From A to Z on child and adolescent bipolar disorder (original) (raw)
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Child and adolescent bipolar disorder
Paediatrics & Child Health, 2001
U ntil relatively recently, the concept of diagnosing bipolar affective disorder in children and adolescents was controversial. The prevailing wisdom in the early part of this century was that prepubertal onset of manic depression did not occur (1). Furthermore, according to some psychoanalytic theories, depression was not possible in children because of a lack of the development of necessary psychological structures. Over the past 20 years, there has been a significant shift toward recognizing the existence of bipolar disorder in children and adolescents. Since 1980, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition: DSM-III, (2), the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised: DSM-III-R (3), and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV (4) have applied adult criteria to diagnose mania in children, with some modifications to take into account differences in developmental stages (5). Despite the recognition of the existence of bipolar disorder in this age group, difficulty in clearly delineating the clinical characteristics of the presentation of this illness in paediatric patients relative to adult patients continues (6).
Development and …, 2006
This review addresses the phenomenology of mania0bipolar disorder from a developmental psychopathology perspective and uses cases with longitudinal information to illustrate major points. Beginning with a summary of the phenomenology of bipolar illness as it occurs in adults, the authors identify diagnostic complexities unique to children and adolescents. These include the challenges of characterizing elation and grandiosity; differentiating mania from comorbid symptoms, rages, sequelae of maltreatment, and typical developmental phenomena; and the unique manifestations of psychosis. We conclude with the observation that a significant difference between early and later onset bipolar disorder is that, in the former, there appears to be a global delay or arrest in the development of appropriate affect regulation; whereas in adult-onset bipolar illness, emotion dysregulation generally presents as an intermittent phenomenon. At this juncture, the study of childhood bipolar illness would benefit from a developmental psychopathology perspective to move beyond the level of cross-sectional symptom description to begin to study individuals over time, focusing on developmental, environmental, genetic, and neurobiological influences on manifest behavior.
Bipolar disorders across the lifespan
Journal of Clinical Psychology, 2008
For several decades, psychological research on bipolar disorder languished. The robust heritability of the disorder , coupled with the great gains provided by lithium , led to a biological zeitgeist. Few psychologists considered the disorder as a target for their work, and the portfolio of NIMH grants for the disorder was quite small. In 1988, an NIH task force was convened to evaluate the state of findings, and their recommendations led to a significant change in the field (Prien & Potter, 1988). Acknowledging the high relapse rates on medications alone, they pushed for more basic research on the predictors of symptoms, as well as more research on psychosocial treatments to supplement medication approaches. Within a few years, a set of psychological treatment outcome trials were funded. These trials did more than supply a set of treatment outcome findings; they increased the visibility of the disorder in psychology departments and at psychology conferences. Within the last 10 years, this visibility has paid off in a new generation of trainees who are entering the field and tackling a broader and broader array of topics.
Bipolar disorder in children and adolescents: an update on diagnosis
Clinical Practice, 2014
Practice points • Despite converging evidence validating pediatric bipolar disorder (PBD), it is still challenging to diagnose PBD accurately. • Consideration of the developmental course and common comorbidities will help improve the diagnostic accuracy of PBD. • Clinical triggers such as family history, early-onset depression, antidepressant-coincident mania, episodic mood lability, episodic aggressive behavior, psychotic features and sleep disturbance should trigger a thorough evaluation of possible PBD. • Semistructured interviews remain the gold standard for assessing for PBD. • Understanding cultural dynamics such as training, class/race issues, stigma and lifestylerelated factors may help bridge the gap between research and practice. Converging evidence from both community and clinical settings shows that pediatric bipolar disorder is a valid diagnosis and a debilitating condition. While the field has evolved considerably, there remain gaps in diagnosis, assessment, research and practice. This article critically appraises: advances in understanding of the phenomenology of pediatric bipolar disorder; changes in diagnostic criteria from the Diagnostic and Statistical Manual (DSM)-IV to DSM-5 and corresponding controversies; the epidemiology of pediatric bipolar disorder; current assessment and diagnostic practices; and cultural factors influencing treatment seeking and diagnosis. We recommend using an evidence-based framework for bridging the gap between research and clinical practice.
