Bipolar Disease in Adolescence Southern New Hampshire University PSY-314-E3541 Disorders of Child/Adolescence Dolores Blier February 17, 2010 Abstract Bipolar in children is not something that should be taken lightly. When children are showing the symptoms of bipolar there is a great chance that they may be misdiagnosed. When dealing with a child that you think may have this disease you should consult a physician. There are medications that are available to help and even control the symptoms. There is a huge part that genes play in the disorder. When a parent or both parents have the disorder the percentage of the child inheriting the trait becomes higher. Genes play a great deal into this particular disorder. Bipolar Disease in Adolescence The Symptoms and Diagnosis: When a child is expressing behavioral problems here are some of the signs that should stand out. According to the (DSM-IV 2000) there are four types of bipolar: Bipolar I. In this form of the disorder, the individual experiences one or more episodes of mania. Depression occur, but not required to diagnose bipolar disorder. Symptoms of mania include: euphoria (elevated mood)silliness or elation that is inappropriate and impairing grandiosity flight of ideas or racing thoughts more talkative than usual or pressure to keep talking irritability or hostility when demands are not met excessive distractibility decreased need for sleep without daytime fatigue excessive involvement in pleasurable but risky activities (daredevil acts, hypersexuality) flight of ideas or racing thoughts poor judgment hallucinations and psychosis For an episode to qualify as mania; there must be elevated mood plus at least three other symptoms, or irritable mood plus at least four other symptoms. Symptoms of depression include: lack of joy and pleasure in life withdrawal from activities formerly enjoyed agitation and irritability pervasive sadness and/or crying spells sleeping too much or inability to sleep drop in grades or inability to concentrate thoughts of death and suicide fatigue or loss of energy feelings of worthlessness significant weight loss, weight gain or change in appetite Stable periods occur between episodes of mania and depression. An episode must last at least one week, or, if hospitalization is necessary, may be of any duration. Bipolar II. In this form of the disorder, the individual experiences recurrent periods of depression with episodes of normal mood (euthymia) or hypomania between episodes. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy. Hypomania can be a time of great creativity and energy and may, but not always, progress into full-blown mania if not treated. Some people with bipolar disorder never develop full-blown mania. Bipolar Disorder NOS (Not Otherwise Specified). Doctors may make this diagnosis when there is severe mood dysregulation with serious impairment, but it is not clear which type of bipolar disorder, if any, is emerging. Perhaps the individual has always been impaired, with cycling apparent since infancy. Maybe there have been no discernable periods of wellness. Perhaps the child is experiencing the emergence of another neurodevelopmental illness and the symptoms of that disorder have not yet been fully expressed. The inability to pinpoint a diagnosis should not be taken as a dismissal of the severity of the child's symptoms. Cyclothymia. This form of the disorder produces recurrent periods of less severe, but definite, mood swings that seriously impair the individual's life. Cyclothymia may progress into full bipolar disorder.End Match Bipolar is talked about as being the chameleon of disorders. (Mondimore, Bipolar Disorder, 1999) This is why this disorder is thought to be a form of ADHD. This disorder is typically misdiagnosed. Due to the fact that it has depression like symptoms it can be diagnosed as depression or borderline personality disorder. It is estimated that 85% of children with bipolar disorder also have ADHD and up to 22% of children with ADHD have bipolar disorder.(Singh, Co- occurrence of bipolar and attention-deficit hyperactivity disorders in children, 2006) Finding a Doctor and Treatments: When your child is showing signs of depression or abnormal social behavior a doctor should be sought out. The steps that should be taken to find a physician should start with the child's school. There are very few doctors out there that are experts in the area of pediatric bipolar disease. When you do find a qualified doctor you should do your research. The family doctor should always be contacted if not for just more information, but to also keep him/her updated. There is a chance that in an emergency that the doctors in the emergency room are able to help. (National Institute of Mental Health, 2010) There are different types of Medication, Counseling/Psycho Therapy, and Electro Convulsive Therapy. There are different types of medication are able to help the child is given one medication it may help the symptoms or make them worse. There is a chance that the child may have to try a few different medications to see which one works best. There are even chances that the child may need to take more than one type of medication. In some cases there is a chance that the original medication can cause other symptoms that can be taken care of with the additional meds. (National Institute of Mental Health, 2010) Children's bodies are still developing unlike full grow adults. When medication is necessary for children they should be given the fewest amounts and the smallest dosage possible to help the symptoms they are showing. When a child is prescribed medication the parent should be in constant contact with the prescribing doctor. If there are any side effects that the child is experiencing the doctor should be contacted immediately. If the child has been on the medication for a long period of time, the child should not stop taking the medication without speaking with their doctor first. If a medication is stopped suddenly there could be dangerous side effects. The treatment of disorder is to the of the physician. If the doctor chooses to medication as the main treatment the doctor will typically implement (Croft, Types of Bipolar Medications, 2009): Mood Stabilizers: Lithium (Eskalith, Lithobid, Divalproex (Depakote) Carbamazepine (Tegretol, Carbatrol) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topomax) Antidepressants: Bupropion (Wellbutrin) Begin Match to source 8 in source list: http://www.psychguides.com/Bipolar_2000.pdfFluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil), Sertraline (Zoloft) Venlafaxine (Effexor)End Match Antipsychotics: