At least 2 million Americans suffer from bipolar disorder, also known as
manic-depressive illness. It is a mental illness involving episodes of
serious mania and depression. The child's mood MAY swing from overly "high" and irritable
to sad and hopeless, and then back again, with periods of normal mood in
between.
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:
- Increased energy, activity, restlessness, racing thoughts, and rapid
talking
- Excessive "high" or euphoric feelings
- Extreme irritability and distractibility
- Decreased need for sleep
- Unrealistic beliefs in one's abilities and powers
- Uncharacteristically poor judgment
- A sustained period of behavior that is different from
usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping
medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
Signs and symptoms of depression include discrete periods
of:
- Persistent sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in ordinary activities, including
sex
- Decreased energy, a feeling of fatigue or of being "slowed
down"
- Difficulty concentrating, remembering, making
decisions
- Restlessness or irritability
- Sleep disturbances
- Loss of appetite and weight, or weight gain
- Chronic pain or other persistent bodily symptoms that are not caused by
physical disease
- Thoughts of death or suicide; suicide attempts
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.
DIAGNOSIS
Bipolar 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
For a diagnosis of Bipolar I Disorder, a patient should have suffered from at least one
manic episode. A manic episode is defined as an elevated, irritable or expansive mood
which is not characteristic of the person and is sustained for at least one
week.
Bipolar II Disorder
In order to be diagnosed with bipolar II disorder, a patient must be suffering from or
have a history of suffering from at least one major depressive and hypomanic episode, and
he/she must never have suffered a manic or mixed episode. In addition, the episode must
cause significant distress or loss of functioning in the patient's
life.
Books for Further Reading
Mondimore, 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 Publications
Greil 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 Web
http://www.nimh.nih.gov/publicat/bipolarmenu.cfm
http://www.nlm.nih.gov/medlineplus/bipolardisorder.html
http://www.bipolarchild.com
http://www.nmha.org/infoctr/factsheets/index.cfm
For further research: http://www.ncbi.nlm.nih.gov/PubMed/
Support Groups and Organizations
Child & Adolescent Bipolar Foundation
1187 Wilmette Ave.
P.M.B. #331
Wilmette, IL 6009l
Fax (847) 920-9498
www.bpkids.org
National Institute of Mental Health
Information Resources and Inquiries Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Telephone: 301-443-4513
FAX: 301-443-4279
TTY: 301-443-8431
FAX4U: 301-443-5158
Website: www.nimh.nih.gov
E-mail:
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National Depressive and Manic Depressive Association
730 Franklin Street, Suite 501
Chicago, IL 60610
Telephone: 312-642-0049; 1-800-826-3632
FAX: 312-642-7243
Website: www.ndmda.org
NAMI The Nation's Voice on Mental Illness
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
Helpline: (800) 950-NAMI (6264)
Tel: 703-524-7600
Fax: 703-524-9094
Website: www.nami.org
National Foundation for Depressive Illness, Inc.
P.O. Box 2257
New York, NY 10116
Telephone: 212-268-4260; 1-800-239-1265
FAX: 212-268-4434
Website: www.depression.org
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
Telephone: 703-684-7722; 1-800-969-NMHA (6642)
FAX: 703-684-5968
TTY: 1-800-433-5959
Website: www.nmha.org |
