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A guide on fighting bipolar disorder symptoms onset prevalence impact treatments and prgonosis

When 480 adults with bipolar disorder were asked when they had their first full mood episode, approximately half reported that their first depressive or manic episode happened during childhood or adolescence AV 1 AV 1. This increase may also be attributed to the prevalence of the disorder in successive generations of families; the more genetic coding for the disorder a person has, the earlier the onset.

Importance of Correct and Early Diagnosis Studies1,3 of adults with bipolar disorder who were children at illness onset have reported that an average of about 16 years passed before these patients received a correct diagnosis and first treatment.

Some children may be misdiagnosed with depression or ADHD. However, treatment for bipolar disorder is different than that for depression or ADHD, so recognizing this disorder early can prevent exposing a child to unnecessary stimulant or antidepressant treatment.

Stimulants and antidepressants may induce kindling or even advance the progression of the bipolar disorder to a worse state. Not treating bipolar episodes may lead to treatment-resistance once patients are accurately diagnosed. Appropriately diagnosing patients as early as possible re-establishes normal psychosocial and academic development.

Differential Diagnoses of Pediatric Bipolar Disorder Adolescents with bipolar disorder are difficult to diagnose, but younger patients are even more difficult to diagnose. ADHD is a primary differential diagnosis, especially in children younger than age 12 years, because manic symptoms such as hyperactivity and distractibility overlap with the criteria for ADHD.

  1. These children have enough symptoms to meet mania criteria but do not meet the duration requirement6; in other words, patients do not have hypomania for 4 full days or mania for 7 days AV 4 AV 4. Behaviors that meet criteria for a manic episode differ by age.
  2. However, treatment for bipolar disorder is different than that for depression or ADHD, so recognizing this disorder early can prevent exposing a child to unnecessary stimulant or antidepressant treatment.
  3. Stimulants and antidepressants may induce kindling or even advance the progression of the bipolar disorder to a worse state. In adolescents, exhibitions of excessive involvement in pleasurable activities, such as excessive spending, sexual indiscretions, substance abuse, or impulsive activities, may be similar to those of adults.
  4. For example, grandiosity, a cardinal symptom of mania, is not part of the diagnostic criteria for ADHD, depression, or schizophrenia, so it is useful in making the diagnosis of bipolar disorder.
  5. Some children may be misdiagnosed with depression or ADHD. The poor prognosis of childhood-onset bipolar disorder.

Conversely, some children with severe ADHD may be misdiagnosed as having bipolar disorder. Unipolar depression is another primary differential diagnosis. Irritability is more commonly a sign of depression than mania in children, although it can also be part of a manic episode. These outbursts may be wrongly attributed to an irritable manic episode instead of anxiety.

Diagnosing Bipolar Disorder in Children and Adolescents 02: If no other manic symptoms are present during this time, the accurate diagnosis may be intermittent explosive disorder rather than bipolar disorder.

  1. For optimal patient care, clinicians should. Irritability is more commonly a sign of depression than mania in children, although it can also be part of a manic episode.
  2. In midspectrum are possible prodromal states, including bipolar disorder NOS, full depression with a family history of bipolar disorder, or ADHD and a family history of bipolar disorder. Conversely, some children with severe ADHD may be misdiagnosed as having bipolar disorder.
  3. The poor prognosis of childhood-onset bipolar disorder.
  4. Irritability is more commonly a sign of depression than mania in children, although it can also be part of a manic episode.
  5. These outbursts may be wrongly attributed to an irritable manic episode instead of anxiety. For Clinical Use Pediatric-onset bipolar disorder is common.

And finally, the presence of psychosis could mean that the child has an early psychotic disorder, including schizophrenia or schizoaffective disorder, and bipolar disorder should be ruled out.

Watch this patient video to view an example of diagnosing young patients with bipolar disorder AV 2 AV 2.

A young patient must meet the full criteria for a manic episode for a bipolar I diagnosis, although depression is not required AV 3 AV 3. Cardinal symptoms of mania aid in differential diagnosis. For example, grandiosity, a cardinal symptom of mania, is not part of the diagnostic criteria for ADHD, depression, or schizophrenia, so it is useful in making the diagnosis of bipolar disorder.

However, in order to identify grandiosity in a child, knowing what a normal experience is for that patient is critical in the diagnostic process. More Another cardinal symptom is the decreased need for sleep. This lack of sleep does not affect their normal energy levels.

Racing thoughts and increased goal-directed activity are also unique to mania, but the latter can also be confused with symptoms of OCD.

Behaviors that meet criteria for a manic episode differ by age. In adolescents, exhibitions of excessive involvement in pleasurable activities, such as excessive spending, sexual indiscretions, substance abuse, or impulsive activities, may be similar to those of adults. Younger children, however, may have hypersexual behavior, become excessively involved in projects, stay up late, or write, draw, or scribble excessively on their walls or their books.

Bipolar disorder NOS has been increasingly diagnosed in children.

Diagnosing Bipolar Disorder in Children and Adolescents

These children have enough symptoms to meet mania criteria but do not meet the duration requirement6; in other words, patients do not have hypomania for 4 full days or mania for 7 days AV 4 AV 4. Younger children tend to have short bursts of manic periods. The Bipolar Spectrum in Children and Adolescents 00: Children with severe mood dysregulation do not have true manic episodes or symptoms, but they tend to be very temperamental and have outbursts.

Children with severe mood dysregulation often develop depression rather than bipolar disorder in adulthood. At the other end of the spectrum are bipolar I and bipolar II disorders.

Kiki D. Chang, MD

In midspectrum are possible prodromal states, including bipolar disorder NOS, full depression with a family history of bipolar disorder, or ADHD and a family history of bipolar disorder. Children who have family histories of bipolar disorder are highly susceptible to developing bipolar disorder. For Clinical Use Pediatric-onset bipolar disorder is common. Bipolar disorder NOS and other bipolar spectrum disorders are common in children and adolescents and are often difficult to diagnose in younger patients.

For optimal patient care, clinicians should: The poor prognosis of childhood-onset bipolar disorder. Long-term implications of early onset in bipolar disorder: The health care crisis of childhood-onset bipolar illness: National trends in the outpatient diagnosis and treatment of bipolar disorder in youth.

American Psychiatric Association; 2000. Clinical course of children and adolescents with bipolar spectrum disorders.