarmenu.cfm http://www.nlm.nih.gov/medlineplus/bipolardisorder.html http://www.nmha.org/infoctr/factsheets/index.cfm For further research: http://www.ncbi.nlm.nih.gov/PubMed/
Support Groups and OrganizationsChild & Adolescent Bipolar Foundation National Institute of Mental Health National Depressive and Manic Depressive Association NAMI The Nation's Voice on Mental Illness National Foundation for Depressive Illness, Inc. National Mental Health Association
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