Bipolar Disorder in Children and Adolescents: Yesterday and Today

Bipolar disorder, also known as manic-depressive illness, is a brain disorder characterized by episodes of mania and depression. These episodes are associated with unusual shifts in mood and energy. Early onset bipolar disorder, which starts during childhood or during the teen years, may be more severe than forms that first appear in older teens and adults. Some evidence suggests that young people with the illness may have more frequent mood switches, be sick more often, and have more mixed episodes (both manic and depressive symptoms).

Yesterday

    Few experts believed that bipolar disorder could occur in childhood.
    Depression and manic-depressive illness weren't considered brain illnesses, and distinct treatments for each illness did not exist.
    Researchers could not distinguish between severe irritability and manic-depressive illness in children, which would make it possible to develop more effective treatments for each.

Today

    A large, nationally representative survey shows that at least half of all cases start before age 25.

    Some medications have been approved for treating manic-depressive illness in children and teens, and psychotherapies, such as family focused therapy, also appear to be effective in helping children to manage their symptoms.

    Children with manic-depressive illness can have co-occurring disorders, such as attention deficit hyperactivity disorder, anxiety disorders, or other mental disorders, in addition to bipolar disorder. Scientists and doctors now know that, while having co-occurring disorders can hinder treatment response, treating bipolar disorder can have positive effects on treatment outcomes and recovery from co-occurring disorders as well. Studies focusing on conditions that frequently co-occur and how they affect one another may lead to more targeted screening tools and interventions.

    Imaging studies are beginning to reveal brain activity patterns and connections associated with specific traits associated with children who have bipolar disorder, such as mood instability and difficulty interpreting social or emotional cues.

    Genetic research reveals genetic similarities among bipolar disorder, depression, and schizophrenia. Such studies point to possible common pathways that give rise to these disorders but also highlight limitations in focusing on specific diagnoses in research. This issue has spurred a new NIMH initiative-the Research Domain Criteria (RDoC) project -to make sense of research findings that don't fit neatly into current diagnostic categories.

Early onset bipolar disorder can be diagnosed and treated. With effective treatment, children and adolescents can lead productive lives into adulthood. If mental illness is suspected, it is important to meet with a mental health professional for proper diagnosis and treatment plan.

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