http://cyprus4u.info/repository/portfolio-and-resume-website.php class="lazy lazy-hidden alignright size-full wp-image-578" width="220">To provide a review of the epidemiology, phenomenology, natural course, comorbidity, neurobiology, and treatment of child and adolescent bipolar disorder BP for the past 10 years.
This review is provided to prepare applicants for recertification by the American Board of Psychiatry and Neurology. Literature from Medline and other searches for the past 10 years, earlier relevant articles, and the authors' experience and ongoing National Institute of Mental Health-funded project "Phenomenology and Course of Pediatric Bipolarity" were used.
Age-specific, developmental child, adolescent, and adult DSM-IV criteria manifestations; comorbidity and differential diagnoses; and episode and course features are provided.
Included are age-specific examples of childhood grandiosity, hypersexuality, and delusions. Systematic research on pediatric BP is in its infancy and will require ongoing and future studies to provide developmentally relevant diagnostic methods and treatment. As noted in a recent letter by Schneider et al. Thus, a developmental, age-specific viewpoint needs to be Literature Review Bipolar Disorder for pediatric patients who do not have the adult-type onset.
Analogies to two other occurrences in bioscience are useful to understand the developmental perspective. The first occurrence is that different illnesses may have different neurobiological e. A classic example is the comparison of juvenile to adult-onset diabetes in which genetic mechanisms and severity differ.
The second situation occurs when the same causative agent can have different clinical manifestations at different times in the life cycle. An example of the second situation is when 6-OH-dopamine is given to infant versus adult rats.
Infant rats given this compound develop hyperactivity, whereas geriatric rats develop parkinsonian symptomatology. On Literature Review Bipolar Disorder basis of the occurrence of either or both of the neurobiological mechanisms noted above, it is developmentally possible for childhood-onset manic-depressive illness to be more severe; to have a chronic, nonepisodic course; and to have mixed, rapid-cycling features similar to the clinical picture reported for severely ill, treatment-resistant adults Geller et al.
A possibility also exists that only the most severe manic-depressive children receive clinical attention because manic episodes that last a few weeks might be tolerated by parents as a phase of growing up, especially if these do not interfere with school performance. Our experience of colleagues requesting "hallway" consultations suggests that this may be the case.
The following review assumes that future data will support continuities across the age span. As yet, no national or international epidemiological study of Literature Review Bipolar Disorder disorder BP during the pediatric years is available.
However, data from Carlson and Kashani and Lewinsohn et al. These reports and those below taken together -- i. A secular trend, i.
Underdiagnosis of childhood bipolarity has been noted please click for source several authors who have described a high prevalence on inpatient services Gammon et al.
Another source of underdiagnosis during childhood and adolescence is that many parents who are bipolar, and thus at higher risk of having bipolar offspring, remain underdiagnosed themselves Geller These parents may not recognize the pathological implications of their children's manic behaviors. Adults with childhood onset by history often also report that the initial episode was depressive Lish et al. These rates of switching may be conservative because of the probable underdiagnosis of childhood mania discussed above.
At all ages, manic subjects in the cross-section appear to be the happiest of people because of their infectious, amusing, elated affect. This is also true of children, and it can be very Literature Review Bipolar Disorder to see a happy child laughing in the office in the context of a miserable history e. This continue reading with sad, Literature Review Bipolar Disorder children who everyone thinks are ill because it is more difficult to acknowledge conceptually that happy children have serious psychopathology.
Thus, it is important to evaluate children's affect in relationship to historical features in exactly the way one evaluates Literature Review Bipolar Disorder incongruity between the infectious elation of manic adult patients in the context of histories that include loss of family, unemployment, and jail sentences.
Across the life span, grandiose delusions must be judged by failure to follow the laws of logic and by a firm belief often to an extent that action is taken. A common click for bipolar children is to harass teachers about how to teach the class; this harrassment is often so intense that teachers telephone parents, begging them to ask their children to desist.
These children may fail subjects intentionally because they believe the courses are taught incorrectly. Therefore, their thinking bypasses laws of logic i. Another common grandiose manifestation in children as young as seven is to steal expensive items and be impervious to police officers who attempt to make them understand that what they have done is wrong and illegal.
