Bipolar Disorder in Childhood

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    Does your child have bipolar manic or depressive episodes?

    Mania/bipolar disorder beginning in childhood or adolescence is a serious condition. One third of adults with bipolar disorder had the onset of the disorder before the age of 20. It is often hard to diagnose because symptoms of childhood mania overlap with other conditions, such as attention deficit hyperactivity disorder, depression, and anxiety. One of the reasons for waiting until age 10 to diagnose the condition is because there is less confusion about diagnosis by that age.  However, while <1% of teens will have full-fledged bipolar disorder, 10% will have serious mood swings that some feel are related to bipolar disorder.

    Severe depression has been divided into two categories: depression only, and depression plus mania or hypomania. This later combination is called Bipolar Disorder. In the case of children, these disorders almost always occur with other disorders (comorbidity). Attention deficit disorder, oppositional defiant disorder, anxiety disorders, autism spectrum disorders and learning disabilities are the most common. The younger the child, the harder it is to be absolutely certain whether the child will continue to have the same disorder the same way in the future, but the younger the child and the more serious and pervasive the symptoms are, the more likely they are to predict continued difficulties of some kind.

    Clinical depression itself is serious, too.  Half of all depressed young adults who have had serious depression, had this depression before the age of 15. In a classroom of 25 children, one will be suffering from a major depressive disorder. That figure triples by the end of adolescence.


    Definitions

    Feeling occasionally depressed, "down", sad or discouraged, is common. The disorder (Major Depressive Disorder or "clinical depression"), on the other hand, is characterized by the association of depressed mood, AND disinterest, irritability, low self esteem, pessimism, suicidal feelings, and not infrequently, poor concentration and physical symptoms. Two weeks is the minimum duration necessary for the diagnosis of actual disorder, but most people have suffered far longer before they realize something is wrong and start to consider getting help. Dysthymia is a type of depression where depressive symptoms are more chronic, somewhat less severe, and never really go away. Untreated episodes of depression generally last 9 to 12 months. Consequences of depression include suicide attempts, suicide, self-medication with drugs of abuse, school failure, family friction, and significant misery for the child/teen.

    In young people, I like to use the acronym DUMPS to remember the symptoms of  depression.

    DEPRESSION

    D = DEFINITE PERSONALITY CHANGE

    A youth who has previously been a good student or a nice kid, who becomes defiant, disagreeable, distant, disorganized.

    U = UNDENIABLE DROP IN GRADES

    A youth whose grades go from As to Cs over a semester or who starts to avoid school altogether, or develops "school phobia".

    M = MORBID PREOCCUPATION

    A youth whose compositions dwell on death and disaster, or who voices suicidal thoughts or who engages in self-destructive behavior.

    P= PESSIMISM / PSYCHOSIS

    A youth who is grim, depressed, demoralized and sees no joy in anything. Acute onset of depressive hallucinations and/or delusions.

    S = SOMATIC COMPLAINTS WITHOUT PHYSICAL BASIS

    A youth who spends more time in the nurse's office than in the classroom, or who has frequent headaches and stomach-aches where there is no apparent medical cause.

     

    MANIA

    Mania is the opposite of depression. Instead of feeling despondent, the person is supremely happy, much more so than circumstances explain. There is an irritable edge to the euphoria, however, so that the person also has a very short fuse. It is this aspect of a manic episode that people focus on when they describe "rages" as being a manifestation of mania. [Rages may be a manifestation of mania, but they may also occur in ADHD, ODD, depression, anxiety, autism, Tourettes Disorder and schizophrenia]. Other manic symptoms include extreme energy, undertaking lots of activities, not wanting to sleep because there is so much to do, moving fast, talking and thinking fast, and having an inflated rather than a low self esteem. Grandiosity, thinking you can do things that are totally impossible because of poor reality testing, is what makes this disorder a "psychosis". Being easily distracted along with the increased energy are two of the symptoms that cause confusion with ADHD. People who are manic are often overly religious or hypersexual during episodes even if they are not when their mood is normal.

    The acronym for manic symptoms is H I P E R S. These symptoms and behaviors occur at the same time and this is called an episode.

    H = HYPERACTIVITY

    Goal directed and pleasure oriented; lots of projects and interests

    I = IRRITABILITY/VOLATILITY

    Having a short fuse. Keep in mind, though, that a short fuse can be a chronic part of someone's personality, be symptom of depression, anxiety, or oppositional defiant disorder

    P = PSYCHOSIS

    Grandiosity, that is, a very significantly inflated self esteem where the person thinks they can do anything. Bragging to the max.

    E = ELATED MOOD

    Feeling so wonderful that it is hard to describe and the feeling occurs when there is no situational circumstance to account for it. Sometimes a person will be very funny, or act in a silly way, but the silly behavior comes from feeling wonderful, not just from being attention seeking.

    R = RACING THOUGHTS, RAPID SPEECH

    People who are manic are on overdrive. Besides having loads of energy, they also think fast, talk fast, you can't get a word in edgewise.

