Diagnosing Bipolar Disorder In Children
Bipolar disorder isnt only an adult problem, it can also occur in children. Diagnosing bipolar disorder in children can be difficult because the symptoms of this disorder can sometimes mimic those of attention-deficit hyperactivity disorder .
If your child is being treated for ADHD and their symptoms havent improved, talk to your doctor about the possibility of bipolar disorder. Symptoms of bipolar disorder in children can include:
- impulsiveness
- emotional outbursts
- periods of sadness
The criteria for diagnosing bipolar disorder in children is similar to diagnosing the condition in adults. Theres no particular diagnostic test, so your doctor may ask a series of questions about your childs mood, sleep pattern, and behavior.
For example, how often does your child have emotional outbursts? How many hours does your child sleep a day? How often does your child have periods of aggression and irritability? If your childs behavior and attitude are episodic, your doctor may make a bipolar disorder diagnosis.
The doctor may also ask about your family history of depression or bipolar disorder, as well as check your childs thyroid function to rule out an underactive thyroid.
How Is Nimh Addressing Bipolar Disorder
The National Institute of Mental Health conducts and supports research on bipolar disorder that increases our understanding of its causes and helps develop new treatments. Researchers continue to study genetics and bipolar disorder, brain function, and symptoms in children and teens who have bipolar disorder, as well as family history in health and behavior.
Learn more about NIMHs research priorities and current studies.
Bipolar Disorders: A Review
AMY L. PRICE, MD, Eastern Virginia Medical School, Norfolk, Virginia
GABRIELLE R. MARZANI-NISSEN, MD, University of Virginia School of Medicine, Charlottesville, Virginia
Am Fam Physician.;2012;Mar;1;85:483-493.
Bipolar disorders are common, disabling, recurrent mental health conditions of variable severity. Onset is often in late childhood or early adolescence. Patients with bipolar disorders have higher rates of other mental health disorders and general medical conditions. Early recognition and treatment of bipolar disorders improve outcomes. Treatment of mood episodes depends on the presenting phase of illness: mania, hypomania, mixed state, depression, or maintenance. Psychotherapy and mood stabilizers, such as lithium, anticonvulsants, and antipsychotics, are first-line treatments that should be continued indefinitely because of the risk of relapse. Monotherapy with antidepressants is contraindicated in mixed states, manic episodes, and bipolar I disorder. Maintenance therapy for patients involves screening for suicidal ideation and substance abuse, evaluating adherence to treatment, and recognizing metabolic complications of pharmacotherapy. Active management of body weight reduces complications and improves lipid control. Patients and their support systems should be educated about mood relapse, suicidal ideation, and the effectiveness of early intervention to reduce complications.
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Diagnosing Bipolar Disorder In Adults
Bipolar disorder, also known as manicdepressive illness, is a medical condition that causes a person to experience intense mood swings that alternate between depression and mania. These mood swings can last for hours, days, or even weeks.
Mental health specialists at NYU Langone Psychiatry Associates, such as psychiatrists, psychologists, and licensed clinical social workers, can help determine if a person has bipolar disorder and, if so, how best to manage symptoms.
When Should You Call Your Doctor
911, your provincial health information line, or other emergency services right away if:
- You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
- You have decided how to kill yourself, such as with a weapon or medicines.
- You have set a time and place to do it.
- You think there is no other way to solve the problem or end the pain.
- You hear voices.
- You have been thinking about death or suicide a lot, but you do not have a plan for suicide.
- You are worried that your feelings of depression or thoughts of suicide aren’t going away.
Seek care soon if:
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Mental Health Treatment Locator
The Substance Abuse and Mental Health Services Administration provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at www.nimh.nih.gov/findhelp.
Bipolar 1 Maintenance Treatment
Following remission of an acute episode, patients may remain at high risk for relapse for up to 6 months. This period of time is considered to be part of the maintenance phase.1 Maintenance treatment for bipolar 1 should be focused on preventing the relapse of manic or depressive episodes, reducing residual symptoms, reducing suicide risk, and improving the overall quality of life for the patient. Per the American Psychiatric Association guidelines, lithium, valproate, and lamotrigine exhibit significant utility in the maintenance of bipolar disorder.2,3
Of note, for patients treated with an antipsychotic medication during a preceding acute episode, the need for ongoing antipsychotic medication should be reassessed. Antipsychotics should be discontinued upon entering maintenance therapy unless they are required for control of persistent psychosis.2,3
As a clinical resource, the American Psychiatric Association has published a quick reference guide on treating bipolar disorders.
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Subtypes Of Bipolar Disorder
There are three main subtypes of bipolar disorder, classified under the DSM-5 Chapter on Bipolar and Related Disorders:1
- Bipolar 1 The individual fluctuates between episodes of mania or hypomania and major depressive episodes, or experiences a mix of these; at least one manic episode is required but a depressive episode is not required for diagnosis.
- Bipolar 2 The individual fluctuates between major depressive and hypomanic episodes; at least one depressive episode and one hypomanic episode are required for diagnosis. Anxiety and substance use disorders are common comorbidities.
