He Bipolar disorder in children Is an increasingly widespread chronic mental illness. In fact, a group of researchers in 2007 announced that the number of children diagnosed with bipolar disorder increased up to 40 times in recent years.
Although it manifests most commonly in late adolescence and early adulthood, it can already be diagnosed over 6 years of age.
This condition affects mood and energy, more specifically causing sudden changes in emotional states. In this way, the child can fluctuate continuously between decay and sadness or activity and euphoria.
Unlike Bipolar disorder In adults, in children depressive and manic symptoms occur on the same day. It can even appear simultaneously, as negative moods with great energy.
The prevalence of the disorder worldwide is around 1-2%. Whereas, if we speak only of the child population, the percentage is between 0.1% and 0.5%, although its frequency is increasing.
Bipolar disorder in children appears to be more common in the male population, with depressive symptoms being more pronounced in girls.
In addition, other disorders that accompany bipolar, such as ADHD, disruptive behavior, depression, etc., are also common.
Types of Bipolar Disorder in Children
There are different types of Bipolar Disorder according to the DSM-V, which are the following:
- Bipolar Type I: Characterized by the predominance of manic episodes. Usually the affected person shows a great euphoria and a high level of activity that prevents him to sleep or to remain still. Happiness and laughter can quickly turn into irritability and aggression.
- Bipolar Type II: Here predominate hypomaniac-type episodes, that is, sadness and apathy are more frequent than episodes of mania. Cursa with episodes Major depressives .
- Cyclothymia Is described in children as periods of 1 year or more where several hypomanic and depressive symptoms occur. In addition, it should be accompanied by nervousness or deterioration in your day to day clinically significant.
- Substance-Induced Bipolar Disorder
- Because Other medical condition
What is bipolar disorder in children?
There are several factors that can cause bipolar disorder in childhood, although it is clear that genetic factors have great weight.
85% of cases are due to inherited genetic factors. In fact, monozygotic twins are more likely (45%) to share the disorder than dizygotic twins (6%).
Bipolar Disorder has been associated with certain regions of chromosomes 4, 6, 8, 10, 13, 18 and 20 (as well as schizophrenia). Although the results are contradictory among the different studies, since it seems that many different genes participate to a greater or lesser extent.
In an important study of the journal Nature by Mühleisen et al. (2014) two genes were found to be very important for bipolar disorder: the ADCY2 gene on chromosome 5 and the MIR2113 and POU3F2 region on chromosome 6.
Thus, if there is a family history of bipolar disorder it is often more likely to present the disease than others who have no family history.
However, the exact causes are still under investigation as they are not fully defined.
Bipolar disorder can also arise from alterations in certain brain structures involved in emotional processing, such as: basal ganglia, amygdala, hippocampus , Thalamus or prefrontal cortex.
It is considered a neurodevelopmental disease. According to Uribe and Wix (2011), this disorder is characterized by a deficiency of GABAergic interneurons and an exaggerated expression of those genes that program neuronal death. It is known that there are periods in our life where there are neuronal deaths (called neural pruning) that are adaptive and healthy. However, when this process is altered (for example, neurons or connections that are useful are removed) can lead to several disorders.
Another trigger is anxiety disorders, it appears that children who have these problems are more likely to develop bipolar disorder (National Institute of Mental Health, 2016).
Symptoms of bipolar disorder in children
According to"The Bipolar Child"many parents of bipolar children indicate that these children were behaving differently. They say that they are difficult children, that they are rarely tired, they sleep very little, they are very sensitive to the external stimuli and they experience a great Separation anxiety .
In early childhood, as we mentioned, the mood alterations oscillate very quickly. They are characterized primarily by a set of symptoms of mania, depression, and major irritability.
The main symptoms are:
- Mood swings: Ranging from euphoria and irritability to depression (sadness and crying). The changes can occur within a few hours (what is known as ultra-fast cycle) and are intense and explosive.
Poor moods are usually given in the morning, so these children find it almost impossible to get out of bed. While in the evenings and nights the energy is fired.
- Anxiety: The child is expectant, tense and with a high level of vigilance.
Over the 5-7 years episodes of separation anxiety in the depressive periods are typical. At this time it can also be observed that the child sleeps more than the count, occurring periods of insomnia during the stages of mania or activation.
- Hyperactivity: You can not sit still and have periods of intense agitation. Appearance of Extreme tantrums Before the refusal of the others.
- Say"no"to everything And to oppose the rules given by adults. Constant disobedience, and it may even lead to aggression and violence.
Is distracted easily.
- Presents a Accelerated thinking , Which is out of the ordinary ( Tachypsychia )
- It starts many activities, but it does not finish any.
- May show preference for Dangerous activities Or risky.
- These children can be bossy, arrogant and excessively outgoing; Or they may experience social phobia.
- Sometimes it can happen enuresis , night terrors , Frequent nightmares and eating disorders.
- Interestingly, delusions or irrational beliefs can also arise that are accepted as true and hallucinations. These are linked to voices or images that threaten you, satanic figures or snakes. They are more common in stages of overactivation or mania.
- In depressive stages, it is common for the child to complain of pain and experience physical discomfort.
However, it is important to know that these symptoms are not the same in all children and do not have to be all. In addition, isolated eyes may be normal behaviors in young children ( What child does not have moments of disobedience and tantrums? ) But here they are accompanied by the symptoms already defined and are so intense that they touch on the problematic.
It is common in children for bipolar disorder to begin with early depression.
How is the diagnosis made?
