Why Bipolar Disorder Can Take So Long To Diagnose
July 25, 2016 / 3:56 PM / HealthDay
People with bipolar disorder may face a long wait from when their symptoms start to the time they get a proper diagnosis.
In fact, a new study reports the average delay is six years.
That lost time can result in greater frequency and severity of episodes of the psychiatric condition, the researchers said.
“While some patients, particularly those who present with psychosis, probably do receive timely treatment, the diagnosis of the early phase of bipolar disorder can be difficult,” study leader Matthew Large, a professor psychiatry at the University of New South Wales, Australia, said in a school news release.
“This is because mental health clinicians are sometimes unable to distinguish the depressed phase of bipolar disorder from other types of ,” he added.
The new research reviewed the results of 27 past studies. Those studies included more than 9,400 patients.
Many patients had and disruptive symptoms for many years before they received proper treatment, the researchers noted.
The delay in diagnosis and treatment was often longer for young patients because symptoms such as can sometimes be mistaken by parents and doctors as just part of being a teen, the study authors said.
“The diagnosis of bipolar disorder can also be missed because it relies on a detailed life history and corroborative information from careers and family, information that takes time and care to gather,” Large explained.
If My Child Wants To Move Out What Do I Do
Remember that confrontation, arguing, and criticism usually arent helpful in any circumstance with your child, says Gregory Simon, M.D., a psychiatrist and researcher at Kaiser Permanente Washington in Seattle. We cant force others to do what we want them to do, but we can provide guidance and encouragement, Dr. Brister says. Share your concerns with your child and talk about what involvement youll have once theyre living independently. If you dont yet have your childs permission to talk to their providers, ask for it nowin case you need to step in and help.
Adhd And Bipolar Disorder
Sometimes the symptoms of and mania or hypomania associated with bipolar disorder can be very similar. Kids might exhibit distractibility, talkativeness, difficulty maintaining attention, and loss of social functioning. Clinicians must assess whether it is one condition or whether the disorders are co-occurring. A child may have both ADHD and bipolar disorder if they experience behavioral outbursts, severe mood swings, and impulsive behaviors. If your child has already been diagnosed with ADHD and they exhibit an inflated sense of self, risky sexual behavior, lack of need for sleep, and self-harming behaviors, then they also may be experiencing mania associated with bipolar disorder. A child psychiatrist can help rule out other diagnoses and suggest treatment options.5
Treating Bipolar Disorder In Kids And Teens
New research is helping practitioners better understand the symptoms of pediatric bipolar disorder
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Of the nearly 11,000 articles on bipolar disorder in children and adolescents, more than 90% have been published in the last 15 yearsafter most practitioners were trained and licensed. Keeping up with that explosion of literature can be a challenge, says Eric Youngstrom, PhD, a professor of psychology, neuroscience and psychiatry at the University of North Carolina at Chapel Hill .
Its great to have the research, says Youngstrom, who also directs the Center for Excellence in Research and Treatment of Bipolar Disorder at UNC Chapel Hill. But the speed of its arrival creates a challenge. How do we find and digest it? How do we learn about new tools and skills and use them?
Over the past decade or so, experts across psychology and psychiatry have helped refine assessment and treatment of bipolar disorder among children and adolescents.
Help Your Loved Ones Understand
Accepting your diagnosis is the first step. While it may be difficult, your loved ones may have a hard time understanding your diagnosis. It may even feel like they arent being as supportive as they could be at times. Thats why its important to talk with them. And keep talking.
To start and keep the conversation going
- Ask your loved ones how they feel about your condition
- Keep them informed of steps youre taking to manage your symptoms
- Ask them for support
Changing Your Outlook May Help
Sometimes it can be a challenge when you have a bad day, such as arguing with a loved one or friend, experience a financial problem, or go through an unexpected event. However, with some practice, you may be able to change how you view these stressful times.
Changing how you view events may help you see stressful events as more manageable. And, it may be enough to have a positive effect.
