Bipolar Disorder and Children - Coursework Example

Bipolar Disorder and Children Formerly called manic-depressive illness, bipolar affective disorder is described by the National Institute of Mental Health as “a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function” (2008a). This brain disorder is not similar to the usual vicissitudes that normal people experience. Rather, bipolar disorder is a serious psychiatric condition that may damage relationships and school performance (NIMH, 2008a). Bipolar disorder is also closely related to school absenteeism, poor academic performance, impaired social functioning, and may later lead to alcohol and substance abuse, and even suicide if left untreated (Wilkinson, Taylor, & Holt, 2002). There is no exact statistics for childhood onset bipolar disorder, as epidemiological studies are still underway. However, its diagnosis is slowly emerging, and more children are found to be affected with this disorder. According to the American Academy of Child and Adolescent Psychiatry, a significant portion of the 3.4 million children in the United States who have been diagnosed with depression may be experiencing early onset bipolar disorder, but have not yet had an episode of mania yet (Wilkinson, Taylor, & Holt, 2002). In addition to this, Wozniak and Biederman of Massachusetts General Hospital discovered that up to 16 percent of pediatric psychiatric cases contribute to bipolar disorder (Fristad & Arnold, 2004). Many children are either undiagnosed, misdiagnosed, or do not have access to proper mental health facilities (Fristad & Arnold, 2004). This failure to recognize, diagnose, and treat bipolar disorder in children proves to be a challenging setback in the mental health care field. These children have bright futures ahead of them, but if their mental illness is not properly treated at the appropriate time, it may progress to more severe depression and mania, and even suicide. It is hence important to delve deeper into the phenomenon of bipolar disorder in children, along with its varying manifestations. Etiology The cause of bipolar disorder may be attributed to genetics, brain structure and function, anxiety disorders, phobias, and other mental and neurologic deficits (NIMH, 2008b). The tendency of bipolar disorder running in families is great, yet genetics cannot be named as a single cause of the illness (NIMH, 2008a). Twin and family studies suggest, however, that first-degree relatives of a person with bipolar disorder are more likely to develop the illness than the rest of the population (Fristad & Arnold, 2004). Brain imaging studies, on the other hand, strongly suggest that the brain structure of people with bipolar disorder differ from the brain structure of healthy people (NIMH, 2008a). in addition to this, brain imaging studies have discovered that neuroanatomic structures that regulate moods are likely to be involved, and that brain lesions resulting from an early brain injury may contribute to the development of the illness (Geller & DelBello, 2003). Lastly, anxiety disorders, phobias, and developmental dysfunctions, all play a great role in the development of the illness (NIMH, 2008b). As such, comorbidity with other disorders have been greatly studied and debated upon. Strong predisposing factors include family history of mood disorders, developmental disorders, and substance abuse (Wilkinson, Taylor, & Holt, 2002). Signs and Symptoms Bipolar disorder causes sensational mood swings, from extremely “high” or irritable, to miserable and hopeless, and then back to “high” again, usually with periods of regular moods in between (NIMH, 2008a). These periods of ups and downs are called manic episodes and depression, while a combination of the two are called mixed episodes (NIMH, 2008a). These symptoms can be dangerous to children as they may sometimes try to hurt themselves during one of their episodes (NIMH, 2008b). Hence, they must not be ignored. In children, extreme elation or very active periods may be classified as manic episodes, and they feel very sad and are much less energetic during their depressed state (NIMH, 2008b). In addition to this, children and teens with bipolar disorder may manifest symptoms and change moods more frequently than bipolar adults (NIMH, 2008b). According to Geller and Del Bello, high rates of rapid cycling are common in childhood and adolescent bipolar disorder (2003). According to the National Institute for Mental Health (2008b), manifestations of manic episodes in children and teens are: Acting happy and silly in a way that’s unusual Having a very short temper and may even throw tantrums Talking really fast with many varying topics Having trouble concentrating Having trouble sleeping yet not feeling tired May talk and think about sex more often (may even act it out