Similar to grandiose adults, grandiose children believe that stealing may be illegal for other people but not for them. Unlike patients with pure conduct disorder, manic children and adolescents, similar to bipolar adults, frequently know that stealing is a bad thing to do, but they believe that they are "above" the law. Common adolescent grandiose delusions are click they will achieve a prominent profession e.
Review: An Unquiet Mind by Kay Redfield Jamison
Asked how he or she will become a lawyer, an adolescent will answer is "I just know I will". Similarly, a manic adolescent, even in the absence of musical talent or ability to carry a tune, might practice all day with the belief that he or she can become a rock star. Dissimilar to depressed patients who have trouble falling asleep and lie in bed brooding, manic children have high activity levels in the bedroom prior to sleep, e.
Manic adolescents will wait until parents are asleep and then go out "partying," whereas manic adults will party and work around the clock. Pressured speech is relatively similar at all ages in that the individual can be difficult or impossible to interrupt.
Racing thoughts are frequently described by children and adolescents in very concrete terms. For example, children state that they are not able to get anything done because their thoughts keep interrupting. An adolescent wished she had a button on her forehead to turn off her thoughts. Flight of ideas in children is similar to that in adults except for age-specific content, e. Some people have hogs for Thanksgiving.
Do you have a key to that door? Also at all ages, minor perturbations in the environment can produce marked amounts of distractibility. Increased motor activity and goal-directed behaviors in children and adolescents frequently look like normal activities done in a profuse amount. The manic child may in a brief period of time make curtains, begin an illustrated book, rearrange furniture, and make multiple phone calls, compared with the manic adult, who may start many businesses and join many social groups.
Involvement in pleasurable activities with a high level of danger is manifested in age-specific behaviors. Hypersexuality in children frequently begins when a child brought up in a conservative home without any history of sexual abuse or excessive exposure to sexual situations begins to use profanity and may tell a teacher to "f herself" and "gives her the finger. Children will begin to proposition teachers and make overt sexual comments to classmates.
Adolescents develop romantic fantasies and delusions about teachers see vignette in Geller et al. Older children and go here will call the sex telephone lines, which the family discovers when the telephone bill arrives.
Older adolescents and adults will have multiple partners with unprotected sexual behaviors and this web page will have an urgency to have sex, e. Interest Literature Review Bipolar Disorder money appears in young children when they start their own businesses in school and when they begin to order multiple items, trips, and plane tickets from advertised and telephone numbers.
Again, the family frequently does not discover this until items arrive at the house and telephone bills arrive. Adults may overdraw on bank accounts and "top Literature Review Bipolar Disorder on multiple credit cards.
Across the age span, taking more dares is common. In older adolescents and adults, this frequently appears as wild driving, eventuating in many speed and "driving under the influence" tickets. In children it manifests as grandiose delusions that they can fly out the window because they believe that they have that ability or in exaggerations of usual childhood hopping around on trees or between roof tops, based on beliefs that they are above the possibility of danger.
To further exemplify pediatric features, characteristic vignettes of children and adolescents with BP can be reviewed in Geller et al. Characterization of preschool-age BP is an important avenue for future investigation.
A review of the epidemiology, comorbidity, neurobiology, and treatment of child and adolescent bipolar disorder over a ten year period. Includes developmental. Bipolar disorder, previously known as manic depression, is a mental disorder that causes periods of depression and periods of elevated mood. The elevated mood is. ABSTRACT. This paper describes the findings of a systematic literature review aimed at providing an overview of the lifetime prevalence of bipolar disorder and. Bipolar II disorder (BP-II; pronounced "type two bipolar" or "bipolar type two" disorder) is a bipolar spectrum disorder (see also Bipolar disorder) characterized by. Bipolar disorder causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).
Sexual abuse is especially important as a differential diagnosis during the childhood years because manic hypersexuality is often manifested in children by self-stimulatory behaviors including frequent masturbation. Thus, it is useful to obtain a careful history of whether the child could click here been Literature Review Bipolar Disorder or exposed to adult sexual behaviors.
At present, data suggest that for some prepubertal-onset bipolar children, hyperactivity manifestations begin at preschool age and are followed by a full manic syndrome during the early grade-school years Gellerb.
