How Is Bipolar Disorder Treated
Children and teens can work with their health care provider to develop a treatment plan that will help them manage their symptoms and improve their quality of life. It is important to follow the treatment plan, even when your child is not currently experiencing a mood episode. Steady, dependable treatment works better than treatment that starts and stops.
Treatment options include:
Treatment Of Comorbid Adhd And Bipolar Disorder
The symptoms of ADHD and bipolar disorder can overlap to some degree and result in misdiagnoses for one or the other condition. Treatment of patients with comorbid bipolar disorder and ADHD is complicated by the fact that bipolar disorder is frequently treated with mood stabilizers, while ADHD is often treated with stimulant medication. Stimulant medications have a risk of exacerbating manic episodes for someone with bipolar disorder.
Recent research has shown some success in using both types of medications for these patients, but it must be monitored. The overall health impacts and the higher risk of suicide that accompany bipolar disorder make it imperative for individuals with ADHD to begin treatment as early as possible when symptoms of the condition first appear.
Symptoms Of Late Onset Bipolar Disorder
One of the reasons bipolar disorder is often misdiagnosed in seniors is because the symptoms are slightly different.
According to professor of clinical psychiatry at Columbia University, Michael First, M.D., seniors seldom exhibit the classic signs of a manic episode. Instead of feeling elated and displaying risky behaviors, seniors are more likely to show signs of agitation and irritability. This is often confused with the normal feelings of aging, leading to misdiagnosis.
Some of the other symptoms commonly noted in seniors with bipolar disorder include,
When bipolar disorder does appear in adults over 60, the symptoms can be sudden and severe. It often seems to cycle faster between depression and mania, and some seniors report experiencing both episodes at the same time.
Seniors with bipolar disorder frequently experience problems with cognitive function that often include,
- Problems with memory
- Loss of perception and judgement
- Difficulty problem solving
Since these are also common signs of dementia and Alzheimers, the bipolar disorder is often misdiagnosed.
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Patterns Of Depression And Mania
If you have bipolar disorder, you may have episodes of depression more regularly than episodes of mania, or vice versa.
Between episodes of depression and mania, you may sometimes have periods where you have a “normal” mood.
The patterns are not always the same and some people may experience:
- rapid cycling where a person with bipolar disorder repeatedly swings from a high to a low phase quickly without having a “normal” period in between
- mixed state where a person with bipolar disorder experiences symptoms of depression and mania together for example, overactivity with a depressed mood
If your mood swings last a long time but are not severe enough to be classed as bipolar disorder, you may be diagnosed with a mild form of bipolar disorder called cyclothymia.
What Is Bipolar Disorder
Bipolar disorder is a mental disorder that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. Sometimes children with bipolar disorder feel very happy or up and are much more energetic and active than usual. This is called a manic episode. Sometimes children with bipolar disorder feel very sad or down and are much less active than usual. This is called a depressive episode.
Bipolar disorder, which used to be called manic-depressive illness or manic depression, is not the same as the normal ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms can make it hard for young people to perform well in school or to get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide.
Most people are diagnosed with bipolar disorder in adolescence or adulthood, but the symptoms can appear earlier in childhood. Bipolar disorder is often episodic, but it usually lasts a lifetime.
With treatment, children and teens with bipolar disorder can manage their symptoms and lead successful lives.
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Severe Changes In Mood
When heading for a manic episode, children with bipolar disorder become either overly elated or extremely irritable. In many cases, a child will display an abnormal sense of happiness and euphoria that may make him act silly in an unusual way. You may notice intense tantrums in younger children or see uncontrollable impatience and frustration in teens that can be long lasting.
Stage : Expanding The Definition Of Bp
Geller et al., Wozniak et al., and Biederman et al., were not the first to challenge the view that mania is rare in children, but their 1994 and 1995 papers have proved highly influential.
In 1994, Geller et al. reported that 32% of a sample of 79 children diagnosed with major depression had converted to BP-I or BP-II when followed over a 2-5 year period . The following year, Geller et al. reported diagnosing 26 children aged 7-18 years with BP using a semi-structured diagnostic interview instrument . They sought to define BP in a way that would allow them to cleanly distinguish it from ADHD: because one of the cardinal symptoms of mania–irritability–is also a symptom of ADHD, they would not give a BP diagnosis to children who exhibited only irritability. On their approach, for mania to be present , children had to exhibit elevated or expansive mood or be grandiose. Crucially, they also maintained that manic and hypomanic symptoms look different in children than in adults. Specifically, they modified DSM’s criteria to allow a diagnosis of mania in children who rapidly cycled from mania or hypomania to euthymia or depression, including those who switched moods in the course of a day, and those whose symptoms did not have onset at the same time .