spontaneously) Doing risky things The symptoms of mania and hypomania in children and adolescents differ from that of adults (Geller & DelBello, 2003). Weller claimed that: “Rather than grandiosity or euphoria in children and adolescents, the mood is most often irritable. They often have a decreased need for sleep—not insomnia, but an actual ability to function well on much less sleep than normal. Psychotic symptoms are also extremely common in children and adolescents with mania, which is why they are often misdiagnosed with schizophrenia” (Rosack, 2002). On the other hand, depressive episodes may manifest through the following (NIMH, 2008b): Feeling extremely sad Complains a lot about pain in different areas of the body such as stomachaches and headaches Irregular sleep pattern (either too little or too much) Feels guilty and worthless (maybe even hopeless or helpless) Disturbed apetite (eats too little or too much) Decreased energy level without any interest in activities that used to be fun for him or her Thinks about hurting oneself, and maybe even death or suicide Diagnosis The usual onset of bipolar disorder is the early 20’s, but some experience their first manic episode during the late 50’s; thus, disorder in children is not commonly noticed upon the onset of its first manic or depressive episode (Videbeck, 2004). As Early onset of bipolar disorder is not common, it has been argued that some children diagnosed with Attention Deficit/Hyperactive Disorder (ADHD) actually have bipolar disorder (Videbeck, 2004). As such, further research is underway to make parameters more accurate as to the diagnosis of early onset bipolar disorder, or pediatric bipolar disorder. The diagnosis of bipolar disorder is crucial to the prognosis of an adult, and moreso, to a child. Bipolar disorder is treatable, yet if it is misdiagnosed, proper treatment will not be given. According to Elizabeth Weller, a professor of psychiatry and pediatrics and vice chair of psychiatry at the University of Pennsylvania School of Medicine, a lot of disturbed children are being misdiagnosed with different disorders when they meet the criteria for bipolar disorder (Rosack, 2002). This misdiagnosis may be attributed, in part, to the fact that symptoms in children vary from the manifestations in adults (Fristad & Arnold, 2004). In addition to this, children often have accompanying developmental disorders, or behavioral and anxiety disorders (Fristad & Arnold, 2004). The symptoms of bipolar disorder may easily be mistaken for symptoms of another developmental disorder, or mere normal emotions and behaviors of teenagers and children (Wilkinson, Taylor, & Holt, 2002). There is not one diagnostic exam for bipolar disorder (NIMH, 2008b). However, according to the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM – IV), there are different types of bipolar disorder (Wilkinson, Taylor, & Holt, 2002). In the bipolar I type, there is one or more manic episodes lasting for at least a week, or mixed episodes with a major depressive episode, while in bipolar II, there is hypomania between one or more episodes of major depression (Wilkinson, Taylor, & Holt, 2002). The characteristics of mania and depression based on the DMV – IV have been provided above. The National Institute for Mental Health provided an illustration suggesting that the various moods in bipolar disorder is a spectrum or continuous range wherein at one end there is severe depression, then moderate depression, and then mild low mood that is commonly called “the blues” when its duration is short, and “dysthmia” when it is long-termed. Above that is mild or moderate mania (hypomania), progressing to severe mania (NIMH, 2008a). Figure 1. NIMH’s Illustration of the Spectrum of Bipolar Disorder. Comorbidity The Comorbidity of bipolar disorder with different developmental and affective disorders is the reason why the diagnosis of the illness in children is very difficult (Rossack, 2002). Through the studies made, it has been found that bipolar disorder is always associated with, or preceded by ADHD and/or oppositional disorder, and/or conduct disorder (Wilkinson, Taylor, & Holt, 2002). The most common and most frequently studied illness is Attention Deficit/Hyperactive Disorder or ADHD. As manic symptoms such as distractibility, irritability, impulsivity, decreased need for sleep, and hyperactivity of bipolar disorder are very similar to that of ADHD, misdiagnosis is common (Wilkinson, Taylor, & Holt, 2002). However, there are distinguishing features between the two disorders as provided by Weller: “In children with ADHD, from the time they start walking, they are wearing the soles right off of their tennis shoes, while with bipolar, the hyperactivity is much more episodic. Conversely, a stimulant, which helps patients with ADHD, pushes a