To start, try these tips:
Notice your thoughtswhen you start to get upset by stressful events, take noteThink about the factstry to avoid black-or-white thinking. Take a step back and examine the eventCreate a positive viewtry thinking of the positives regarding stressors. And remember, sometimes something that seems bad may eventually result in a positive
Try practicing positive thinking as events and stressors arise and see how it works for you.
Unspecified Bipolar Disorder: Definition Causes Symptoms And Treatment
Some bipolar disorders dont have a specific pattern. They also dont match the other three disorders. Yet, they still have to meet the criteria for abnormal mood changes.
The subtypes of bipolar disorder are bipolar 4 and 5. They are subthreshold types of disorder. This means their symptoms are not as pronounced.
Bipolar IV Disorder
In this subtype, hypomanic and manic episodes come from taking antidepressant drugs. Doctors prescribe antidepressant medication to treat other types of mental illness. Unfortunately, this can trigger bipolar disorder.
Patients must then learn to cope with the manic and depressive feelings. They must learn to avoid substances like alcohol as well.
Bipolar V Disorder
This subtype involves people who have genetic bipolar disorder. The patient only suffers from major depression despite a family history of bipolar disorder.
Bipolar Disorder In Children And Teens
Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows more often than other children? Do these mood changes affect how your child acts at school or at home?
Some children and teens with these symptoms may have bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, activity levels, and day-to-day functioning. With treatment, children and teens with bipolar disorder can get better over time.
Bipolar Disorder And Relationships
When it comes to managing a relationship while you live with bipolar disorder, honesty is the best policy. Bipolar disorder can have an impact on any relationship in your life, perhaps especially on a romantic relationship. So, its important to be open about your condition.
Theres no right or wrong time to tell someone you have bipolar disorder. Be open and honest as soon as youre ready. Consider sharing these facts to help your partner better understand the condition:
- when you were diagnosed
- what to expect during your depressive phases
- what to expect during your manic phases
- how you typically treat your moods
- how they can be helpful to you
One of the best ways to support and make a relationship successful is to stick with your treatment. Treatment helps you reduce symptoms and scale back the severity of your changes in mood. With these aspects of the disorder under control, you can focus more on your relationship.
Is It Teenage Mood Swings Or Bipolar
As your read through the symptoms, you might be thinking: “Don’t all teens exhibit those symptoms sometimes?”
The short answer is “yes.”
But there are significant differences that a mental health professional will look for to determine whether you’re dealing with teenage bipolar symptoms or one of the other issues misdiagnosed as bipolar disorder.
Typically, a person displaying symptoms of bipolar disorder will:
- Have a history of episodic mood swings
- Be more likely to be withdrawn and sleep more, rather than less
- Be less likely to exhibit agitation and weight loss
- Be relatively young at onset
- More commonly exhibit atypical symptoms of depression
- Have a family history of bipolar disorder
- Have brief, but numerous episodes
- Not respond well to antidepressant therapy
- Have a tendency toward psychotic behavior
- Have a seasonal pattern to their moods
- Be more likely to abuse substances or attempt suicide
As you can see, the differences are subtle but real.
That’s why it’s critical to keep an eye on your teen’s symptoms, even keeping a diary of moods and episodes if possible. That way your doctor will have the most information possible to make a clear and correct diagnosis.
What To Do When Things Escalate
The extreme mood swings associated with bipolar disorder can be unpredictable and scary for both the person experiencing them and anyone who witnesses them. During a severe mood episode, your teens judgment will be seriously impaired. During a manic phase, they may engage in risky behavior that can have serious consequences, go several days with little to no sleep, become hostile and violent, increasingly disorganized, or psychotic. These erratic behaviors can put your teen, your family, and others at risk. During a depressive phase, your teen may become actively suicidal. Theres also a greater risk of drug or alcohol misuse or abuse during a depressive phase.
If your teen spirals out of control, you need to take steps to ensure everyones safety. A brief hospital stay may be necessary to keep your teen safe and get manic or depressive symptoms under control. Dont hesitate to reach out for help. You can:
- Contact your childs treatment provider
- Enlist the help of a close family member or friend
- Take your child to the nearest hospital emergency room
Signs And Symptoms Of Bipolar Disorder
On average, it may take up to 6 years for someone to get a bipolar disorder diagnosis. This could be due to the difficulty of differentiating it from depression. It could also be due to the presence of a co-occurring disorder or addiction.
