Bipolar Disorder in Children

Bipolar Disorder In Children

Bipolar disorder (BD) in children, or pediatric bipolar disorder (PBD), formerly known as "manic depression", is characterized by extreme changes in mood that range from depressive "lows" to manic "highs" (typified by feelings of excessive happiness or rage). It is important to note that these moods exceed normal responses to life events, represent a change from the individual's normal functioning, and cause problems in daily activities - for instance, in getting along with family, friends and teachers, or in completing schoolwork.

Depressive symptoms of BD often include sadness, irritability, an inability to enjoy one's usual activities, changes in appetite or weight, and/or sleeping more than normal or having difficulty falling/staying asleep even when tired. Manic symptoms of BD may include: inflated or unrealistic self-esteem; less need for sleep; talking more/faster than normal; changing the topic of conversation so quickly/often that it interferes with communication; experiencing "racing" thoughts; increased distractibility; difficulty sitting still; an unusual drive to engage in activities or pursue goals; and engaging in risky or dangerous behaviors.

Identifying BD in youth is challenging because, while adults with BD often have distinct periods of depression and mania that last for weeks, months, or longer, youth diagnosed with BD frequently have depressive and manic symptoms that occur daily, and sometimes simultaneously. Comorbid disorders are common, which makes determining what symptoms are signs of BD and which are due to other disorders (e.g., depression, ADHD, disruptive behavior problems) critical.

The diagnosis of bipolar disorder in children is a controversial topic. While some believe the DSM-IV-TR criteria should be followed others have proposed other behavioral markers specific for children BD. The DSM-5 may include a new type of mood and conduct disorder, Disruptive Mood Dysregulation Disorder, as a replacement for most pediatric bipolar diagnoses. Some prominent psychiatrists, such as Dr. Stuart Kaplan and Dr. Allen Frances, advocate applying less severe and better-researched diagnoses such as ADHD and Oppositional Defiant Disorder instead of pediatric bipolar disorder. Another origin for controversy is the rise in the number of diagnoses in the last years, almost exclusively in the USA, with several possible causes for this increase. It has been argued that several factors including biomedical reductionism, neglect of trauma and attachment factors, the symptom checklist but decontextualised model of psychiatric nosology embodied in DSM, influence of the pharmaceutical industry and "diagnostic upcoding" particularly in the US health system have contributed to the epidemic of pediatric BD.

Prevalence of children who meet DSM criteria for BD is around 2%, but it can be argued that DSM criteria are interpreted differently by different researchers. For example ultradian cycling of mood is highly controversial as having validity for episodes of mania or hypomania as a more traditional interpretation requires sustained manic/hypomanic mood states over several days to weeks or months.

Management usually consists of pharmacological and psychological therapy. The drugs most commonly used are mood stabilizers and atypical antipsychotics. Psychological treatment usually combines education on the disease, group therapy and cognitive behavioral therapy. Cases of BD in children have been known for a long time, although they were thought to be rare. This view has changed since the mid 1990s, and future research directions include improving treatments, diagnostic criteria, and the knowledge of BD in children.