Pediatric Bipolar Disorder

Bipolar disorder was first thought of as juvenile disorder in the mid 1990s by Joseph Biederman of Havard and Barbara Geller of Washington University in St. Louis

What is Pediatric Bipolar?

DSM-IV Criteria

Children that have relatives with alcoholic tendencies are more likely to be bipolar.

Genetic:“Anticipation”: Genetic disorders are passed on

at a higher rate causing symptoms to show up earlier and earlier and in some cases becoming more serious

Possible Causes

Bipolar disorder begins before the age of 13 about 15-28% of the time and before the age of 19 about 50-66% of the time.

1997 estimate: juvenile bipolar disorder thought only to affect 1 out of 20,000 children. In 2007 it is believed to be around 1 in 2,000.

Estimated that 1/3 of the time symptoms of bipolar disorder first appear in childhood or adolescence

Differences Between Pediatric and Adult Bipolar Disorder Critics argue that normal children have quickly changing

moods Juvenile bipolar diagnosis has been neglected in the past

because children do not usually show the extreme mood swings that last several months with normal behavior in between that adults typically show.

Facts About Pediatric Bipolar Disorder

ADHD Bipolar disorder is difficult to distinguish between ADHD The three major symptoms that they both share are:

Impulsiveness Distractibility Hyperactivity

Up to 30% of children diagnosed with ADHD are given a diagnosis of bipolar disorder

Up to 50% of children with bipolar disorder fit the criteria for the diagnosis of ADHD Children with a bipolar parent have a higher than average rate of ADHD Symptoms of bipolar in children are often mistaken for ADHD and the symptoms of

bipolar are different in adults. 1/3 of children diagnosed with ADHD actually suffer from normal symptoms of

bipolar disorder

Oppositional Defiant Disorder Conduct Disorders Mood Disorders

Possible symptoms of pediatric bipolar disorder overlap with other mood disorders. Some of these include: rapid mood changes, inappropriate moods, and bursts of rage

Comorbidity: Disruptive Disorders

Comorbidity: Anxiety Disorder

Comorbidity: Substance Abuse

The National Institute of Mental Health funded Course and Outcome of Bipolar Illness in Youth (COBY) followed 263 children ages 7 to 17 for 2 years. They found that 70% recovered from their first episode of mania or depression. However, they relapsed an average of three times. These children only had symptoms 60% of the time but only were diagnosed with bipolar disorder 20% of the time. Many with no bipolar symptoms had other problems such as ADHD. Children originally diagnosed with bipolar disorder eventually developed typical adult bipolar symptoms.

The COBY study has also shown that children and adolescents with bipolar disorder (171, mean age of 13.2 years) continue to suffer from the same disorder 2 years later, with 68% recovering from their initial episode but 58% experiencing a recurrence. This shows stability of bipolar disorder through adolescence and, among some, into early adulthood.

86 patients with prepubertal onset bipolar disorder for four years with a mean age of 10.8 years, 72% of them relapsed.

Longitudinal Study

Drug OptionsIn adults bipolar is usually treated with mood

stabilizersLithium is the most popular drug Experts believe that for children with early

onset bipolar treatment should start with a single drug (lithium) and than drugs are added or subtracted with response.

Antipsychotic medications are also used in more severe cases.

Treatment Options

Psychosocial treatment Supportive therapy provides strategies for solving everyday

problems Psychodynamic therapy may help older children and adolescents

explore current and past relationships, their psychological development, and how to deal with uncomfortable feelings

Cognitive therapy where children and adolescents observe and change their behavior. They can be taught proper social skills and problem solving if they threaten to relapse to their mood swings. Going to sleep and getting up at the same times each day may help with mania and mood swings.

Parent education on how to cope with a child with erratic behavior is necessary to help the child and not make the child’s problems and family situations worse. Family therapy and support groups are needed to help the parents and children deal with the behavioral problems.

Treatment Options Cont’d

Studies and Research

Summary

References