BIPOLAR DISORDER

Bipolar Disorder is a psychiatric diagnosis involving both elevated and depressive mood states. The duration and intensity of mood states varies widely among people with the illness. Fluctuating from one mood state to the next is called “cycling”. Mood swings can cause impairment or improved functioning depending on their direction (up or down) and severity (mild to severe).

There can be changes in one’s energy level, sleep pattern, activity level, social rhythms and cognitive functioning. Some people may have difficulty functioning during these times, and the disorder can involve great distress and disruption and is associated with a higher-than-average risk of suicide.

Bipolar Disorder is commonly categorized as either Type I, when there are full-blown manic episodes (not triggered by medication), or Type II, when the episodes do not go beyond ‘hypomanic’. In addition there are ‘rapid cycling’ subtypes. Because there is so much variation in the severity and nature of mood-related problems, the concept of a bipolar spectrum of subtypes is often employed, and sometimes the concept of a continuum of mood variation merging in to the ‘normal’ range.

Causes

Bipolar disorder is considered to be a result of complex interactions between genes and environment. The disorder runs in families, with over two thirds of people with bipolar disorder having at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a genetic component.

Researchers suggest that abnormalities in the structure or function of certain brain circuits could underlie bipolar and other mood disorders, and studies have found anatomical differences in areas such as the prefrontal cortex and hippocampus.

The nature of personality and temperament may play a role. Some studies suggest that bipolar patients were significantly more extroverted, intuitive, and perceiving, and less introverted, sensing, and judging than were unipolar patients.

The “kindling” theory asserts that people who are genetically predisposed toward bipolar disorder can experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Eventually, a mood episode can start (and becomes recurrent) by itself. Not all individuals experience subsequent mood episodes in the absence of positive or negative life events, however.

Individuals with late-adolescent/early adult onset of the disorder will very likely have experienced childhood anxiety and depression. Some argue that childhood-onset bipolar disorder should be treated early.

Diagnosis of Bipolar disorder

Flux is the fundamental nature of bipolar disorder. Both within and between individuals with the illness, energy, mood, thought, sleep, and activity are among the continually changing biological markers of the disorder. The diagnostic subtypes of bipolar disorder are thus static descriptions — snapshots, perhaps— of an illness in continual change. Individuals may stay in one subtype, or change into another, over the course of their illness.

There are currently four types of bipolar illness. The DSM-IV-TR details four categories of bipolar disorder, Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified). The behavioral manifestations of bipolar disorder are often not understood by patients nor recognized by mental health professionals, so people may suffer unnecessarily for many years before receiving proper treatment.

recognizing mania in a child with autism

While depression can be quite obvious, recognizing mania may be more difficult in a child with autism. The following seven categories follow the symptoms of mania or hypomania.

Inflated self-esteem or grandiosity

When a child cannot talk or has a communication disorder, it may be hard to identify this symptom. Many of our kids act like they are in charge of the world anyway. What you may see in a child with autism is a marked improvement in the child's usual mood. The child may seem overly happy, silly, or laugh inappropriately or even hysterically. A child who once feared certain situations may show no fear. The child may show irritability rather than a good mood. Behavior may become more aggressive than usual. Tantrums may increase dramatically. The child may act like the rules no longer apply to him or her. The child may act as if he or she has "super powers". The child may say he or she will report others to the principal or to the police, etc.

Decreased need for sleep

Many children with autism have sleep issues to begin with so this may be a difficult symptom to track. What you may see in a child with autism is that the child may not sleep at all or their normal sleep times are decreased significantly. Alternatively, since sleep is usually a pleasurable activity, the child may sleep too much in the beginning of a manic cycle. Many children and adults with Bipolar Disorder have a "crash" after a manic phase and may not want to get out of bed at that time.

More talkative than usual or pressure to keep talking

For children who have a communication disorder this symptom would not seem to apply. However, many children and adults with autism and Bipolar Disorder show an increase in their speech and vocalizations during a manic cycle. I have had many parents report the "good news" that their child is suddenly more verbal only to later report that the child is driving them crazy with the accompanying manic behavior. Children with autism may use more words, talk/vocalize faster than normal, be difficult to stop or interrupt, and/or may talk through the night.

Flight of ideas or subjective experience that thoughts are racing

The child's interest in activities may increase dramatically. The child will be restless, bombard you with "requests" for activities or other things, and will flit from one activity or thought to another. If the child is verbal he or she may be able to talk about their many conflicting thoughts and interests. Their speech may make no sense, may be a series of unrelated sentences or words, or may be songs or rhymes that have little relation to what is going on. May be expressed as extreme hyperactivity.

Distractibility

Attention is too easily drawn to unimportant or irrelevant external stimuli. Many children with autism and ADHD have this symptom already. However, in a manic cycle the distractibility would be more than usual. May focus on unusual aspects of objects that are different from their usual interests.

