A bipolar disorder (previously also known as manic-depressive disorder) is characterized by alternating episodes of elevated, exalted mood (mania) and mood depression and despair. The mood between these phases is usually normal.
Children often switch abruptly between excited, cheerful and enterprising mood and depressed, withdrawn and confused behaviour or get angry and even violent. Doctors make the diagnosis based on the symptoms and results of psychiatric tests.
The diagnosis of bipolar disorders in young children is quite controversial. Mood-stabilizing drugs for the treatment of mania as well as antidepressants against depression and psychotherapy are suitable treatment approaches.
Slight mood swings are not uncommon in children; a happy and active child can suddenly turn into a sourpuss. These fluctuations rarely indicate a mental disorder. A bipolar disorder is far more serious than these normal mood swings, and these moods last much longer, often weeks or months.
Bipolar disorders are rare in children. In the past, they were often diagnosed when young children (between 4 and 11 years of age) were excessively irritated several times a day. Instead, these children are likely to have a disruptive mood disorder.
Bipolar disorder usually starts in middle adolescence or early adulthood.
Bipolar disorders in adolescents have similar symptoms to adults. The cause is unknown, but the predisposition to the development of a bipolar disorder may be inherited. One possible cause may be chemical imbalances in the brain. In children with the disorder, stress can trigger an episode.
Certain other conditions, such as hyperthyroidism or attention deficit/hyperactivity disorder (ADHD), can also cause similar symptoms. Certain drugs and toxins in the environment (such as lead) cause similar symptoms.
In many children, the first symptom of bipolar disorder is one or more episodes of depression.
The main symptoms are phases of strong enthusiasm and excitement (mania) alternating with episodes of depression, which can occur more frequently. Children can have severe mood swings.
During a manic phase, sleep is disturbed and children can behave aggressively. They can be in a very good mood or very irritable and may talk quickly. Their thoughts can race. You can develop delusions of grandeur. For example, they may be convinced that they have a special talent or have made an important discovery. Your judgment may be limited. Young people may behave irresponsibly, for example through sexual excess or reckless driving. Younger children may experience a drastic mood that often lasts only a few moments. School performance often deteriorates.
During a depressive phase, children with a bipolar disorder experience feelings of extreme depression, as do children with normal depression, and they lose interest in normal activities. They tend to think and move slowly and sleep more than usual.
They are overwhelmed by hopelessness and guilt. Between episodes, children with bipolar disorders appear normal, unlike children with ADHD who have a permanently elevated level of activity.
Symptoms often occur gradually. However, before the disorder develops, children are typically very temperamental and difficult to control.
Tests to assess other causes
Doctors diagnose the bipolar disorder based on the description of typical episodes by the child and its parents. Doctors try to determine whether the episode can be traced back to something such as severe stress.
It is very important to distinguish a bipolar disorder from another disease. For example, children are very active in both bipolar disorder (in the manic phase) and ADHD. However, the distinction is usually relatively easy because ADHD does not cause severe mood swings.
The doctor will investigate whether the child is taking drugs or is consuming drugs that could promote the symptoms. The doctor may also look for signs of other disorders that may promote or cause the symptoms. For example, he can order blood tests to rule out hyperthyroidism.
In bipolar disorder, episodes of mania and agitation are treated with mood-stabilizing medications. Mood-stabilizing medications include:
Antipsychotic drugs that stabilize mood
Anticonvulsants that stabilize mood
Depressive episodes are treated with psychotherapy and antidepressants. Antidepressants can turn depression into a mania and are therefore usually administered together with mood-stabilizing medications.
Individual and family psychotherapies help the children and their families to cope with the consequences of the disease. Psychotherapy can be useful for adolescents with low compliance to the treatment regimen so that they can continue to follow the treatment regimen. When adolescents have mild to moderate symptoms and adhere to their medication plan, they are usually well.