bipolar child into increased symptoms of mania” (Rossack, 2002). In addition to this, another key feature that can separate the two is that tantrums in ADHD children tend to be over in a short period of time, while outbursts of those with bipolar may take hours (Wilkinson, Taylor, & Holt, 2002). Another illness that is commonly diagnosed along with bipolar (in most cases before the diagnosis of bipolar), is conduct disorder. However, Weller again states the distinguishing feature between conduct disorder and bipolar disorder – the lack of guilt (Rossack, 2002). According to Weller, “children with CD will do something wrong, but have no remorse, whereas bipolar children often feel guilty, even for no reason. Children with conduct disorder also often feel paranoid, as do children with bipolar illness, but paranoia in kids with conduct disorder is not evidence of psychosis, it’s justified—they did something wrong, and now someone is out to get them for it.” (Rossack, 2002). Treatment There is no cure for bipolar disorder but there is an effective way that can treat symptoms, eventually helping the child to live a normal and even successful life, provided that there is continuity (NCMH, 2008b). it is most effect to provide the child or adolescent with collaborative care, ranging from medications, psychiatric help, cognitive-behavioral therapy, and of course, moral and emotional support from family members and friends. The drug of choice for bipolar disorder are mood stabilizers, and lithium is the constant pharmacologic agent used (Rossack, 2002). It is important, however, to keep in mind that even if the same drug is used for adults, the dosage is smaller for children (NCMH, 2008b). Lithium is a salt in the body that is similar to trace elements such as gold, copper, and magnesium (Videbeck, 2004). Lithium is considered an anti-manic agent that is able to prevent acute cycles of manic-depressive behavior (Videbeck, 2004). As with any medication, there are minor side effects. However, these side effects bear little weight compared to the benefits that the drug brings to the patient. Lithium produces increase in apetite and minor weight gain, and slight tremors (Fristad & Arnold, 2004). Another medication that is used is carbamazepine, an anti convulsant agent that has mood-stabilizing properties as well (Videbeck, 2004). Psychotherapy for children and adolescents, on the other hand, are essential in the success of treatment, as they can aid in symptom management, prevent relapses, maximize functioning, and manage comorbid disorders, as well as improve peer and social functioning (Fristad & Arnold, 2004). Combined with pharmacotherapy, psychotherapy can reduce the risk of injusry and suicide, and prevent death (videbeck, 2004). Cognitive Behavior Therapy and Interpersonal therapy has been widely used in the treatment of depression, and has shown to provide improvement in the cognitive and social functioning of the child (Fristad & Arnold, 2004). Cognitive behavioral therapy attempts to identify irrational thought patterns and altering them to better fit reality, and prevent depression and mania (Wilkinson, Taylor, & Holt, 2002). On the other hand, Interpersonal therapy attempts to improve communication skills in the social setting, thereby improving relationships within and outside the home (Fristad & Arnold, 2004). There are different therapies that families can choose from, yet what is key to the successful and effective treatment is emotional and moral support, as well as proper diagnosis. Before the proper treatment is put in motion, a correct diagnosis must first be made. In children, it is important to always be observant with regard to their behavior, as bipolar disorder is difficult to diagnose, and if left undetected and untreated, may lead to suicide, or even death. References Geller, B. & DelBello, M.P. (2003). Bipolar disorder in childhood and early adolescence. New York: Guilford Press. Fristad, M.A. & Goldberg, J.S. (2004). Raising a moody child: how to cope with depression and bipolar disorder. New York: Guilford Press. National Institute of Mental Health. (2008a). Bipolar disorder. Retrieved December 13, 2008, from http://www.nimh.nih.gov/health/publications/bipolar-disorder/nimhbipolar.pdf National Institute of Mental Health. (2008b). Bipolar disorder in children and teens. Retrieved December 15, 2008, from http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens-brochure.pdf Rossack, J. (2002). Bipolar Often Misdiagnosed in Children, Expert Says. Psychiatric News, 26. Videbeck, S.L. (2004). Psychiatric Mental Health Nursing (2nd ed.). Philadelphia: Lippincott Williams & Wilkins. Wilkinson, G.B., Taylor, P., & Holt, J.R. (2002). Bipolar Disorder in Adolescence: Diagnosis and Treatment. Journal of Mental Health Counseling, 24 (4), 348. Read More