BIPOLAR DISORDER is a psychiatric disorder which is characterized by MOOD SWINGS. As the patient’s mood, swings between two extremes of expression i.e. mania and depression, it is also called manic-depressive disorder. The mood changes that are observed in a bipolar disorder patient are very strong as compared to those observed in a normal person.
AGE OF ONSET: It is not limited to a specific age group, and effects people at any time in life. But the severity of disease differs amongst the two age groups, affecting teenagers more seriously when compared to adults. Independent of the age time of onset and of the mode of disease, this illness lasts for the whole life.
POSSIBLE CAUSES AND RISK FACTORS: Although this disorder is still under research to find out its exact cause, the few possible risk factors that may lead to the disease are found to be family history, depression, anxiety, Attention Deficit Hyperactivity Disorder and some structural or functional pathology in brain.
BIPOLAR DISORDER IN CHILDREN AND TEENS;
Patients with early-onset bipolar disorder show more severity in symptoms as compared to adults. The major sign that can be observed in a patient going thorough manic-depressive disorder is the ‘extremes in their energy levels’ along with the swinging symptoms of feeling severely ‘low’ at one time and ‘high’ at the other. The’ manic’ and ‘depressive’ episodes that a child or teenager goes through, are characterized by some specific symptoms which may also be seen in normal persons but to a very low degree.
SYMPTOMS OF MANIC EPISODE IN CHILDREN:
1-the child becomes short tempered, shouting and fighting at normal happenings.
2-He talks more and very fast as if wanting to complete the whole story in a single sentence. This is a result of the racing thoughts during mania.
3-The child acts very silly in an unusual manner, and also talks in a silly way jumping from one topic to the next one. He talks about non-relevant things when answering a specific question.
4-An evident symptom that is seen in manic patients is loss of concentration, which causes problem focusing on study or any other activity. The child is unable to maintain his grades due to deterioration of concentration while studying and focusing.
5-Compared to normal children, they are found thinking about sex more often.
6-Sleep disturbance is usual. The child is less tired and more active even after sleeping for a few hours.
SYMPTOMS OF DEPRESSIVE EPISODE IN CHILDREN:
1-The child feels’ low’ and depressed for long periods. He doesn’t feel comfortable talking, instead remains inactive and depressed.
2-He doesn’t show interest in playing or in his favorite fun activities.
3-He often complains of aches and pains like headache or general muscle ache.
4-The child either eats too less and loses weight or eats too much, gaining weight.
5-The child feels shy, worthless and guilty. He blames himself for the unrelated bad event
6- Suicidal attempts are also more common during this phase in children as compared to adult onset disease.
7-Loss of energy is also a common symptom.
DIAGNOSIS OF BIPOLAR DISORDER:
The diagnosis of bipolar disorder is solely clinical and no laboratory investigations are required, but a few blood tests and some imaging scans of brain are done to exclude other psychiatric brain diseases. As many of the above mentioned manic-depressive symptoms are also shown by a normal child during childhood, an accurate diagnosis of bipolar disorder can be made by deeply and constantly visualizing the child’s behavior. A diseased child or teenager will remain in an active or depressive mood for most of the day, and on most days of the week.
A number of childhood psychiatric illnesses which may be associated with bipolar disorder are depression, anxiety and attention deficit hyperactivity disorder.These disorders may a predisposing factor for bipolar disorder or they might occur in association with it, without any previous history. Alcohol abuse is also common in teenage patients.
TREATMENT OF BIPOLAR DISORDER:
There are many regimes followed by different doctors to treat bipolar disorder but the best results are seen by a combination of psychotherapy and medication. The treatment should be started soon after assessing the mental and physical health status of a child with bipolar disorder. In children and teenagers the medication should be kept at a low dose while at the same time giving more preference to the psychotherapy sessions. The only and best medications discovered and approved by FDA for bipolar disorder are the following.
1-lithium (mood stabilizer) It is mandatory to keep a regular record of thyroid and renal function tests while using lithium.
2-resperidone (from age 10 years plus)
3-aripiprazole (age 10-17 years)
Medications have some side effects, and should be brought to the physician’s notice, by visiting him regularly.
Other medications that may be combined are Atypical anti psychotics and Anti- depressants.