The American Journal of Managed Care says 56 percent of bipolar people have an addiction. Alcohol is the substance bipolar people abuse the most. Such substances complicate the disorder screening process. They make it difficult to make a timely and accurate diagnosis.
Its tough to diagnose young patients as well. Thats because teenagers are at the age where they can experience constant mood swings. Some of them also experiment with many drugs. This skews the results of their medical checkups.
Patients go through about three incorrect diagnoses before doctors discover they are bipolar. Dr Wes Burgess wrote that in Bipolar Handbook: Real-Life Questions with Up-to-Date Answers. This means people suffer from their symptoms for years before they get treatment.
The problem with this condition going untreated is it may destroy the persons life. It leads to bankruptcy, risky behavior, substance abuse, deteriorating relationships, and death. Moreover, struggling to understand ones risky actions can cause more stress.
As mentioned earlier, the various symptoms appear during one of the patients episodes. Out of the normal phase, the patient will be in a depressive or manic state.
- High-energy and tirelessness
- Strong sex drive
What Should I Do If My Child Stops Taking Their Meds
Its common for a person with a mental illness to stop their medication, so expect this to happen at some pointand be prepared, advises Dr. Brister. Talk to your child about the consequences of stopping medication and give feedback on the positive changes you see from treatment, Dr. Hamilton suggests. Remember, this is your childs lifetreatment choices are ultimately theirs to make, Dr. Brister adds. Like any other choices our adult children make, we may not always agree. And this doesnt mean that they arent doing well.
Following Your Treatment Plan
Once youve started a treatment plan, you may start to feel better and think you dont need your medication. However, if youre having doubts about your treatment plan or medication, talk to your doctor.
Remember, bipolar depression is a lifelong condition that requires treatment. If youre feeling better, chances are its because your treatment plan is helping to control your symptoms.
What Is Bipolar Disorder In Teens
Bipolar disorder is a type of depression.
There are 3 main types of depression:
Persistent depressive disorder
A teen with bipolar disorder often has extreme mood swings. These mood swings go beyond the days normal ups and downs. A teen may have times of great elation, happiness, elevated mood, or irritability. This is called mania. These episodes are countered by periods of major depression. That is why this disorder has two poles or symptoms.
How Getting The Wrong Diagnosis Can Be Harmful
For individuals who are misdiagnosed with bipolar disorder, one potential pitfall may involve health problems that result from taking the prescription drugs used to treat the condition, according to Zimmerman. He notes that some medications, including atypical , can increase the risk for high cholesterol and diabetes, while others, such as lithium, have been linked to and kidney problems.
Conversely, up to 20 percent of people with bipolar disorder may be mistakenly diagnosed with depression by their primary care doctors, according to a study published in July 2011 in the British Journal of Psychiatry. And another study, published in August 2017 in the journal Bipolar Disorders, analyzed the delay in diagnosis of 382 people with bipolar disorder and found that 90 of those individuals initially received a diagnosis of depression before being correctly diagnosed. According to the study, the lag between diagnoses was about nine years. The patients who were originally diagnosed with depression tended to be younger, have more manic symptoms, and have better coping skills, which perhaps helped them function throughout the day and contributed to the delay in getting the correct diagnosis.
These findings arent surprising, says Jeremy Schwartz, a psychotherapist in Brooklyn, New York. Bipolar disorder can be hard to diagnose, he says, because people often seek professional help only during their down periods and neglect to mention their up, or manic, periods.
Difference Between Type 1 And Type 2
The main difference between type 1 and type 2 bipolar is full manic episodes. Bipolar II patients dont go beyond hypomania. Second, bipolar II disorder has more frequent cycling than bipolar I disorder. It also has a more chronic course than type 1.
When it comes to diagnosis, it is much easier to confirm bipolar 1 than bipolar 2. This is because type 1 looks for evidence of a manic episode. Type 2 depends on identifying hypomania after emerging from a depressive state.