Begin Match to source 9 in source list: http://www.californiabipolarfoundation.org/medicationsOlanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Clozapine (Clozaril) Aripiprazole (Abilify) There is a great chance that relapse can happen even with the best treatments and medications. The child needs to be on a regiment of medication and therapy. When the child is placed on medication he/she should be in constant contact with both the prescribing physician and their therapist. The best results come when both coincide with each other if both are needed. When dealing with a child that has bipolar is the illness. Medication and psychosocial treatment can help manage the symptoms. When these are used in conjunction it can help to keep the child's behavior stable, and or more predictable. While trying to manage a child's symptoms medication will lesson them and psychosocial treatment whether it is family or individual this therapy is of great importance. In fact, a study of adults with bipolar disorder found that people taking medications to treat bipolar disorder are more likely to get well faster and stay well longer if they also receive intensive behavioral therapy. (Hellander, Child and Adolescent Bipolar Foundation, 2007) the benefit of the child the should be educated and brought up to speed on the illness. This education needs to be mostly for the parents. When the parents learn the symptoms of the disorder then they are able to redirect the child's actions to have more positive outcomes. This will help the child have a strong support system and stay on the treatments that are recommended. When the child is seeking treatment the child will then be less likely to relapse. There is also a chance that hospitalization is needed. When this happens it can be traumatizing to the child. This chart is from (Joan Arehart-Treichel, Rise in Hospitalization of Youth for Bipolar Disorder Puzzles Experts, 2007) [pic] According to (Hellander, 2007, Child and Adolescent Bipolar Foundation) there are different components that lead to a good treatment and what can harm a treatment plan: There are many components to a good treatment plan. Ideally, your menu will include: Medication and monitoring of side effects. Close monitoring of symptoms. Education about the illness for your child and you. Psychotherapy for your child and family. Treatment of coexisting disorders. Accommodations at school. Stress reduction. Good nutrition and steady exercise. Adherence to a regular sleeping schedule and a consistent routine. Factors that contribute to a better outcome are: Early diagnosis and treatment. Access to competent medical care. Adherence to medication and treatment plan. A flexible but consistent low-stress home and school environment A supportive network of family and friends Family members who are effective advocates for the child's medical, educational, and therapeutic needs Factors that hinder treatment effectiveness are: Time lag between onset of illness and treatment. Limited access to competent medical care. Not taking medication as prescribed. Not having a regular sleep/wake cycle. Co-occurrence of other disorders including any use of alcohol or unprescribed drugs. Stressful, inflexible, or negative home or school environment. Traumatic life events. Lack of insight. Genetics: Children with bipolar in their family history are more likely to get the disorder. Bipolar disorder is a complex genetic illness. The illness being inherited are extremely high. Published in the June 16, 2003 issue of the journal Molecular Psychiatry, the findings indicate that a mutation in a gene that regulates sensitivity to brain neurotransmitters such as dopamine, causes bipolar disorder in as many as 10 percent of bipolar cases. The mutation in this gene, G protein receptorkinase 3 (GRK3), occurs in a portion of the gene called the promoter, that regulates when the gene is turned on.End Match (Kelsoe and Barrett, Researchers Identify Gene Involved in Bipolar Disorder, 2003) The following statistics support the search for the genetic origins of bipolar disorder according to (Hellander, Child and Adolescent Bipolar Foundation, 2007). There are many statistics that fall into place when it comes to genetics: For the general population, a conservative estimate of an individual's risk of having Bipolar I disorder is 1% to 3%. Disorders in the bipolar spectrum are thought to affect at least 4% to 6 % of the general population. When one parent has bipolar disorder, the risk that his or her child will have bipolar disorder is 15% to 30%. When both parents have bipolar disorder, the risk increases to 50% to 75%. If a sibling (including a fraternal twin) has bipolar disorder, the child's risk is 15% to 25%. The risk in identical twins is approximately 85%. The family trees of many children who develop pediatric bipolar disorder include individuals who suffered from substance abuse or mood disorders (perhaps undiagnosed) or both. Because previous generations were less likely to diagnose bipolar disorder, affected family members may have been written off as "crazy Auntie" or simply as prone to troubling behaviors, such as alcoholism, frequent periods of unemployment, dysfunctional personal relationships, bankruptcies, or incarceration. Interestingly, the family tree might also have many members who are highly- accomplished, creative, charismatic and extremely successful in business, politics, and the arts. (Hellander, Child and Adolescent Bipolar Foundation, 2007) Reference: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000 Singh MK, Delbello MP, Kowatch RA, Strakowski SM. Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children. Bipolar Disord. 2006 Dec;8(6):710-20 Harry Croft, MD (Psychiatrist), Types of Bipolar Medications, Jul 08, 2009 Martha Hellander (J.D.), Sheila McDonald (J.D.), Lisa Pedersen (M.A.), and Susan Resko (M.M.), Child and Adolescent Bipolar Foundation, 2007 Dr. Duffy and her colleagues, Genetics and Risk, 2005 Kelsoe and Barrett, additional authors are Richard Hauger, M.D., and Meghan Alexander, B.A., UCSD and VA Departments of Psychiatry; James L. Kennedy, M.D., University of Toronto, Canada; A. Dessa Sadovnick, Ph.D., University of British Columbia, Vancouver; Ronald A. Remick, M.D., St. Paul's Hospital, Vancouver; Paul E. Keck, M.D. and Susan L. McElroy, M.D., University of Cincinnati; and Sarah H. Shaw, Ph.D., UCSD Department of Psychiatry, Researchers Identify Gene Involved in Bipolar Disorder, June 15, 2003 Joan Arehart-Treichel, Rise in Hospitalization of Youth for Bipolar Disorder Puzzles Experts, 2007
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