Increase in goal-directed activity or psychomotor agitation

It may be impossible to redirect ritualistic behaviors. Once the child starts an activity he or she is almost impossible to stop. May repeat activities over and over (with more intensity than usual). The child may masturbate or engage in other sexual activity to an extreme degree.

Excessive involvement in pleasurable activities that have a high potential for painful consequences

Examples involve unrestrained buying sprees, sexual indiscretions, or foolish business investments in an adult context. As above, sexual activity/interest may be taken to the extreme. The child may sleep excessively, self-stimulate excessively, eat excessively, toilet excessively, or engage in any other pleasurable behavior with more frequency and intensity.

What parents do if they suspect bipolar disorder?

If you suspect your child has Bipolar Disorder, talk with your child's physician about a referral for an evaluation. Usually a psychiatrist will make the diagnosis. Treatment often involves medication but there are behavioral interventions and alternatives to medication that are also effective. An important fact to remember is that Bipolar Disorder is not something that "takes over" your child - he or she is a participant in the process. There are steps you can take to lessen the impact of a manic phase. For great strategies, see this link: How To Avoid a Manic Episode.

Children, Bipolar disorder and problems with diagnosis

Children with bipolar disorder do not often meet the strict DSM-IV definition. In pediatric cases, the cycling between elevated and depressed mood states can occur very quickly, sometimes within the same day or the same hour. When the symptoms of both mania and depression occur simultaneously, mixed cycling occurs.

Often other psychiatric disorders are diagnosed in bipolar children. These other diagnoses may be concurrent problems, or they may be misdiagnosed as bipolar disorder. Depression, ADHD, ODD, schizophrenia, and Tourette syndrome are common comorbid conditions.

Misdiagnosis can lead to incorrect medication. Incorrect medications can trigger mania and/or suicidal ideation and attempts. The energy, impulse control difficulties, and lack of maturity in bipolar children can make suicide risk a serious concern, even with children younger than 8 years old.

During severe episodes of mania and mixed states, a child may suffer from symptoms of psychosis. These episodes can be negative (such as thinking their poster on the wall is staring at them angrily) or positive (such as telling people that a rock band is coming to his or her birthday party).

There are many medications which can help calm the symptoms of bipolarity, including in children and adolescents. However, finding the right medicine or combination of medicines is not easy. An exact scientific means of choosing medication for bipolar treatment does not exist. With children this problem is made worse by the fact that as children grow, their weight, metabolism, hormones, brain structure, etc. changes. These changes often require adjustments in the medication(s), significantly more often than adults.

Bipolar children are often both bullies, and the victims of bullies. They rarely see how their actions result in severe social problems at school, home, and elsewhere. These children are confusing for parents, teachers and other professionals, because bipolar disease is one that cycles. Bipolar children may have periods of sweetness, success, creativity, and other wonderful behaviors. Unfortunately, they may also show behaviors that are also extremely negative. This combination makes parenting, teaching, and counseling these children challenging.

Family and friends of the parents of bipolar children rarely understand how difficult things can get when the child is having severe symptoms. This may lead to strained relations with the friends and families of the parents of the affected child.

Fortunately, research and resources for bipolar children have been rising increasing steadily since the year 2000. As of 2005, the level of research has increased at a faster rate, though the results are still sketchy at best.

While finding professionals to help with bipolar children is difficult in a metropolitan area, it can be impossible in areas with smaller populations. Parents with bipolar children need to do as much research as possible in order that they are able to better understand the changes that the child is going through and be informed of the most current information.

Treatment of Bipolar disorder

Currently, bipolar disorder cannot be cured, though psychiatrists and psychologists believe that it can be managed. The emphasis of treatment is on effective management of the long-term course of the illness, which usually involves treatment of emergent symptoms. Treatment methods include pharmacological and psychotherapeutic techniques such as Cognitive Behavioral Therapy. Ultimately one’s prognosis depends on many factors, which are, in fact, under the individual’s control: the right medicines; the right dose of each; a very informed patient; a good working relationship with a competent medical doctor; a competent, supportive, and warm therapist; a supportive family or significant other; and a balanced lifestyle including a regulated stress level, regular exercise and regular sleep and wake times.

There are obviously other factors that lead to a good prognosis, as well, such as being very aware of small changes in one’s energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one’s doctor for how to manage subtle changes that might indicate the beginning of a mood swing. Some people find that keeping a log of their moods can assist them in predicting changes.

The goals of long-term optimal treatment are to help the individual achieve the highest level of functioning while avoiding relapse.

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Please note the section Recognizing Mania in a Child with Autism is under the copyright of Gary Heffner and is used with his permission. The rest of this autism fact sheet is licensed under the GNU Free Documentation. It is derivative of an autism and Asperger's syndrome-related articles at http://en.wikipedia.org