Bipolar II patients are more likely to commit suicide than those with bipolar I disorder.
Proactively Manage Your Triggers
Working closely with your doctor and getting support from your loved ones is essential when treating your bipolar depression. Another crucial part of your treatment is understanding and managing your triggers.
Triggers are external environmental factors that could set off an episode of depression. Once you know your triggers, you may be able to better manage them and your reactions.
Some triggers you should pay attention to include:
- Lack of sleepideally you should keep a regular sleep schedule
- Stressstress can include both good and bad life events. These events may include going away to college, getting married, giving birth, losing a loved one, financial strains, job loss, moving or a breakup/divorce
- Seasonal changessome episodes may follow a seasonal pattern
To help maintain and manage your triggers:
- Educate yourselflearn about bipolar depression and its challenges to be a better advocate for yourself
- Live healthyexercise regularly, eat balanced meals, and stick to a sleep schedule
- Stay connectedjoin a support group or talk with a loved one
- Monitor your moodstracking your sleep, activities, and feelings may help you see patterns and changes
Identifying and understanding your triggers is important. Becoming more aware of those factors can help you develop a plan to manage or avoid those triggers.
Bipolar Disorder In Young Children
Diagnosing bipolar disorder in young children is difficult, because many of the symptoms are similar to those of attention deficit hyperactivity disorder or conduct disorders — or even just normal, childhood behavior. One problem is that used for are often stimulants, which can potentially trigger in children with bipolar disorder.
Young children in a manic phase might be more irritable than adults; they may be more likely to have psychotic symptoms, hearing and seeing things that aren’t real. During a depressive episode, they might be more likely to complain of physical symptoms, like aches and pains.
One of the most notable differences is that bipolar disorder in children cycles much more quickly. While manic and depressive periods may be separated by weeks, months, or years in adults, they can happen within a single day in children.
Early Diagnosis Is Best
According to Dr. Casdorph, researchers have found that the earlier the diagnosis and the sooner treatment begins, the fewer problems the child will have into adulthood. There is no cure yet for bipolar disorder, but weve found that 90 percent of kids who are diagnosed with bipolar disorder as a child have a long and happy life if they use their medications properly and receive the proper education about their condition, he says.
Because bipolar disorder can be devastating to the entire family, Dr. Casdorph believes family counseling is necessary. The entire family, especially parents, needs to know exactly what is going on and what to expect. They need counseling to understand the gravity of the situation and how best to manage it.
With proper treatment, bipolar children and teens can have a normal life. They can have lots of friends, avoid trouble at school, get good grades, control their anger, sleep regularly, and avoid mood issues, says Dr. Casdorph. Their minds can be at rest without the chaos they had before, he adds.
To learn more about bipolar disorder, talk to your doctor or health care provider or search for a provider.
Health Tips – Bipolar Disorder
Bipolar Disorder in Teens
1)Bipolar disorder is a chronic, severe mood disturbance. Typically, it’ll start before the age of 18 children are being diagnosed with it. It’s a chronic, serious illness with major complications if not treated.
Symptoms Of Bipolar Disorder
4)and it has to last at least seven days.
Which Teens Are At Risk For Bipolar Disorder
A teen is at higher risk for bipolar disorder if another family member has it. Researchers are still looking for the gene or genes that may cause the disorder.
The disorder often starts in the teen years or early adulthood. It affects boys and girls equally. But girls tend to have more symptoms of depression.
Stage 2 Tightening The Definition Of Bp And Beginning To Define A New Diagnosis
In the early 2000s, some researchers began to speak of a BP spectrum, stretching from Narrow Phenotype BP to Broad Phenotype BP. Narrow Phenotype children were largely synonymous with strictly defined BP-I patients. In 2003 Ellen Leibenluft et al., described the Broad Phenotype children:
Children exhibiting the broad phenotype may ultimately prove to be a heterogeneous group. Some may eventually meet the strict criteria for mania; the course of others’ illness may be consistent with dysthymia, major depressive disorder, or some form of disruptive behavior disorder; and still others may prove to have a syndrome that is not well captured by the current diagnostic system .
