Child and Adolescent Bipolar Disorder Info Posted: 07-07-03 19:35pm
Research findings, clinical experience,
and family accounts provide substantial
evidence that bipolar disorder, also
called manic-depressive illness, can occur
in children and adolescents. Bipolar
disorder is difficult to recognize and
diagnose in youth, however, because it
does not fit precisely the symptom
criteria established for adults, and
because its symptoms can resemble or
co-occur with those of other common
childhood-onset mental disorders. In
addition, symptoms of bipolar disorder may
be initially mistaken for normal emotions
and behaviors of children and adolescents.
But unlike normal mood changes, bipolar
disorder significantly impairs functioning
in school, with peers, and at home with
family. Better understanding of the
diagnosis and treatment of bipolar
disorder in youth is urgently needed. In
pursuit of this goal, the National
Institute of Mental Health (NIMH) is
conducting and supporting research on
child and adolescent bipolar disorder.
A Cautionary Note
Effective treatment depends on appropriate
diagnosis of bipolar disorder in children
and adolescents. There is some evidence
that using antidepressant medication to
treat depression in a person who has
bipolar disorder may induce manic symptoms
if it is taken without a mood stabilizer.
In addition, using stimulant medications
to treat attention deficit hyperactivity
disorder (ADHD) or ADHD-like symptoms in a
child with bipolar disorder may worsen
manic symptoms. While it can be hard to
determine which young patients will become
manic, there is a greater likelihood among
children and adolescents who have a family
history of bipolar disorder. If manic
symptoms develop or markedly worsen during
antidepressant or stimulant use, a
physician should be consulted immediately,
and diagnosis and treatment for bipolar
disorder should be considered.
Symptoms and Diagnosis
Bipolar disorder is a serious mental
illness characterized by recurrent
episodes of depression, mania, and/or
mixed symptom states. These episodes cause
unusual and extreme shifts in mood,
energy, and behavior that interfere
significantly with normal, healthy
functioning.
Manic symptoms include:
Severe changes in mood—either extremely
irritable or overly silly and elated
Overly-inflated self-esteem; grandiosity
Increased energy
Decreased need for sleep—ability to go
with very little or no sleep for days
without tiring
Increased talking—talks too much, too
fast; changes topics too quickly; cannot
be interrupted
Distractibility—attention moves constantly
from one thing to the next
Hypersexuality—increased sexual thoughts,
feelings, or behaviors; use of explicit
sexual language
Increased goal-directed activity or
physical agitation
Disregard of risk—excessive involvement in
risky behaviors or activities
Depressive symptoms include:
Persistent sad or irritable mood
Loss of interest in activities once
enjoyed
Significant change in appetite or body
weight
Difficulty sleeping or oversleeping
Physical agitation or slowing
Loss of energy
Feelings of worthlessness or inappropriate
guilt
Difficulty concentrating
Recurrent thoughts of death or suicide
Symptoms of mania and depression in
children and adolescents may manifest
themselves through a variety of different
behaviors 1,2. When manic, children and
adolescents, in contrast to adults, are
more likely to be irritable and prone to
destructive outbursts than to be elated or
euphoric. When depressed, there may be
many physical complaints such as
headaches, muscle aches, stomachaches or
tiredness, frequent absences from school
or poor performance in school, talk of or
efforts to run away from home,
irritability, complaining, unexplained
crying, social isolation, poor
communication, and extreme sensitivity to
rejection or failure. Other manifestations
of manic and depressive states may include
alcohol or substance abuse and difficulty
with relationships.
Existing evidence indicates that bipolar
disorder beginning in childhood or early
adolescence may be a different, possibly
more severe form of the illness than older
adolescent- and adult-onset bipolar
disorder 1,2. When the illness begins
before or soon after puberty, it is often
characterized by a continuous,
rapid-cycling, irritable, and mixed
symptom state that may co-occur with
disruptive behavior disorders,
particularly attention deficit
hyperactivity disorder (ADHD) or conduct
disorder (CD), or may have features of
these disorders as initial symptoms. In
contrast, later adolescent- or adult-onset
bipolar disorder tends to begin suddenly,
often with a classic manic episode, and to
have a more episodic pattern with
relatively stable periods between
episodes. There is also less co-occurring
ADHD or CD among those with later onset
illness.
A child or adolescent who appears to be
depressed and exhibits ADHD-like symptoms
that are very severe, with excessive
temper outbursts and mood changes, should
be evaluated by a psychiatrist or
psychologist with experience in bipolar
disorder, particularly if there is a
family history of the illness. This
evaluation is especially important since
psychostimulant medications, often
prescribed for ADHD, may worsen manic
symptoms. There is also limited evidence
suggesting that some of the symptoms of
ADHD may be a forerunner of full-blown
mania.
