Bipolar Disorder in Children - Signs and Symptoms

Signs and Symptoms

Pediatric bipolar disorder causes a significant impairment in the ability of children to function normally, especially in academics and psychosocial areas, and it is a chronic disorder that persists throughout the lifetime. Children with PBD experience chronic periods of mania, characterized by elevated and irritable moods, or depression. The DSM-IV-TR states that the requirements for mania include inflated self-esteem, decreased need for sleep, and more talkative than usual. It is important to be able to tell the difference between a decreased need for sleep and insomnia which is the difficulty of falling or staying asleep. The American Academy of Childhood and Adolescent Psychology (AACAP) states that the same, unalthered DSM-IV-TR criteria should be used with children, adolescents, and adults. PBD patients are ten times more likely to commit suicide than healthy children. Severe manic and depressive symptoms are associated with early age of diagnosis, meaning children often display more acute symptoms than adults. In children, mania often presents with psychotic symptoms and mixed manic depressive episodes. Such a presentation of mania often differs from classic descriptions of mania in adults, yet children who are diagnosed with bipolar disorder show the same brain abnormalities as adults, further complicating diagnosis. Children with PBD display anger, dysphoria, irritability, belligerence, and mixed-manic depressive symptoms more commonly and for more erratic time periods than adults. Bipolar disorder is episodic, which means the symptoms do not always appear and may come and go at random times. The need for both elation and grandiosity is recommended and supported by many studies. "Findings from the Course and Outcome of Bipolar Illness among Youth (COBY) study, for example, suggest that, in about 80% of the cases, both elation and irritability are present during the most severe symptomatic episodes among youth with BD..." This requirement is not in the current issue of the DSM, but may be in the future.