Get Adobe Flash player

Main Menu

(47) Bipolar Disorder

Bipolar disorder + affairs: how often does this occur?

Bipolar, Adultery and ‘Fool Husbands.’

Bipolar infidelity

Bipolar and divorce

Bipolar Disorder in Children

Bipolar Disorder in Children and Teens

BD47

Do children get bipolar disorder?

Bipolar disorder was once thought to occur only rarely in youth, with the peak age of onset in the early thirties. However, approximately 20% of all bipolar patients have their first episode during adolescence, with a peak age of onset between 15 and 19 years of age. Rates of bipolar disorder in children, once considered extremely low, are now thought to be closer to rates in adults, although due to questions of diagnostic reliability, true rates are not known. It is known that 20% to 30% of youth with major depression go on to develop bipolar disorder. The DSM-IV-TR criteria for bipolar disorder are not believed to adequately describe the symptoms present in childhood, which is why the disorder is often missed in the younger age groups.

Depression as well was once believed to be rare in children, but symptoms of major depression are now known to occur. Rates of mood disorders in general in children have been rising over the past half-century for unclear reasons. Bipolar illness in childhood is more likely to affect the offspring of parents with bipolar disorder. While manic symptoms are the same in children as described for adults, the duration criteria are believed to be too long for diagnosis in children. The mood shifts between   mania, depression, and euthymia can occur several times within a day. In addition, children with mania are more likely to be irritable than elated. Older bipolar adolescents are more likely to have presentations similar to adults. In children, it may be difficult to distinguish bipolar disorder from attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, developmental disorders, or anxiety disorders. Although there remains debate and controversy over the diagnosis of mania in children, it is increasingly recognized that there are children with severe affective dysregulation manifested by severe tantrums, destructiveness, and aggression that may in fact be early bipolar disorder. In fact, childhood onset mania is often considered more chronic rather than episodic, most likely with a mixed (with depression) presentation and psychotic features more common. Early-onset substance abuse may signal bipolar disorder as well.

How is childhood bipolar disorder different from adult bipolar disorder?

Childhood bipolar disorder is not given specific diagnostic criteria in the DSM-IV-TR because the criteria for bipolar disorder are considered applicable to all age groups. The younger the age of onset, however, the less the disorder looks as described in the DSM. Prepubertal-onset bipolar disorder tends to be a nonspecific, chronic, rapid-cycling mixed manic state. For adolescent onset, the presentation of mania is more closely matched to the adult presentation. It is more likely, however, that depression precedes mania in an adolescent.

The onset of bipolar disorder in patients with a history of ADHD is often between 11 and 12 years of age. Many children who develop bipolar disorder develop a depressive disorder first. Of youth with major depression, up to a third go on to develop mania/bipolar disorder.

Studies have shown that observation of five behavioral symptoms in children/early adolescents aid in correctly diagnosing childhood bipolar disorder. Manic symptoms that do not overlap with ADHD are elation, grandiosity, flight of ideas/racing thoughts, a decreased need for sleep, and hypersexuality (in the absence of sexual abuse or overstimulation). As opposed to adults, however, children with mania seldom experience euphoric mood; the most common mood disturbance is severe irritability with “affective storms” (prolonged and aggressive temper outbursts). In between outbursts, these children are described as persistently irritable or angry. Manic children do often have a decreased need for sleep-they can function well on less sleep than normal. Due to their aggressiveness, these children frequently receive a diagnosis of conduct disorder. Aggressive symptoms often result in the psychiatric hospitalization of manic children.

What are the risks for suicide in children and adolescents?

Suicide is a very real risk for depressed youth. Suicide is the third leading cause of death in teenagers. One in five people with bipolar disorder commit suicide. A study by the Centers for Disease Control and Prevention of high school students indicated that nearly 20% of teens had seriously considered suicide and that more than 1 in 12 had made a suicide attempt in the previous year. Male teens are more likely to kill themselves, while more females attempt suicide. The majority of teen suicides are with guns. Children also can have suicidal ideation but are less apt to make attempts the younger they are.

Risk factors for suicide include:

• Previous suicide attempts

• Depression

• Alcohol or substance abuse

• Family history of psychiatric illness

• Stressful circumstances

• Access to guns

• Exposure to other teens who have committed suicide Stressful life events tend to be higher in children and adolescents who attempt suicide and may include loss of family members due to death or separation, physical or sexual abuse, frequent arguing in the home, or witnessing violence. Youth who are grappling with their sexual identity are particularly at high risk for suicide.

Suicidal youth tend to have poor social adjustment and are lacking adequate social supports. Bipolar youth are at increased risk due to higher rates of mixed mania and depression along with poor impulse control.

Some depressed adolescents engage in self-injurious behavior of cutting themselves without the specific intention of killing themselves, a symptom that is more typical in persons who experience a chronic emptiness and “emotional numbness.” The pain from cutting is described as a relief because the physical pain detracts from the emotional pain. Such behaviors are a sign that help is needed and is typically seen in depression when occurring in adolescence, but it is also a feature in some personality disorders in adults. While those who engage in self-injurious behaviors don’t necessarily intend to kill themselves, “accidental death” is a risk as well as the development of permanent scarring. Often the cutting behavior is transient, occurring during particularly stressful periods (e.g., loss of relationship) and dissipates with the development of better coping skills and improved impulse control.

Share

Google+

googleplus sm

Translate

ar bg ca zh-chs zh-cht cs da nl en et fi fr de el ht he hi hu id it ja ko lv lt no pl pt ro ru sk sl es sv th tr uk

Verse of the Day

Global Map