Bipolar Disorder In Children & Teens

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• QHow can I tell if treatment for my child's bipolar disorder is working?

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  A Keith Star , Psychology, answered on behalf of Tarzana Treatment Centers

  Medical professionals and families of children and teens with bipolar disorder should monitor symptoms and treatment to decide if changes to the treatment plan are needed. Different medications can be more helpful for one type of symptom than another. The child or teen may need to change medications or try different treatments if symptoms change.
  
  It is recommended to work closely with your child's doctor and therapist and discuss treatment choices can make treatment more effective.
  
  You may want to monitor your child's daily mood symptoms, treatments, sleep patterns, and life events. This can help you and your child.
• QHow is bipolar disorder treated in children and teens?

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  A World Federation For Mental Health (WFMH) answered

  Guidelines indicate that for treatment of bipolar disorder in children and adolescents, combination treatment (medications and psychotherapy) is recommended:

  • Maintenance Therapy: Medications such as lithium, divalproex sodium, or carbamazapine are most commonly used to treat children and adolescents; risperidone and aripiprizole were recently approved in the U.S. for use in children and adolescents in the U.S.
  • Treatment of Acute States (mania and depression): Additional medications are also needed to treat the acute phases of the disorder. Because of the severity and complexity of the disorder in young children and adolescents, many treatment pathways are used.
  • Overall Treatment of the Disorder: Once a child is stabilised with medication, therapy can help build skills and provide families with the information and support they need to help their child or adolescent. A comprehensive and coordinated approach to medication and psychotherapy is recommended for optimal care for children and adolescents with bipolar disorder.

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• QHow is bipolar disorder diagnosed in children?

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  A Dr. Michael Roizen, MD , Internal Medicine, answered

  Bipolar disorder can be diagnosed in young children, but it is about as difficult as it is to get a two year old to sit down for 20 minutes. We all know that children’s behavior and moods tend to change as fast and as often as a stop light, especially when they are tired, sick, or hungry, so it can be hard to pinpoint the exact reason for the changes in their mood or behavior. Your child’s doctor will need to rule out factors such as trauma, attention deficit hyperactivity disorder (ADHD), or behavioral problems that often occur along with bipolar disorder.

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• QWhat mental conditions may occur along with bipolar disorder in children?

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  A World Federation For Mental Health (WFMH) answered

  Often, those with Childhood-Onset Bipolar Disorder are diagnosed with other mental health disorders, known as comorbid conditions. These other diagnoses can mask or co-occur with Bipolar Disorder:

  • attention-deficit disorder with hyperactivity (ADHD)
  • disruptive behaviour disorders
  • anxiety disorders
  • substance abuse
  • developmental and intellectual disabilities

  In adolescents, bipolar disorder is often misdiagnosed as borderline personality disorder, post-traumatic stress disorder (PTSD), or schizophrenia. Studies have indicated between 40-90% of children with bipolar disorder also have ADHD, and around 50% have comorbid conduct disorder.

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• QHow do I choose a mental health expert for my bipolar child?

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  A Dr. Michael Roizen, MD , Internal Medicine, answered

  Finding a mental health expert for your bipolar child can be a challenge, especially since child psychiatrists these days are almost as rare as a Siberian tiger. Your best bet for finding one is to start by asking your doctor and your child’s doctor for referrals. You can also find the closest teaching hospital to your home and contact their child and adolescent psychiatry department. If that still doesn’t get you what you’re looking for, you can search the online doctor finder of the American Academy of Child and Adolescent Psychiatrists website or the CABF Directory of Professional Members. If you still can’t find a child psychiatrist, select a psychiatrist with experience treating mood disorders in adults and children.

   

  Once you’ve identified a mental health professional that you are interested in working with, ask what insurance he/she takes. Ideally, you will want to find one that takes your insurance.

  
  

   

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• QHow should I choose a doctor for my child with bipolar disorder?

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  A International Bipolar Foundation answered

  Find a pediatrician or child psychiatrist (or pediatric psychiatrist) who specializes in mood disorders. Be persistent in finding someone who has had extensive experience with children manifesting symptoms of all kinds of mood disorders. Ask the doctor or pediatric psychiatrist whether they've treated any children with pediatric bipolar disorder before. Ask them their opinion of the debate surrounding this mood disorder.
• QWhat medications help treat bipolar disorder in children?