- Cyclothymic disorder the individual experiences periods of hypomania and depressive symptoms that occur over at least 2 years. To rule out, the number, duration, and severity of symptoms must not meet the full criteria for a;major depressive episode;or a;hypomanic episode .
Other specified or unspecified bipolar and related disorders may be considered when the patient does not meet diagnostic criteria for the above three subtypes but still experiences clinically significant and abnormal periods of mood elevation. See more detail on diagnostic criteria.
A noted specifier in the bipolar spectrum is substance/medication-induced bipolar disorder. This occurrence refers to an episode of mania, hypomania, or depression that may be caused by alcohol, phencyclidine, hallucinogens, or amphetamines. SAMHSA notes that there are nine potential substance-induced disorders.
What Are The Complications Of Bipolar Disorder
If left untreated, bipolar disorder can lead to longer and more severe mood changes. For example, episodes of bipolar-related depression can last up to 6 months, while manic episodes can last up to 4 months without ongoing treatment.
Someone living with bipolar disorder may also have a higher risk of the following:
- unhealthy weight
- suicidal thoughts
Some of these problems may need to be managed at the same time as bipolar disorder.
With the right treatment and support, most people with bipolar disorder can live productive and fulfilling lives.
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How To Know If You Have Bipolar Disorder
If you think you may have bipolar disorder, its important to look at how this mental health condition might be impacting your daily life. While getting a professional diagnosis is the best way to truly determine if you do have bipolar disorder, there are some things you can look for on your own.;
In bipolar disorder, mania and depression can act together to create a constant rollercoaster of emotions that most people find difficult to deal with.
To find out how to know if you are bipolar, you can first ask yourself the following questions:
- Do you have symptoms of mania and/or symptoms of depression?
- Do you experience episodes of psychosis that are related to another illness?
- Does your depression and/or mania frequently occur in cycles?
- Does your depression and/or mania affect your daily life?
Its important to remember that depression and sadness are two different emotions, and mania and happiness are different as well.;
Symptoms of bipolar disorder can often mimic other illnesses like ADHD, major depressive disorder, and schizophrenia. Perhaps surprisingly, they can also mimic non-psychiatric diseases such as syphilis, HIV, and lupus.;
These are all reasons that seeking professional help is so essential in getting a diagnosis. Talk to your doctor or a mental health care professional for more about how to know if you are bipolar.
Symptoms And Diagnosis Of Bipolar Disorder
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Information presented in this article may be triggering for some people. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Bipolar disorder isn’t just about having mood swings. It’s a serious mental health condition that used to be referred to as manic depression.
According to the DSM-5, the guide used to diagnose mental illnesses, there are two main types of bipolar disorder that can be diagnosed based on the severity and nature of their symptoms:
- Bipolar I ;Individuals;with bipolar I experience at least one manic;episode in their lives. Although not required for the formal diagnosis, the vast majority will also experience major depressive episodes during the course of their lives.
- Bipolar II; Individuals;with bipolar II have at least one hypomanic episode and at least one major depressive episode.
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Whats The Screening Test For Bipolar Disorder Like
Current screening tests for bipolar disorder dont perform well. The most common report is the Mood Disorder Questionnaire .
In a 2019 study, results indicated that people who scored positive on the MDQ were as likely to have borderline personality disorder as they were to have bipolar disorder.
You can try some online screening tests if you suspect you have bipolar disorder. These screening tests will ask you a variety of questions to determine if youre experiencing symptoms of manic or depressive episodes. However, many of these screening instruments are home grown and may not be valid measures of bipolar disorder.
Symptoms for shifts in mood include:
| Mania, or hypomania | Depression |
When getting a diagnosis for bipolar disorder, the usual method is to first rule out other medical conditions or disorders.
Your healthcare provider will:
- order tests to check your blood and urine
- ask about your moods and behaviors for a psychological evaluation
If your healthcare provider doesnt find a medical cause, they may refer you to a mental health professional, such as a psychiatrist. A mental health professional may prescribe medication to treat the condition.
You may also be referred to a psychologist who can teach you techniques to help recognize and manage shifts in your mood.
Even in the case of rapid cycling or mixed episodes, a bipolar diagnosis requires someone to experience:
| Type |
Treating Bipolar Spectrum Disorders
Early assessment and treatment of bipolar spectrum disorders is crucial, especially considering that both medical and psychiatric comorbidities are common in this patient population. Further, the rate of suicide among individuals diagnosed with bipolar disorder is approximately 10 to 30 times higher than that of the general population.
See our bipolar 1 disorder treatment guidelines for mental health clinicians and new research on how brain patterns tied to reward anticipation may help clinicians differentiate bipolar disorder from schizophrenia.
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Bipolar 1 Vs Bipolar 2
All types of bipolar disorder are characterized by episodes of extreme mood. The highs are known as manic episodes. The lows are known as depressive episodes.
The main difference between bipolar 1 and bipolar 2 disorders lies in the severity of the manic episodes caused by each type.
A person with bipolar 1 will experience a full manic episode, while a person with bipolar 2 will experience only a hypomanic episode .
A person with bipolar 1 may or may not experience a major depressive episode, while a person with bipolar 2 will experience a major depressive episode.