    S = SLEEP

    The person is full of energy and doesn't want or feel the need to sleep. This is not insomnia where the person wants to sleep but can't (more a depressive or anxiety symptom).


    Bipolar/Mania Screening Questionnaire

    If you are interested in finding out your child might have mania/bipolar disorder, we have several attachments on this website for your information.
    1. Bipolar Screening Questionnaire
      If you feel your child has mania/bipolar disorder, please complete the Initial Survey which can be accessed below.
      1. If your child is younger than age 10 or older than age 17, you should print out the questionnaire and bring it to your child's psychiatrist, pediatrician or family doctor. That person can decide if further referral is necessary and who they would recommend.
      2. Stony Brook's Division of Child and Adolescent Psychiatry is taking part in treatment studies for mania in children and teens ages 10-17. If your child is between ages 10 and 17 (inclusive), AND YOU LIVE WITHIN 40 MILES OF STONY BROOK, NY, click "submit" at the end of the questionnaire to send the information to our division. We will review your response and if the information suggests further evaluation for bipolar disorder might be helpful, we will try to contact you. Please tell us whether you prefer to be contacted by phone or by e-mail. 

        Please note: You are considering having your child participate and would like us to provide you with some basic information and to have someone contact you. (You are consenting to let us contact you).

      3. For further information about bipolar disorder
        1. Articles on Bipolar Disorder by Dr. Carlson describing diagnostic and treatment issues
        2. Dr. Carlson's credentials
        3. Websites for further information about Bipolar Disorder:
          http://www.aacap.org/cs/BipolarDisorder.ResourceCenter

          http://www.thebalancedmind.org
            (formerly bpkids.org)

      Access Bipolar Screening Questionnaire


    Depression Screening Questionnaire

    If you feel your child has mania/bipolar disorder, please complete the Initial Survey which can be accessed below.
    1. If your child is younger than age 7 or older than age 17, you should print out the questionnaire and bring it to your child's psychiatrist, pediatrician or family doctor. That person can decide if further referral is necessary and who they would recommend. 
    2. Stony Brook's Division of Child and Adolescent Psychiatry is taking part in treatment studies for depression in children and teens ages 17-17. If your child is between ages 7 and 17 (inclusive), AND YOU LIVE WITHIN 40 MILES OF STONY BROOK, NY, click "submit" at the end of the questionnaire to send the information to our division. We will review your response and if the information suggests further evaluation for bipolar disorder might be helpful, we will try to contact you. Please tell us whether you prefer to be contacted by phone or by e-mail. 

      Please note: You are considering having your child participate and would like us to provide you with some basic information and to have someone contact you. (You are consenting to let us contact you).

    3. Websites for further information about Bipolar Disorder:
      http://www.aacap.org/cs/Depression.ResourceCenter

      http://www.thebalancedmind.org
        (formerly bpkids.org)

       

    Depression Screening Questionnaire

    Short Mood and Feelings Questionnaire -- Parent / Caregiver Version

    This form is about how your child might have been feeling or acting recently.  For each question, please check how much your child has felt or acted this way in the past two weeks.  If a sentence was not true, fill in the bubble for not true.  If it was sometimes true, fill in the bubble for sometimes.  If a sentence was true most of the time, fill in the bubble for true.
      0
    Not True
    1
    Sometimes

    True
    1.S/he felt miserable or unhappy   
    2.S/he didn't enjoy anything at all   
    3.S/he felt so tired s/he just sat around and did nothing   
    4.S/he was very restless   
    5.S/he felt s/he was no good anymore   
    6.S/he cried a lot   
    7.S/he found it hard to think properly or concentrate   
    8.S/he hated him- or herself   
    9.S/he felt s/he was a bad person   
    10.S/he felt lonely   
    11.S/he thought nobody really loved him or her   
    12.S/he thought s/he could never be ase good as other kids   
    13.S/he felt s/he did everything wrong   

    Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., & Silver, D. (1995)

    Score higher than 11 signifies depression


    Descriptions of our 2 studies:

    1)  Bipolar disorders Study

    When your child or teen has mood swings and irritability with heightened energy and unexplained optimism, every day can be a struggle.  In fact, your child may have bipolar mania.  Medical researchers are working to find treatments.   Doctors Carlson and Rundberg-Rivera in Stony Brook University's Child and Adolescent Psychiatry Division are currently enrolling children and teens, ages 12-17, in a clinical research study evaluating an investigational medication for bipolar I disorder.  Each child or teen will receive comprehensive, study-related evaluations by medical professionals at no cost.  

    To learn more, please call Gregory at (631) 632-8828. 

    2) Study for Children with ADHD and Behavioral Control Problems

    Stony Brook University's Division of Child and Adolescent Psychiatry is conducting a study supported by the National Institute of Health of treatment steps for children, ages 6 – 12, who have attention deficit hyperactivity disorder and other behavioral control problems such as aggressiveness, explosiveness and low frustration tolerance. Eligible children receive free evaluation and study treatment, including medication and help with behavioral support strategies.

    For further information, please call Lauren Chorney at (631) 632-8317.