Bipolar Children and Teenagers
by: Amy Otis, BSN, RN
Bipolar
Disorder in Children and Teenagers
Bipolar
disorder can occur in children and adolescents and has been
investigated by federally funded teams in children as young
as age six. Although once thought rare, caseloads of patients
examined for federally funded studies have shown that approximately
seven percent of children seen at psychiatric facilities fit
bipolar disorder using research standards.
Symptoms
of Bipolar Disorder in Children and Adolescents
One of the biggest challenges has been to differentiate children
with mania from those with attention deficit hyperactivity
disorder. Both groups of children present with irritability,
hyperactivity and distractibility. These symptoms are not
useful for the diagnosis of mania because they also occur
in ADHD. But, elated mood, grandiose behaviors, flight of
ideas, decreased need for sleep and hypersexuality occur primarily
in mania and are uncommon in ADHD. Below is a brief description
of how to recognize these mania-specific symptoms in children.
Elated children may laugh hysterically and act infectiously
happy without any reason at home, school or in church. If
someone who did not know them saw their behaviors, they would
think the child was on his/her way to Disneyland. Parents
and teachers often see this as “Jim Carey-like”
behaviors.
Grandiose behaviors are when children act as if the rules
do not pertain to them. For example, they believe they are
so smart that they can tell the teacher what to teach, tell
other students what to learn and call the school principal
to complain about teachers they do not like. Some children
are convinced that they can do superhuman deeds (e.g., that
they are Superman) without getting seriously hurt, e.g. "flying"
out of windows.
Flight of ideas is when children jump from topic to topic
in rapid succession when they talk and not just when a special
event has happened.
Decreased need for sleep is manifested by children who sleep
only four to six hours and are not tired the next day. These
children may stay up playing on the computer and ordering
things or rearranging furniture.
Hypersexuality can occur in children with mania without any
evidence of physical or sexual abuse. These children act flirtatious
beyond their years, may try to touch the private areas of
adults (including teachers), and use explicit sexual language.
In addition, it is most common for children with mania to
have multiple cycles during the day from giddy, silly highs
to morose, gloomy suicidal depressions. It is very important
to recognize these depressed cycles because of the danger
of suicide.
Treatments,
Medications and Psychosocial Effective Therapies
At this time there are several ongoing studies of how to best
treat children, but until more scientific data is available
clinicians are left using their best judgment on how to manage
using medications that have been effective in adults. These
are largely three main types of drugs -- Lithium, anticonvulsants
(e.g., Depakote or other valproate products) and atypical
neuroleptics (e.g., risperidone, olanzapine, ziprasidone,
aripiprazole, quetiapine).
Side
Effects — Including Those That May Only Occur in Young
People.
Side effects that are particularly troublesome and that are
worse in children include the following. Atypical neuroleptics
(except aripiprazloe) are associated with marked weight gain
in many children. One day we hope to have specific genetic
tests that will tell us beforehand which people will gain
weight on these medications. But right now, it is trial and
error. The dangers of this weight gain include glucose problems
that may include the onset of diabetes and increased blood
lipids that may worsen heart and stroke problems later in
life. In addition, these drugs can cause an illness called
tardive dyskinesia, which is irreversible, unsightly, repeated
movements of the tongue in and out of the mouth or cheek and
some other movement abnormalities. Depakote may also be associated
with increased weight and possibly with a disease called polycystic
ovarian syndrome (POS). In some cases POS is associated with
infertility later in life. Lithium has been the market the
longest and is the only medication that has been shown to
be effective against future episodes of mania and of depression
and of completed suicides. Some people who take lithium over
a long time will need a thyroid supplement and in rare cases
may develop serious kidney disease.
It is very important that children on these medications be
monitored for the development of serious side effects. Side
effects need to be weighed against the dangers of the manic-depressive
illness itself.
At this time, with childhood and adolescent onset the disease
regrettably appears more severe and with a much longer road
to recovery than is seen with adults. While some adults may
have episodes of mania or depression with better functioning
between episodes, children seem to have continuous illness
over months and years.
Impact on Educational Achievement
It is challenging to educate a child who is seriously too
"high" or too "low." Therefore educators
need to be aware of the diagnosis and make special arrangements.
Suicide
Risk
Any talk about wanting to die, or asking why they were born
or wishing they were never born must be taken very seriously
as even quite young children can hang themselves in the shower,
shoot themselves or complete suicide by other means.
Coolnurse.com
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