Child and Adolescent Bipolar Disorder: An Update from the National Institute of Mental Health
February 5, 2003
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....
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:
o Severe changes in mood — either extremely irritable or overly silly and elated
o Overly-inflated self-esteem; grandiosity
o Increased energy
o Decreased need for sleep — ability to go with very little or no sleep for days without tiring
o Increased talking — talks too much, too fast; changes topics too quickly; cannot be interrupted
o Distractibility — attention moves constantly from one thing to the next
o Hypersexuality — increased sexual thoughts, feelings, or behaviors; use of explicit sexual language
o Increased goal-directed activity or physical agitation
o Disregard of risk — excessive involvement in risky behaviors or activities
Depressive symptoms include:
o Persistent sad or irritable mood
o Loss of interest in activities once enjoyed
o Significant change in appetite or body weight
o Difficulty sleeping or oversleeping
o Physical agitation or slowing
o Loss of energy
o Feelings of worthlessness or inappropriate guilt
o Difficulty concentrating
o Recurrent thoughts of death or suicide
Symptoms of mania and depression in children and adolescents may manifest themselves through a variety of different behaviors. 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...
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. 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...
NIMH home page address: http://www.nimh.nih.gov