Diagnosing Psychiatric Disorders In Children Can Be Challenging
Before taking a closer look at the debates in the US, we should recall two reasons that it can be difficult to diagnose psychiatric disorders in children. Psychiatric disorders are predictable clusters of emotional, behavioral and sometimes somatic symptoms that cause impairment and emerge on a spectrum. Bright lines do not separate individuals whose emotions and behaviors are and are not disordered enough to receive a BP diagnosis. Second, because different diagnoses, some of which are themselves contested can share some of the same symptoms, deciding which diagnostic label to apply to a particular patient can be challenging.
Moreover, identifying symptoms and making a diagnosis can be harder in children than in adults. Younger persons can have difficulty noticing and describing symptoms and providing accurate accounts of time of onset and duration of symptoms . Further, given how rapidly children’s brains develop, even practitioners can and do disagree about whether a given behavior or mood is developmentally appropriate or a symptom of disorder. Is, for example, a 4-year-old’s claim that she is superwoman a sign of imagination, self-confidence, or grandiosity? If a child accompanies her claim to be superwoman with a clear indication that she is about to jump from a hotel balcony, there is good reason to infer the presence of a symptom. Other times the answer will be less obvious.
What Can You Do If You Have Bipolar Disorder
The high or low episodes can last from a few weeks to months. It is important to recognise that you are not alone and to keep up hope. Some people only have one or two episodes. For others the highs and lows can occur through their adult life. When this happens, it is important that you learn to live with it and manage it.
- The first step is recognising that something is different or a problem. Other people are likely to have noticed that you seem different from your usual self, particularly those who live with you.
- Speak to people who know you well, such as family and friends.
- Seeking medical advice early on is very important. If the bipolar illness can be identified and treated quickly, this reduces its harmful effects.
- If you already have a diagnosis, understand your illness and problems. This can help you to take control and get help before it gets more difficult. This can mean steps like planning for a crisis and making choices about your career.
- Do things which help you to have a good health, like having a balanced healthy diet, doing some exercise, and getting a good nights sleep.
- Try to identify what makes you feel stressed and identify ways of dealing with it.
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Bipolar Disorder In Kids
Judith Lederman’s son tried to jump off a pier in his first suicide attempt. He was 5 years old. “A psychologist said he was just trying to get attention,” Lederman recalls. “He was 8 years old when he had his first full-blown manic episode,” says Lederman. “He stopped sleeping for days on end, became very hostile, was pulling knives on us, and tried to attack his brother.”
Lederman and her husband took their son to the hospital, where he was admitted for a three-day evaluation. At the end of the three days, he had been diagnosed with bipolar disorder.
From that day forward, the Lederman family’s life changed. And even though their son’s condition is now stable, it requires “constant vigilance,” says Lederman, author of the forthcoming book, Swing Shift: The Ups & Downs of Parenting a Bipolar Child.
Previously known as manic-depression, bipolar disorder is a mood disorder marked by extreme changes in mood, energy levels, and behavior. Although symptoms typically emerge in adolescence or adulthood, they can be seen in children as young as 7 or 8, says Robert Kowatch, MD, professor of psychiatry and pediatrics at Cincinnati Children’s Hospital Medical Center.
What To Do If You Suspect Bipolar Disorder In An Autistic Person
If you think your symptoms or those of a loved one are the result of bipolar disorder, see a psychiatrist. They can determine whether an acute medical issue is responsible for the symptoms.
If they rule out such a condition, they can refer you to another mental health specialist. While general practitioners are wonderful for many health issues, consulting with a psychiatrist or other mental health expert is best in this situation.
Make an appointment with one of these specialists to review your concerns. Together, you can work to find a diagnosis or an explanation for the symptoms youre experiencing, whether thats bipolar disorder or another condition.
The Rate Of Bp Diagnoses Is Rising Faster In The Us Than Elsewhere
Though debates about the diagnosis of BP in children can be traced back to the 1950s , and though Gabrielle Carlson published “Bipolar affective disorder in childhood and adolescence” in 1983 , the rapid increase in the number of diagnoses of BP did not begin in the US until the mid 1990s . While some symptoms now associated with the BP label can be found in previous versions of the DSM in descriptions of disorders such as “unsocialized aggressive reaction of childhood,” “adjustment reaction of childhood,” and “schizophrenic reaction, childhood type,” DSM’s description of BP did not in the past and does not now explicitly address diagnosis of this disorder in childhood.
Table 1 Timeline: The Recent Debate about BP in Children
The increase in diagnoses seems to begin with germinal 1994 and 1995 articles by Barbara Geller et al., Janet Wozniak et al. and Joseph Biederman et al., which proposed that BP was more prevalent in children than previously thought . When DSM-IV was published in 1994, it contained a new section, “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.” While this section does not specifically mention BP, it does contain the observation that “many disorders included in other sections of the manual have an onset during childhood or adolescence .”
