Bipolar disorder in children
[1] Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously.
While there is limited understanding regarding the development of bipolar disorder, research shows that there are many environmental and biological risk factors.
[10] Pediatric bipolar disorder can be difficult to diagnose, especially in children under 11–12 years as they may be unable to properly self-assess and communicate any possible symptoms.
[11] Therefore, it is helpful to obtain information from multiple sources, such as family members and teachers, and use questionnaires and checklists for a more accurate diagnosis.
[6] The American Psychiatric Association's DSM-5Tooltip Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the World Health Organization's ICD-10Tooltip International Classification of Diseases (ICD-10), use the same criteria to diagnose bipolar disorder in adults and children with some adjustments to account for differences in age and developmental stage, particularly with depressive episodes.
[1][2] Just as in adults, bipolar I is the most severe form of PBD in children and adolescents, and can impair sleep, general function, and lead to hospitalization.
A combination of medication and psychosocial intervention is recommended for most pediatric populations with PBD and has been proven to lead to improved prognosis.
[13][7][9] In order to choose the best medication and therapy, it is important to consider the child's age, their psychosocial environment, presentation and severity of symptoms, and their family history.
[8][13] Mood stabilizers used for the treatment of PBD include: lithium, valproic acid, divalproex sodium, carbamazepine, and lamotrigine.
[5][9] Atypical antipsychotics that have been approved for use by the FDA for treatment of PBD include risperidone, cariprazine, lurasidone, olanzapine-fluoxetine combination, and quetiapine.
[5] Medications for the treatment of PBD can produce significant side effects, so it is recommended that families of patients be informed of the different possible issues that can arise.
[17][22] Typical antipsychotics may produce weight gains as well as other metabolic problems, including diabetes mellitus type 2 and hyperlipidemia.
Currently, interventions involving dialectical behavioral therapy (DBT) are being explored due to the focus on mindfulness and distress tolerance skill building.
According to the APA, studies have shown that DBT may lead to decreased suicidal ideation compared to typical psychosocial treatments.
Nutritional interventions are also currently undergoing further research along with other lifestyle modifications including exercise and proper sleep habits.
[12] Other risk factors for poor outcomes of PBD and increased severity of symptoms are comorbid pathologies and early onset of disease.
[5][6][8][21] Studies have shown that among adolescents with PBD, 44% report a lifetime suicide rate, twice as much compared to teens diagnosed major depressive disorder.
Grandiosity is also a distinguishing factor as mania typically presents with increased self-esteem and in ADHD children may actually have lower self esteem.
In 1898, a detailed psychiatric case history was published about a 13-year-old that met Jean-Pierre Falret and Jules Baillarger's criteria for folie circulaire, which is congruent to the modern conception of bipolar I disorder.
[27] In Emil Kraepelin's descriptions of bipolar disorder in the 1920s, which he called "manic depressive insanity", he noted the rare possibility that it could occur in children.
In addition to Kraepelin, Adolf Meyer, Karl Abraham, and Melanie Klein were some of the first to document bipolar disorder symptoms in children in the first half of the 20th century.
[5] Recognition came twenty years after, with epidemiological studies showing that approximately 20% of adults with bipolar disorder already had symptoms in childhood or adolescence.