The smaller the child, the more complications there are for diagnosis and the more common the errors.
That is why it is usually expected a few years to prove that it is bipolarity and not another condition, since an incorrect diagnosis would lead to a treatment that is not appropriate. This could be very harmful to the child, so it is preferred to act with caution. There are cases that are not even diagnosed until the child has reached adolescence.
However, the sooner the disorder is detected and the earlier it is treated, the better the progress of the disease will be.
The diagnosis of bipolar disorder in children has been very controversial, declaring some authors that it is actually less frequent than it is (ie, it is diagnosed more than necessary); While others think otherwise.
There are also other problems linked to diagnosis and are linked to the fact that this problem can be confused very easily with other disorders.
To diagnose bipolar disorder, the professional will delve into the existence of depressive or manic episodes, sleep pattern and activity, possible associated disorders, current psychological state, stressful events or difficult situations through which the child passes, physical illnesses, violent behavior , etc.
Do not confuse with...
- Attention deficit disorder and hyperactivity (ADHD)
- Disruptive Dysregulation Disorder of Mood.
- Challenging Negative Disorder
- Childhood Schizophrenia
Sometimes Bipolar Disorder can coexist with any of the above.
Treatment and advice
Bipolar disorder in children is a chronic disease, but it has treatment, there are various techniques for the child to be the best possible and develop a satisfactory life. It is best to opt for a comprehensive approach, covering all possible aspects of the small.
- Medication: The first objective will be to stabilize the child's mood. The most common drugs are lithium carbonate, sodium valproate, carbamazepine, oxcarbazepine, topiramate and tiagabine.
If psychotic symptoms or aggressive behavior occur, Antipsychotics Atypicals such as risperidone, olanzapine, quetiapine and aripiprazole.
It is important that you receive the right medication for each child and strictly follow their administration. It may be helpful to use any reminders that are necessary so that no missed calls are taken.
Be cautious about side effects of drugs, as these substances have been studied mostly in adults and not children; So the effects can not be known.
- Psychological therapy: Once the child stabilizes due to pharmacological intervention, it is essential to receive therapy in order to achieve stable changes. That way you can change your habits, behaviors and improve social relationships with others.
It is not a good option to opt for therapy if the child is in the severe stages of the disease, still without medication. Since, in this case, it will not collaborate and will be very difficult to work with.
- Family therapy: It can sometimes be necessary if the child's behavior is disrupting the whole family and causing serious problems in relationships.
On the other hand, this type of therapy can be useful for the family to learn about the problem, know how to educate and treat the child properly in the home, and also that your child's disorder does not absorb them.
According to Diaz Atienza and Blánquez Rodríguez, in global terms, the family must learn to:
- To stand up to the child's disruptive behavior and tantrums.
- Be more tolerant of those difficulties that the child is not so important, nor compel him to obey unnecessary rules. They must understand that the little one can not control their emotions and actions.
- Set clear limits, but also be not too rigid in the home.
- Practice relaxation techniques, listen to quiet music.
- Avoid problems and discussions in the family, trying to maintain a quiet environment.
- Escape risky situations and not leave dangerous objects near the child.
It is essential that the intervention covers everything possible: affective, behavioral, family and psychosocial aspects of the affected.
- Adaptation by the school: It is important to inform the teachers of the condition of the child so that they can adapt the activities to their work pace. Therefore, agreements must be reached with school workers. There may even be periods when the child can not attend, and it is essential to report everything to the school.
- Maintain a routine: It is essential to reduce stress to the child's environment as much as possible, and to set a schedule where you wake up every day, lie down, and have meals at the same time.
- Support for the child: Can be complicated, but it will be better for a happy life so the child will feel understood and be patient with him. It is beneficial for parents to try to listen to you and talk to you, as well as let you know that it is important that you follow the treatment to make you feel better. It is also good that you devote time of leisure and fun.
- Acting before any sign of suicidal ideas: It is better not to think that they are calls for attention and to act if it is observed that the little one talks about the death, Self-injurious Or somehow expresses that he wants to die. It is appropriate to seek help as soon as possible and remove any dangerous objects from the reach of the child.
References
- Bipolar Disorder in Children and Teens. (S.f.). Retrieved on August 8, 2016, from the National Institute of Mental Health.
2. Children and Teens With Bipolar Disorder. (S.f.). Retrieved on August 8, 2016, from WebMD.
3. Díaz Atienza, J. y. (S.f.). Bipolar Disorder in Childhood and Adolescence. Retrieved on August 8, 2016, from Guides for parents of the Child Health Mental Health Unit of Almería.
4. Frequently Asked Questions About Early-Onset Bipolar Disorder. (S.f.). Retrieved on August 8, 2016, from The Bipolar Child.
5. Leibenluft, E. (n.d). Severe Mood Dysregulation, Irritability, and the Diagnostic Boundaries of Bipolar Disorder in Youths. American Journal Of Psychiatry, 168 (2), 129-142.
6. Linares, A.R. (s.f.). Bipolar disorder in children and adolescents. Retrieved on August 8, 2016, from Center London.
7. Muhleisen, T., Leber, M., Schulze, T., Strohmaier, J., Degenhardt, F., Treutlein, J., &... Cichon, S. (2014). Genome-wide association study reveals two new risk loci for bipolar disorder. Nature Communications, 5.
8. Uribe, E., & Wix, R. (2012). Review: Neural migration, apoptosis and bipolar disorder. Journal of Psychiatry and Mental Health (Barcelona), 5127-133.