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Pediatric Bipolar Disorder
Bipolar disorder is a brain disorder that is also referred to as manic-depressive illness which results in disturbances in the regulation of mood. Children with bipolar disorder experience extreme “ups" or mania, “downs" or depression, or a combination of both. Childhood bipolar disorder can challenge a child’s ability to do well in school and be successful in social relationships with friends and family due to mood episodes (NIMH). Mood episodes last for a week or longer and the symptoms of mania or depression will be evident for the majority of each day.
The symptoms, according to the National Institute of Mental Health, of childhood manic episodes and depressive episodes include:
- Feeling very happy of acting very silly in a way that’s unusual
- Having a very short temper
- Talking really fast about a lot of different things
- Having trouble sleeping but not feeling tired
- Having trouble staying focused
- Doing risky things
- Feeling very sad
- Complaining about pain a lot, including stomachaches and headaches
- Sleeping too little or too much
- Feeling guilty or worthless
- Eating too little or too much
- Having little energy and no interest in fun activities
- Thinking about death or suicide
A child can experience both manic and depressive symptoms during a mixed episode which must last for at least seven days. The National Institute of Mental Health said that children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated, but these symptoms could indicate other conditions as well.
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Diagnosis of Childhood Bipolar Disorder
According to the National Institute of Mental Health, no blood tests or brain scans can diagnose bipolar disorder but may be used to rule out other possible causes of a child’s symptoms. An evaluation for childhood bipolar disorder will review changes in a child’s mood, sleep patterns, activity or energy levels, and the family mental health history.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), there are four types of bipolar disorder:
1.) Bipolar I Disorder
Characterized by manic or mixed episodes that last at least seven days or severe manic symptoms which require hospitalization. Depressive episodes are usually experienced and last at least two weeks. Manic and depressive symptoms must be dramatically different from the child’s normal behavior.
2.) Bipolar II Disorder
Features a pattern of depressive episodes that shift back and forth with hypomanic episodes that are not full-blown manic or mixed episodes. A hypomanic episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood that lasts at least four days.
3.) Bipolar Disorder Not Otherwise Specified
A person has symptoms of the disorder that are outside the normal range of their behavior but they do not meet the diagnostic criteria for bipolar I or bipolar II.
4.) Cyclothymic Disorder or Cyclothymia
A mild form of bipolar disorder where children have episodes of hypomania that shift back and forth with mild depression for at least one year. The child does not meet the diagnostic criteria for any other type of bipolar disorder.
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Treatment of Childhood Bipolar Disorder
There is no cure for bipolar disorder and treatment is used to help control symptoms. Childhood bipolar disorder is treated with medication, psychotherapy, or a combination of both. The Systematic Treatment Enhancement Program for Bipolar Disorder, by the National Institute of Mental Health, found that combined treatment of medication and psychotherapy helped adults to get better faster and stay well longer than those who received less intensive psychotherapy. It is suspected that the combination would benefit children as well and research studies related to children are just beginning.
The motto for prescribing medication for a child with bipolar disorder is, “start low, go slow," so that the smallest amount of medication that relieves the symptoms can be detected (NIMH). Finding the right medication/s may take weeks or months. Keeping a log of symptoms can help the doctor to identify whether medication is necessary and assist in the selection of a specific drug. The most common medications prescribed for children to treat bipolar disorder are lithium, risperdone (Risperdal), and aripiprazole (Abilify).
Psychotherapy, also known as talk therapy, can assist children with behavior and routine management so that medication is taken regularly. McClellan and authors (2007) said that the goal of therapy is to ameliorate symptoms, provide education about the illness, and promote adherence to treatment, thus working to prevent relapse, reduce long-term morbidity, and promote normal growth and development. Common psychotherapy treatments include cognitive behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and psychoeducation (NIMH). Cognitive behavioral therapy helps children to identify and change negative thought patterns and behaviors. Family-focused therapy works with the family to develop coping strategies which improve communication and problem solving. Interpersonal and social rhythm therapy assists children with the management of daily activities and relationships. The National Institute of Mental Health emphasizes the importance of maintaining routine and sleep schedules in order to protect against manic episodes. Psychoeducation helps children and their families learn about bipolar disorder and its treatment. Both medication and psychotherapy in the treatment of bipolar disorder vary on an individual basis according to each child’s needs.
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American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edition, (DSM-IV-TR). Washington, DC: American Psychiatric Association.
McClellan, J. et al. (2007). Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder. Journal of American Academy of Child Adolescent Psychiatry, 46 (1), 107-125.
National Institute of Mental Health. Bipolar disorder in children and teens: A parents guide. U. S. Department of Health and Human Services. (http://www.nimh.nih.gov)