BIPOLAR DISEASE IN CHILDREN AND YOUNG ADOLESCENTS By Priya Modi and Kojo Koranteng and Aarushi Sharma

What is Bipolar? Manic – depressive disorder Causes extreme mood swings that include emotional highs and lows Disruptive, long term condition

Symptoms Vary from person to person The Diagnostic and Statistical Manual of Mental Disorders – lists criteria for diagnosing bipolar

Bipolar I - at least one manic episode, preceded or followed by hypomanic or major depressive episodes Bipolar II – at least one major depressive episode lasting a least 2 weeks and at least one hypomanic manic episode lasting at least 4 days Cyclothymic disorder – At least 2 years or 1 year in children and young adolescents and having numerous periods of hypomania symptoms. Other types – Bipolar related to other conditions such as Cushing’s syndrome, MS, stroke

For manic and hypomanic episodes, 3 or more of the following symptoms have to be present: Inflated self – esteem Decreased need for sleep, insomnia Unusual talkativeness Racing thoughts Distractibility Increased agitation, restlessness Doing unusual things with painful consequences Depressed mood, feeling sad Reduced interest or feeling no pleasure Weight loss, weight gain (in children failure to gain weight) Fatigue Recurrent thoughts of death or suicide

Symptoms often come and then disappear in children Not always the case therefore hard to diagnose child with bipolar Children with bipolar frequently diagnosed with other mental conditions Most prominent signs in children and young adolescents are unusual mood swings

Causes: Biological: physical changes in brain Neurotransmitters: imbalance Inherited traits:

Risk factors: First degree relative: parent or sibling Periods of high stress Drug or alcohol abuse Major life changes, such as death of a family member or other traumatic experinces

Conditions often in association with bipolar Anxiety disorders Post traumatic stress disorder Attention – deficit/ hyperactivity disorder Addiction or substance abuse Physical health problems – such as heart disease, thyroid problems or obesity

Treatment Currently no treatment for bipolar disease But medications and psychotherapy people are helped to overcome episodes Doctor has to do a ‘baseline’ assessment Mood stabilizers – such as lithium first choice (also used in children older than 12) Anticonvulsant - used to treat seizures and sometimes mood stabilizers Atypical Antipsychotics Anti depressants

Psychotherapy Cognitive behavioral therapy – helps young people with bipolar to learn how to change harmful or negative thoughts Family focused therapy – enhances family coping strategies Interpersonal and social rhythm therapy – helps children and teens improve their relationship with others and manage their daily routines Psychoeducation – teaches young people about illness and treatment. This helps to recognise signs of impending relapse

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