Less Frequent Symptoms For Children With Bipolar Disorder:
- Migraine Headaches
- Self-Mutilating Behaviors
- Cruelty to Animals
It’s important to remember a childhood bipolar diagnosis is an expert opinion and not all experts will agree on what fits a child best. As more is learned about bipolar disorder in children, diagnoses and treatments are likely to change.
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Treatment Of Adhd In Patients With Bipolar Disorder
High-risk studies have reported an increased prevalence of attention-deficit/hyperactivity disorder in children born to parents with bipolar disorder . There is also evidence that children with ADHD have a higher risk of BD being diagnosed later in life. Given that ADHD is often a lifelong condition, it is expected and reported that ADHD and BD co-occur often.
A 25-year-old man first came to psychiatric attention when he was 18 years old after experiencing a manic episode with psychotic features in the context of cannabis abuse. He did not have any first-degree relatives with psychiatric disorders. Several years later, he presented with ADHD symptoms, mainly concentration and attention difficulties and impulsive behaviours. The diagnosis of ADHD was retained after a complete screening. The rest of the psychiatric evaluation did not identify any other symptoms. Atomoxetine was initiated and titrated to 80 mg daily. A dramatic improvement of ADHD symptoms was observed and was sustained for a few months without major adverse effects. Thereafter, he presented with disorganized behaviour, euphoria and religious exaltation. Atomoxetine was discontinued, and after few months he agreed to take long-acting aripiprazole. The manic symptoms remitted completely, and the patient resumed all functioning except for his work, owing to attention and concentration problems.
Case Study : Rachel’s Story Aged 15
“Rachel is fifteen-year-old girl who has suffered episodes of depression in the past. Two months ago she started to talk very quickly and seemed to have lots of energy. She was excited about everything and was making all her friends laugh a lot.
Over a three-day period Rachel barely slept or ate and started to say things that did not really make sense for example, she told friends that was a princess in Taiwan. She also started swearing and became extremely flirtatious, which was out of character. She is quoted as saying, “I’ve never felt so great – I’m flying. I’m eleven on a scale of one to ten.”
Rachel’s parents were very worried and on the fourth night of her not sleeping, they took her to the local A& E department, where she was seen by a psychiatrist who arranged for her to stay in hospital. A diagnosis of bipolar disorder was confirmed and treatment was given to bring Rachel’s mood back to normal. She now has treatment to help prevent episodes of both depressed and abnormally high mood in the future.
She has been working with a community psychiatric nurse to improve her abillity to recognise her own mood state and take measures to protect herself from further episodes.”
Extract from The Young Mind: an essential guide to mental health for young adults, parents and teachers.
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What Can Children And Teens Expect From Treatment
With treatment, children and teens with bipolar disorder can get better over time. Treatment is more effective when health care providers, parents, and young people work together.
Sometimes a childs symptoms may change, or disappear and then come back. When this happens, your childs health care provider may recommend changes to the treatment plan. Treatment can take time, but sticking with the treatment plan can help young people manage their symptoms and reduce the likelihood of future episodes.
Your childs health care provider may recommend keeping a daily life chart or mood chart to track your childs moods, behaviors, and sleep patterns. This may make it easier to track the illness and see whether treatment is working.
Bipolar Disorder In Children: Signs Symptoms Treatment
There is medical debate about whether bipolar disorder should be diagnosed in children as currently, there are no specific symptoms for bipolar disorder in children, only for adult bipolar disorder. Moreover, many clinicians believe bipolar disorder cannot be diagnosed in pediatric patients.
However, research suggests 20% – 30% of adults with bipolar disorder type 1 first showed symptoms before the age of 20. Additionally, 20% of youths diagnosed with depression later go on to experience a manic episode.2
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What To Expect From Treatment
The goal of treatment for bipolar disorder is to stabilize moods and prevent broad shifts in mood. This can help stop manic or depressive episodes. With proper treatment, someone with bipolar disorder may be able to regulate their own behavior and mood more easily.
Some psychiatrists may also prescribe a family treatment intervention, especially with children. This combination of education and therapy may help improve behavior and decrease severe shifts in mood.
For people with communication difficulties, which is common for people on the autism spectrum, this is a serious concern. If they arent able to communicate about their side effects, the toxicity may not be discovered until too late.Therefore, this medication should be taken with close supervision by ones caregivers and doctor.
Valproic acid is also an example of a mood stabilizer.
If other medications and interventions havent worked and the challenges are quite severe, autistic children may be prescribed one or more antipsychotic or mood-stabilizing medications.