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Bipolar Disorder and Adolescents

Symptoms of bipolar disorder in children and adolescents may look like other disorders

Traditionally bipolar disorder has been thought to first show in early adulthood – and more often in females.  Bipolar disorder was considered to be quite rare as few as 20 years ago, to be more exact. The first emergence came in the early 20s, mainly in females. But, our knowledge about bipolar disorder has grown rapidly in the last 20 years.

Instead of the single manic-depressive diagnosis – which included diagnostic criteria of both depressive periods, alternating with manic periods – described as “euphoria”?

Those who did not have clearly rhythmic, alternating periods of a “happy” and frantic manic phase with a classic depression period were mishandled, misdiagnosed, mistreated, or dismissed.

Bipolar ChildrenIn addition, it wasn’t really known that bipolar disorder could start in adolescence or even childhood, or that there are different types of bipolar disorder.  Today, it still isn’t “officially” recognized in the “psychiatric bible” – the Diagnostic Statistical Manual of Mental Disorders (DSM), but at least more practitioners do know that it exists.

Today, we don’t exactly know what causes bipolar disorder (only that there is a genetic link of some kind, and often some past trauma). But, we can at least identify adolescent and childhood bipolar illness.  We also recognize a variety of different types of bipolar disorder (Such as mixed manic episodes, rapid cyclers, people without a depressive phase, hypomania, dysphoria rather than euphoria and cyclothymia). We also have a “catch-all” type – Bipolar NOS or “not-otherwise-specified”.

Adolescent or childhood bipolar disorder is official known as: “early onset bipolar disorder”.  In fact, childhood bipolar disorder can be more serious than a similar disease in adults and may have slightly different symptoms.

Symptoms of bipolar illness in children can often be more severe, and the cycling period may be more frequent.  Children also have more mixed episodes.  Children also have slightly different symptoms – so even the depression phase of the cycle may not be obvious.

Pediatric patients (children and adolescents) with bipolar disorder may have:

Bipolar Disorder in Children•    Abrupt mood swings
•    Periods of hyperactivity followed by lethargy
•    Intense temper tantrums
•    Frustration
•    Defiant behavior
•    Chronic irritability

These symptoms have to appear in more than one setting (school and home) and cause “distress”.

The problem is that many of these symptoms may look like other disorders.  They might be disorders such as ADHD, childhood depression, anxiety disorder, obsessive compulsive disorder, conduct disorder, premenstrual syndrome, oppositional defiant disorder and others. The danger might come from a misdiagnosis and improper treatment.

Bipolar disorder is treated with anti-manic agents (lithium), anti-convulsants (Depakote, lamotrigine) or atypical antipsychotics (Abilify, Risperdal).  In many cases, anti-depressant won’t be needed.  Treatment for other disorders like ADHD or depression may make bipolar disorder worse. Childhood bipolar disorder is something that desperately needs treatment as the distress caused to the patient, and the family can predispose the youngster to

•    Drug or alcohol abuse
•    Stealing
•    Involvement with law enforcement
•    Poor social integration
•    Poor academic performance
•    Suicidal tendencies
•    Premature sexual behavior

The Balanced Mind has a good self-check list of symptoms that can help a parent or a teen decide if bipolar disorder might be an issue.  Self-testing is not always accurate and should be discussed with a doctor, (preferably with test results in hand).  Not all doctors accept pediatric bipolar disorder. Parents may have to seek advice from more than one mental health professional and be aware that insurance may not cover the illness.

Melissa Lind