Bipolar disorder in children

Overview
Children with bipolar disorder do not often meet the strict DSM-IV definition. In pediatric cases, the cycling between moods can occur very quickly (see the section on rapid cycling in the main bipolar disorder article).

PEA-BP
Prepuberal and early adolescent bipolar I disorder phenotype (PEA-BP) is bipolar disorder I in DSM-IV-TR.

Children with bipolar disorder may have rapid-cycling or mixed-cycling. Rapid cycling occurs when the cycles between depression and mania occur quickly, sometimes within the same day or the same hour. When the symptoms of both mania and depression occur simultaneously, mixed cycling occurs.

Often other psychiatric disorders are diagnosed in bipolar children. These other diagnoses may be concurrent problems or they may be misdiagnosed as bipolar disorder. Depression, ADHD, ODD, schizophrenia, and Tourette syndrome are common comorbid conditions.

Misdiagnosis can lead to incorrect treatment. Incorrect medications can trigger mania and/or suicidal ideation and attempts. The energy, impulse control difficulties, and lack of maturity in bipolar children can make suicide risk a serious concern, even with children younger than 8 years old.

During severe episodes of mania and mixed states, a child may suffer from symptoms of psychosis. These episodes can be negative (such as thinking their poster on the wall is staring at them angrily) or positive (such as telling people that a rock band is coming to his or her birthday party).

There are many medications which can help calm the symptoms of bipolarity, including in children and adolescents. However, finding the right medicine or combination of medicines is not easy. An exact scientific means of choosing medication for bipolar treatment does not exist. With children this problem is made worse by the fact that as children grow, their weight, metabolism, hormones, brain structure, etc. changes. These changes often require adjustments in the medication(s), significantly more often than adults.

Bipolar children are often both bullies, and the victims of bullies. They rarely see how their actions result in severe social problems at school, home, and elsewhere. These children are confusing for parents, teachers and other professionals, because bipolar disease is one that cycles. Bipolar children may have periods of sweetness, success, creativity, and other wonderful behaviors. Unfortunately, they may also show behaviors that are also extremely negative. This combination makes parenting, teaching, and counseling these children challenging.

Family and friends of the parents of bipolar children rarely understand how difficult things can get when the child is having severe symptoms. This may lead to strained relations with the friends and families of the parents of the affected child.

Diagnosis
Before the DSM-III, bipolar disorder had been considered as a disease of adults or those who have past their puberty. Various studies found that childhood bipolar exist; it is simply difficult to diagnose. There is a high comorbidity between Reactive attachment disorder and Bipolar disorder in children (Alston, 2000)

On September, 2007, experts (from New York, Maryland and Madrid) found that the number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, and it was increasing ever since. However, the increase was due to the fact that doctors more aggressively applied the diagnosis to children, and not that the incidence of the disorder had increased. The study calculated the number of visits which increased, from 20,000 in 1994 to 800,000 in 2003, or 1% of the population under age 20.

Treatment
Usual treatment involves medication and psychotherapy

Handbooks for researchers and clinicians
[http://books.google.com/books?vid=ISBN1593852932&id=m2mSld3Oq0IC&pg=PP1&lpg=PP1&ots=vSJU2klrYo&dq=barbara+geller+bipolar&sig=28-yq7S2V5PZb6Lt3WhOujoQj58 Bipolar Disorder in Childhood ad Early Adolescence. Gellar, B., & BelBello, M. (ed)]