Findings from an NIMH-supported study
suggest that the illness may be at least
as common among youth as among adults. In
this study, one percent of adolescents
ages 14 to 18 were found to have met
criteria for bipolar disorder or
cyclothymia, a similar but milder illness,
in their lifetime 3. In addition, close to
six percent of adolescents in the study
had experienced a distinct period of
abnormally and persistently elevated,
expansive, or irritable mood even though
they never met full criteria for bipolar
disorder or cyclothymia. Compared to
adolescents with a history of major
depressive disorder and to a
never-mentally-ill group, both the teens
with bipolar disorder and those with
subclinical symptoms had greater
functional impairment and higher rates of
co-occurring illnesses (especially anxiety
and disruptive behavior disorders),
suicide attempts, and mental health
services utilization. The study highlights
the need for improved recognition,
treatment, and prevention of even the
milder and subclinical cases of bipolar
disorder in adolescence.
Treatment
Once the diagnosis of bipolar disorder is
made, the treatment of children and
adolescents is based mainly on experience
with adults, since as yet there is very
limited data on the efficacy and safety of
mood stabilizing medications in youth 4.
The essential treatment for this disorder
in adults involves the use of appropriate
doses of mood stabilizers, most typically
lithium and/or valproate, which are often
very effective for controlling mania and
preventing recurrences of manic and
depressive episodes. Research on the
effectiveness of these and other
medications in children and adolescents
with bipolar disorder is ongoing. In
addition, studies are investigating
various forms of psychotherapy, including
cognitive-behavioral therapy, to
complement medication treatment for this
illness in young people.
Valproate Use
According to studies conducted in Finland
in patients with epilepsy, valproate may
increase testosterone levels in teenage
girls and produce polycystic ovary
syndrome in women who began taking the
medication before age 20 5. Increased
testosterone can lead to polycystic ovary
syndrome with irregular or absent menses,
obesity, and abnormal growth of hair.
Therefore, young female patients taking
valproate should be monitored carefully by
a physician.
NIMH is attempting to fill the current
gaps in treatment knowledge with carefully
designed studies involving children and
adolescents with bipolar disorder. Data
from adults do not necessarily apply to
younger patients, because the differences
in development may have implications for
treatment efficacy and safety 4. Current
multi-site studies funded by NIMH are
investigating the value of long-term
treatment with lithium and other mood
stabilizers in preventing recurrence of
bipolar disorder in adolescents.
Specifically, these studies aim to
determine how well lithium and other mood
stabilizers prevent recurrences of mania
or depression and control subclinical
symptoms in adolescents; to identify
factors that predict outcome; and to
assess side effects and overall adherence
to treatment. Another NIMH-funded study is
evaluating the safety and efficacy of
valproate for treatment of acute mania in
children and adolescents, and also is
investigating the biological correlates of
treatment response. Other NIMH-supported
investigators are studying the effects of
antidepressant medications added to mood
stabilizers in the treatment of the
depressive phase of bipolar disorder in
adolescents.
An NIMH Snapshot
The National Institute of Mental Health
(NIMH) is one of 25 components of the
National Institutes of Health (NIH), the
Government's principal biomedical and
behavioral research agency. NIH is part of
the U.S. Department of Health and Human
Services. The actual total fiscal year
1999 NIMH budget was $859 million.
NIMH Mission
To reduce the burden of mental illness
through research on mind, brain, and
behavior.
How Does the Institute Carry Out Its
Mission?
NIMH conducts research on mental disorders
and the underlying basic science of brain
and behavior.
NIMH supports research on these topics at
universities and hospitals around the
United States.
NIMH collects, analyzes, and disseminates
information on the causes, occurrence, and
treatment of mental illnesses.
NIMH supports the training of more than
1,000 scientists to carry out basic and
clinical research.
NIMH communicates information to
scientists, the public, the news media,
and primary care and mental health
professionals about mental illnesses, the
brain, mental health, and research in
these areas.
For More Information
Office of Communications, NIMH
Information Resources and Inquiries
Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX4U: 301-443-5158
E-mail: nimhinfo@ni
h.gov
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bobowv
New User, Becoming EHEALTHy
Joined: 29 Aug 2003 Posts: 3
My Child Is Bi-polar Posted: 08-29-03 12:42pm
My child was diagnosed with adhd and odd
when he was five years old. Over the
years symptoms began to worsen when at
last when he was in the eighth grade
everything exploded. His grades were
slipping, he was moody and violent at
times and at other times he was so happy
it seemed he would never come down. He
came home in may of his eighth grade year
and wanted to kill me, his sister, father,
and his teacher. He started making plans
to do this. I could not do anything with
him that evening. He was worse than I
had ever seen him. We had to take him to
the hospital kicking, screaming, hitting
and bawling the whole way. He was
hospitalized in a juvenile psychiatric
ward when he was diagnosed as also being
bi-polar. Since then he has been put on
ritalin la, trileptal, risperdal, and
paxil cr. He is doing alot better, but
still has some episodes of violent
outbursts. He will always need the
medication, and counseling, but I thank
god every day that we finally seem to have
the right combination of medications and
strategies for dealing with his disorders.
It is not the least bit easy having a
child with these problems, and the other
kids don't understand what my son is all
about. Also, his sister is jealous
sometimes and feels left out because my
son needs so much special care. But to
everyone out there who is facing this,
hang on.