The Concept of Bipolar Disorder in Children: A History of the Bipolar Controversy
Child and Adolescent Psychiatric Clinics of North America, 2009
Phenomenologists in child and adolescent psychiatry frequently aspire to the perceived certitude with which adult psychiatry conceptualizes bipolar disorder. However, there is a good deal of uncertainty in how this condition is operationalized, classified, and distinguished from other conditions even in adults. There are multiple issues. They include the following: (1) the degree to which mania is a spectrum that ranges from a severely psychotic, paranoid, and agitated condition that can be confused with schizophrenia to one that borders on normal behavior; (2) the degree to which depression may be punctuated by fluctuations of mood, which range from euthymia to hypomania to mania (ie, circular manic-depression, bipolar II disorder, and recurrent unipolar depression); (3) the degree to which the onset of a mood state can be distinguished from some kind of baseline state in which mood changes are part of the person's temperament or personality (eg, a hyperthymic energetic temperament or ''cluster B personality disorders'' in which chronic mood lability is present, exacerbations of which may or may not be related to manic-depression); (4) the degree to which the mood disorder is autonomous versus precipitated by, or associated with, another CNS condition, including drugs (prescribed or illicit) or illness, that is, the primary/secondary distinction. To these muddy waters, child psychopathology adds two more: (1) the degree to which symptoms and behaviors thought to be basic to the definition of mania or depression mean the same thing in children of different ages and (2) the degree to For the sake of this discussion, manic-depression will refer to a clearly episodic disorder as still described in ICD-10. Bipolar disorder refers to the post-1980 construct of people who meet symptom criteria and represent a broader spectrum.
Diagnostic Challenges in Youth With Bipolar Disorder
Current Treatment Options in Psychiatry, 2016
Bipolar disorder I Children I Adolescents I Mania in youth I Bipolar disorder diagnosis Opinion statement The purpose of this review is to understand the diagnostic challenges found in children and adolescents with bipolar disorder (BD). BD youth presentation tends to be atypical when compared with adults. BD in children is characterized by a more chronic course, rapid cycling, with multiple cycles in the same day. Cardinal symptoms include elevated mood, grandiosity, and decreased need for sleep, while the most common symptoms are increased energy, distractibility, and pressured speech. Overlapping symptoms with other psychiatric disorders and high rates of comorbidity complicate the diagnosis and can lead to misdiagnosis and inappropriate treatments. Child and adolescent psychiatric field has made significant advances in order to acknowledge BD in this population. Nevertheless, despite the evident growth in scientific literature's attention toward BD in youth, until today, there is no agreement about the best diagnostic criteria. The controversy has shifted, though, in the last ten years, from whether it can be diagnosed to how it is diagnosed.
Pediatric-Onset Bipolar Disorder: A Neglected Clinical and Public Health Problem Gianni
Harvard Review of Psychiatry, 1995
disorder (BPD), probably the most prevalent psychotic disorder in adults, has been relatively neglected or controversial in children and adolescents over the past century. We reviewed the literature on early-onset BPD.* Estimates of prevalence, particularly before puberty, are limited by historical biases against pediatric mood disorders and by formidable diagnostic complexity and comorbidity. Although clinical features of pediatric and adult BPD have similarities, pediatric cases probably cannot be defined solely by features characteristic of adult cases. Onset was before age 20 years in at least 25% of reported BPD cases, with some increase in this incidence over the past century. Pediatric BPD is familial more often than is adult-onset BPD, may be associated with a premorbid cyclothymic or hyperthymic temperament, and can be precipitated by antidepressant treatment. Pediatric BPD episodes frequently include irritability, dysphoria, or psychotic symptoms; they are commonly chronic and carry high risks of substance abuse and suicide. BPD is often recognized in adolescents, but the syndrome or its antecedents are almost certainly underrecognized and undertreated in children. Controlled studies of shortand long-term treatment, course, and outcome in this disorder remain strikingly limited, and the syndrome urgently requires increased clinical and scientific interest. (HARVARD REV PSYCHIATRY 1995;3:171-95.) From the International Consortium on Bipolar Disorders Research (Drs.