Bipolar Disorders in Children and Adolescents

Authors and Disclosures

Naomi A. Schapiro, RN, MS, CPNP is Associate Clinical Professor, Department of Family Health Care Nursing, University of California, San Francisco.

Sidebar: BOX 1. Criteria for Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three or more of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity

2. decreased need for sleep

3. more talkative than usual or pressure to keep talking

4. flight of ideas or subjective experience that thoughts are racing

5. distractibility (ie, attention too easily drawn to unimportant or irrelevant internal stimuli)

6. increase in goal-directed activity (either socially, at work or school, or sexually or psychomotor agitation)

7. excessive involvement in pleasurable activities that have a high potential for painful consequences (eg, engaging in unrestrained buying sprees, sexual indiscretions or foolish business investments)

C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment) or a general medical condition (eg, hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant therapy (eg, medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Copyright 2000. American Psychiatric Association.

Sidebar: BOX 2. Criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical conditions, or mood-incongruent delusions or hallucinations.

1. depressed mood most of the day, nearly every day, as indicated by either subjective report (eg, feels sad or empty) or observation made by others (eg, appears tearful). Note: In children and adolescents, can be irritable mood.

2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account of observation made by others

3. significant weight loss when not dieting or weight gain (eg, a change of more than 5% in body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, failure to make expected weight gains

4. insomnia or hypersomnia nearly every day

5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6. fatigue or loss of energy nearly every day

7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely guilt or self-reproach about being sick)

8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet the criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, ie, after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Copyright 2000. American Psychiatric Association.

Sidebar: BOX 3. Web Resources for NPs

Cytochrome P and Drug-Drug Interactions


https://www.fda.gov/cder/consumerinfo/druginteractions.htm
https://www.mhc.com/Cytochromes/index.html

Sidebar: BOX 4. Resources for Families

Books

Greene, R. W. (2001). The explosive child: A new approach for understanding and parenting easily frustrated, chronically inflexible children (2nd Ed.). New York: HarperCollins.
Lederman, J., & Fink, C. (2003) The ups and downs of raising a bipolar child: A survival guide for parents. New York: Simon & Schuster.
Papolos, D., & Papolos, J. (2002). The bipolar child: The definitive and reassuring guide to childhood's most misunderstood disorder. New York: Broadway Books.
Waltz, M. (2000). Bipolar disorders: A guide to helping children & adolescents. Sebastopol, CA: O'Reilly & Associates.

Organizations/ Web Resources

Child and Adolescent Bipolar Foundation
https://www.bpkids.org
The Juvenile Bipolar Research Foundation
https://www.bpchildresearch.org
The National Alliance for the Mentally Ill (NAMI)
https://www.nami.org