Medications For Manic Hypomanic Or Mixed Episodes
Per the American Psychiatric Associations practice guidelines,2 in cases of severe mania or mixed episodes , the initiation of either lithium plus an antipsychotic or valproate plus an antipsychotic is recommended as first line. For less ill patients, monotherapy with lithium, valproate, or an antipsychotic may be utilized. Use of depot antipsychotics may be used if the patient is not willing to take oral medications.
Several large multicentric double-blind, placebo-controlled and comparative randomized studies have supported the use of antipsychotics, including the following, in the management of acute mania:3
- olanzapine
- paliperidone
- ziprasidone
For patients with breakthrough episodes of mania or hypomania , the first step in management involves optimization of the ongoing agent. Optimization may be achieved by monitoring serum levels of agents such as lithium or valproate. If necessary, the addition of antipsychotics and benzodiazepines may be used, depending on the severity of episode.
If the first-line agent, at optimal doses, fails to produce significant clinical benefit, alternative strategies may include switching lithium to valproate or vice versa, or adding carbamazepine or oxcarbazepine in lieu of additional first-line medication, or adding antipsychotics if not already used.
Clozapine may be particularly effective in the treatment of refractory illness.
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Can Bipolar Disorder Be Prevented
While theres no guaranteed way to prevent someone from developing bipolar disorder, many people successfully manage it with the right treatment and support. A successful strategy may include medication, therapy and other self-help strategies.
If you have a family history of bipolar disorder, its important to be aware of early warning signs, and for friends and family to be aware of them too. Avoid taking substances that can trigger manic or hypomanic episodes such as:
- recreational drugs such as cocaine, ecstasy and amphetamines
- excessive amounts of caffeine
Other ways to prevent relapses or episodes include learning to manage your stress and getting enough sleep.
Causes Of Bipolar Disorder
The exact cause of Bipolar Disorders is not precisely understood. It seems to be a combination of 3 things:
1. Genetics.
2. Chemical imbalances in the brain.
3. Stress and triggering events that somehow activate an inherited or genetic predisposition to the disorder.
When you go for an assessment, just like with any other illness, you will be asked about family history. A close relative such as a parent with suspected or diagnosed bipolar disorder greatly increases the likelihood other family members also having the illness.
So far, there does not seem to be any way to prevent the illness, but you can prevent some episodes of mania or depression once a doctor establishes that you do in fact have Bipolar I Disorder.
Bipolar I almost always requires the person to take medication for effective management. Dont worry stability and sanity is SO worth it!3
The key factor is stabilization. Regular therapy, a healthy diet, exercise and MOST OF ALL mood stabilizing medications such as lithium can greatly reduce the frequency and severity of Bipolar I episodes.
References:
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How Do I Get Help If I Think I Have Bipolar Disorder
The usual first step to getting help is to speak to your GP.
It can help to keep a record of your moods. This can help you and your GP to understand your mood swings. Bipolar UK have a mood diary and a mood scale on their website. You can find their details in the Useful contacts section at the bottom of this page.
Your GP cant diagnose bipolar disorder. Only a psychiatrist can make a formal diagnosis. Your GP may arrange an appointment with a psychiatrist if you have:
- depression, and
- ever felt very excited or not in control of your mood or behaviour for at least 4 days in a row.
They might refer you to a psychiatrist at your local NHS community mental health team .
Your GP should make an urgent referral to the CMHT if they think that you might have mania or severe depression. Or there is a chance that you are a danger to yourself or someone else.
Your GP should refer you to your local NHS early intervention team if you have an episode of psychosis and its your first one.
Bipolar disorder can be difficult to diagnose because it affects everyone differently. Also, the symptoms of bipolar disorder can be experienced by people who have other mental illness diagnoses. It can take a long time to get a diagnosis of bipolar disorder.
You can find more information about:
- NHS mental health teams by clicking here.
What Are The Different Types Of Bipolar Disorder
There are different types of bipolar disorder.
What is bipolar disorder I disorder?
A diagnosis of bipolar I disorder means you will have had at least 1 episode of mania that lasts longer than 1 week. You may also have periods of depression. Manic episodes will generally last 3-6 months if left untreated. Depressive episodes will generally last 6-12 months without treatment.
What is bipolar II disorder?
A diagnosis of bipolar II disorder means it is common to have symptoms of depression. You will have had at least 1 period of major depression. And at least 1 period of hypomania instead of mania.
What is bipolar I or II disorder with mixed features?
You will experience symptoms of mania or hypomania and depression at the same time. You may hear this being called mixed bipolar state. You may feel very sad and hopeless at the same time as feeling restlessness and being overactive.
What is bipolar I or II disorder with rapid cycling?
Rapid cycling means you have had 4 or more depressive, manic or hypomanic episodes in a 12-month period.
What is bipolar I or II with seasonal pattern?
Seasonal pattern means that either your depression, mania or hypomania is regularly affected in the same way by the seasons. For example, you may find that each winter you have a depressive episode, but your mania doesnt regularly follow a pattern.
There can be some similarities between bipolar I or II with seasonal pattern and another conditional called seasonal affective disorder.
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