That is, while there was a small group of children who did warrant the Narrow Phenotype BP label, there was a larger group that would be better be captured under the rubric of Broad Phenotype BP. Some of the children in that latter, heterogeneous group might someday exhibit BP I, some might be conceptualized as exhibiting depression or a disruptive behavior disorder–and some might best be conceptualized as having a disorder that was not articulated in DSM IV. That is, Leibenluft et al. were suggesting that some children who had been receiving a BP diagnosis might be better served by a new diagnosis, perhaps called Severe Mood Dysregulation .
Disagreement About Labels But Agreement That These Children Desperately Need Help
Some researchers, physicians, and parents argue that the sharp increase in rates of BP diagnosis simply reflects overdue recognition of this disorder in children. As workshop participant and patient advocate Susan Resko urged us to remember, a 40-fold increase sounds like a lot until one recalls the raw percentages: from the BP diagnosis being present in 0.025% of office visits in 1994 to it being present in approximately 1.0% of the visits in 2003. Moreover, these percentages refer to a clinic sample, not the community at large.
Those who are not alarmed by the increase suggest that in the past clinicians missed cases of BP because they did not understand that it can affect children and because BP symptoms can look different in children and adults. As child psychiatrist David Axelson asked, “if it is possible for children to suffer from anxiety, depression and other disorders experienced by adults, why not BP?” Moreover, they emphasize that, untreated, these children risk school failure, rejection by peers, physical injury, substance abuse, and even suicide–and their families can be torn apart.
How Does Bipolar Disorder Affect Caregivers And Families
Caring for a child or teenager with bipolar disorder can be stressful for parents and families. Coping with a childs mood episodes and other problemssuch as short tempers and risky behaviorscan challenge any caregiver.
It is important that caregivers take care of themselves, too. Find someone you can talk to or consult your health care provider about support groups. Finding support and strategies for managing stress can help you and your child.
Diagnosing Kids Can Be Tricky
A bipolar disorder diagnosis is sometimes difficult with kids, says Dr. Casdorph, because they can’t always explain that their thoughts are racing, or admit that they’re doing certain behaviors that are inappropriate. Theres also a lot of overlap between bipolar disorder and other conditions that you see in kids, he says. Like ADHD. In fact, most kids who end up being diagnosed with bipolar disorder were first labeled with ADHD because hyperactivity and inattentiveness are common features in both conditions. One big distinction between the two is in bipolar disorder, you have a disturbance of sleep that’s abruptly different. The teen may sleep less yet still has plenty of energy to go around. And bipolar kids are more explosive than ADHD, and they have more episodes of outbursts.
One of the main risk factors for bipolar disorder is genetics, says Dr. Casdorph. Chances are, there’s somebody in the family that has had these kinds of problems. Because of that, many parents are at least aware of the concept.
Early Signs Of Bipolar Disorder In Teenagers
Bipolar disorder can arise at any age, including in children, but it most commonly develops in the late teens and early adult years. An estimated 2.8 percent of people over the age of 18 years in the United States have bipolar disorder.
The prevalence of the condition in men and women is approximately the same.
When symptoms show up during a persons adolescence or teenage years, it is important to consider that they are already going through a lot of changes due to puberty and hormonal shifts.
As a result, doctors will want to take great care to monitor the teen to ensure that they are not mistaking typical mood changes for signs of bipolar disorder.
Signs to look out for during a manic episode include:
- a short temper or unusual outbursts
- appearing extremely happy or acting very silly in a way that is not typical for people their age
- trouble sleeping or not sleeping at all
- not feeling tired
- feeling angry or irritated with no known cause
- changes in eating habits, for example, eating too much or too little
- having very little energy even if they got enough sleep
- taking little interest in activities that would usually excite them
- romanticizing death or thinking about taking their own life
In adults, an episode may range in duration from a few weeks to a few months. Between episodes, people may experience periods in which they have normal moods.
Bipolar disorder is a complex condition, and doctors do not fully understand what causes it.