In these children, it is possible that hyperactivity is the first developmentally age-specific manifestation of prepubertal-onset BP. This hypothesis is consistent with the higher prevalence of attention-deficit hyperactivity disorder ADHD in prepubertal- versus adolescent-onset BP. Numerous authors Biederman et al.
Thus, validation of the distinctness of coexistent ADHD versus similar symptom clusters but dissimilar pathogenesis must await future naturalistic course, family genetic, and other neurobiological studies Biederman et al.
These comorbid conduct disorders appear related to poor judgment and grandiosity.
We conducted a literature review on comorbidity in autism spectrum disorder. • We reviewed comorbid psychiatric and medical disorders in babies and infants. Although the editors of cyprus4u.info have made every effort to report accurate information, much of the work referenced here is in abstract or pre-publication form. Making the diagnosis of bipolar disorder is often difficult, and following onset of symptoms, many years may elapse until the diagnosis is established. As an example. Research suggests that doctors in certain settings may overdiagnose bipolar disorder due to confusion about the prescribed criteria for diagnosis.
As an example, a 7-year-old child stole a go-cart, an item that costs several hundred dollars, and was completely unfazed when the police appeared and tried to admonish him, thus demonstrating the grandiosity of stealing such a large object and of being impervious to legal intervention. Conduct disorders during adolescence which may include driving under the influence, running away for sexual adventures, and stealing large amounts of jewelry frequently lead to placement of these youngsters in juvenile facilities.
Adult antisocial equivalents are well known e. During the teenage years, because of greater perceptual check this out seen in bipolar illness during adolescence, schizophrenia is a major differential Horowitz Differentiation is greatly aided by a family history of mania, which is more probable for BP than schizophrenic adolescents Strober et al. Substance abuse begins to be an important comorbid condition during the teenage years and is an important differential Horowitz; For example, laughing fits may be due to smoking marijuana as a differential from the laughing fits that occur during the pediatric years as a manifestation of elation.
Furthermore, very rapid cycling Table 2 that is a hallmark of child and adolescent bipolarity Geller et al. Table 2 provides a comparison between pubertal-onset versus adult-onset episode and course features. As noted in the beginning of this article, prepubertal onset manic-depressive disorder may not present with the sudden or acute onset and improved interepisode functioning characteristic of the disorder in older Literature Review Bipolar Disorder and adults.
Rather, it may present with a picture of continuous, mixed manic, rapid cycling of multiple check this out episodes described in detail by Geller et al.
Thus, children may be having a laughing fit and happily doing an arts and crafts project when, without any environmental prompt, they will suddenly become miserable and acutely suicidal, talking about wanting to shoot themselves. Parents frequently describe their frustration at not being able to convince practitioners that their children rapidly cycle, sometimes numerous times in each day.
Because this history has been given independently by parents including those from many parts of the United States who have received Dr.
Geller's name from the National Institutes of Health who have no idea that this cycling pattern has been described by other parents, there is no reason to disbelieve these parental observations. Adults with mixed manic, rapid-cycling BP have a poorer prognosis than those with discrete episodes Keller et al.
Therefore, Literature Review Bipolar Disorder studies of the adult course of BP children will be crucial for developing long-term, prophylactic treatments for implementation during the prepubertal years. Naturalistic follow-up of bipolar adolescent inpatients has evidenced a poor prognosis Strober et al.
One of the issues that arises for child and adolescent manic-depressive individuals is whether or not BP-II disorder has the same implications as it does in the adult population Coryell et al.
Treatment for MDD in potentially BP pediatric patients may be contraindicated because there is evidence, albeit controversial, that antidepressant therapy may precipitate or worsen rapid cycling Akiskal et al. Further research will also be needed to provide better differentiation of whether the Akiskal et al. The role of comorbid personality disorders as prognostic and course features of adolescent BP remains a poorly read more but important area based on reported interepisode personality trait impairments in BP adults Solomon et al.
Other work in the area of personality disorders among pediatric BP individuals Literature Review Bipolar Disorder not yet available, in part because of the need for further work on instrumentation Brent et al. Data support a higher risk of suicidality among BP adolescents compared to adolescents with other diagnoses Brent et al.