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  A International Bipolar Foundation answered

  Although not something parents like to hear and often experience some resistance to, prescribed medications are the mainstay of treatment for stabilizing the moods in children and adolescents with bipolar disorder. There are several medications approved by the Food and Drug Administration for the treatment of bipolar disorder in children and adolescents. They include lithium, and the second generation antipsychotics (SGAs) Risperdal, Abilify, Seroquel, and Zyprexa. However, it is important to keep in mind that many medications used to treat childhood illnesses, including childhood cancers, may be Food and Drug Administration (FDA) approved for use in adults, but not for use in children. Often times, we extrapolate the use of these medications from adults to children and adolescents. There are several other medications that have been or are used to treat bipolar disorder in children and adolescents with varying degrees of success. They include the anticonvulsants Depakote, Tegretol, Trileptal, Topamax, Neurontin and Lamictal, as well as other SGAs, such as Geodon and Clozaril. Many of these medications are used alone or in combination, depending upon each individual's unique circumstances.
  
  The use of antidepressant medications, such as the selective serotonin reuptake inhibitors (SSRIs), including Prozac, Paxil, Zoloft, Celexa and Lexapro, while often helpful in treating depressive symptoms in children and adolescents, pose serious risks when used in attempting to treat depressive symptoms in the context of bipolar disorder in children and adolescents. Activation, disinhibition, the triggering of a manic episode and the worsening of mood symptoms are not uncommon results. If these medications are to be used, caution and careful monitoring are required.
• QHow should my child be evaluated for bipolar disorder?

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  A World Federation For Mental Health (WFMH) answered

  Because of the difficulty in diagnosing bipolar disorder in youth, it is critical to get a longitudinal perspective of the child's behaviour to determine how best to understand what is observed on any given day. A thorough evaluation should be done by a healthcare professional, who should:

  • Create a timeline to determine the episodic nature of symptoms and their relationship to relevant developmental issues
  • Conduct a structured interview to determine differential diagnosis and/or other comorbid conditions that may exist
  • Generate a 3-generation or diagram to determine family history and family dynamic information
  • Administer a symptom severity (depression and mania) rating scale
  • Complete a global rating scale to track outcomes
  • Generate a mood log so the family can monitor treatment and share results with treatment providers
• QWhat is the course of bipolar disorder in children and teens?

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  A International Bipolar Foundation answered

  Studies suggest that 40% to 100% of children and adolescents who suffer from a manic episode will usually recover from that episode within one to two years. However, according to the Journal of American Academy of Child and Adolescent Psychiatry, of those who do not recover, up to 60-70% will experience a recurrence of an episode within 10-12 months. In addition, many of these young people will experience frequent fluctuations in their moods, most often with depressed or mixed episodes, on an ongoing basis, aside from the recurrent episodes. The factors associated with a worse outcome over time for these children and adolescents include an early age of onset, a long duration of the illness, mixed episodes, rapid cycling, the presence of psychotic symptoms, a lack of treatment, and poor compliance with medication treatment. About 20-25% of children and adolescents with Bipolar Disorder Not Otherwise Specified (NOS) and Bipolar Type II are likely to progress to the Bipolar Type I Disorder in adulthood. Between episodes, many of these young people experience what are called "subsyndromal" symptoms of bipolar disorder, or mood and behavioral symptoms that are beyond what would be considered normal, but not severe enough to reach the level of a full blown episode. For children and adolescents, 30% of the time, full blown mood shifts between mania and depression will likely occur one time or less per year, while 50% of the time, the mood shifts will likely occur more than five times per year. Almost 40% of the time, the mood shifts between depression and mania will occur more than 10 times per year, and in 24%, they will occur more than twenty times per year.
• QWhy can it be difficult to diagnose bipolar disorder in children and teens?

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  A World Federation For Mental Health (WFMH) answered

  Diagnosing bipolar disorder in children and adolescents is difficult because children are naturally growing and changing, and developmental considerations must always be kept in mind when determining whether a behaviour is a "symptom" or merely a reflection of youth.
  For example, many elementary school children are highly energetic and can talk fast when excited. The behaviours in question need to occur across different settings (e.g. home and school) and cause impairment in order to be deemed a symptom.
  Diagnosing the disorder in youth is also difficult because the disorder looks different in children and adolescents than it does in adults. Rather than the well-defined episodes of depression and mania seen in adults, children and adolescents spend more time in mixed states, which cycle rapidly.
  Diagnosis of the disorder in children is also complicated because its symptoms can resemble (or co-occur with) those of other common childhood-onset psychiatric disorders, particularly for children in the manic state. The bipolar symptoms of inattention, impulsivity, and even hyperactivity overlap with those of attention deficit hyperactivity disorder.