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Understanding Bipolar Disorder

Understanding Acquired Brain Injury

Bipolar disorder is a mood disorder that causes severe shifts in mood, energy, thinking and behaviour. It is defined by the experience of extreme emotional highs and lows. The “high moods”, or manic episodes, is where one has an abnormal inflated, euphoric mood. The “low moods”, or depressive episodes, is where one has a persistent, significantly lowered mood (Centre for Clinical Interventions 2016).

While this disorder is often diagnosed in adulthood, there is a prevalence of children and adolescents who have been diagnosed, even as young as the age of six. In Canada, about 16,600 children ages 11-17 meet the criteria for bipolar disorder (Waddell, Shepherd, Schwartz & Barican, 2014). Historically, bipolar disorder was rarely diagnosed in children, but there has been a shift in the last 20 years.

Many children diagnosed with bipolar disorder also have co-morbid diagnoses (disorders appearing together) of Attention-Deficit Hyperactivity Disorder or Oppositional Defiant Disorder. According to the National Institute of Mental Health, children with bipolar disoder are reportedly at higher risk to abuse alcohol and drugs (NIMH, 2015).

Bipolar disorder in children looks slightly different than it does in adults. At times, there are rapid shifts of mood that can cycle through many times a day. Children may appear temperamental, irritable and oppositional (Papolos & Papolos 2002). It can be difficult to define and diagnose.

Signs and Symptoms

Source: TherapistAid.com, "What is Bipolar Disorder?", 2015

According to the Centre for Clinical Interventions, the following are symptoms of bipolar disorder:

Depressive Episode Symptoms

  • Persistent sad and anxious moods
  • Overwhelming feeling of hopelessness and worthlessness
  • Loss of enjoyment in activities that used to bring pleasure
  • Poor or disrupted sleep
  • Poor concentration
  • Decreased interest in social activities
  • Thoughts of suicide or suicide attempts

In children, possible additional symptoms are eating too little or too much, feeling intense guilt, and complaining about pain, such as headaches or stomachaches.

Manic Episode Symptoms

  • Irritability
  • Experience of rapid flow of ideas or thoughts
  • Grandiose ideas
  • Uncharacteristically poor judgement
  • Risky behaviours

In children, additional symptoms include having a very short temper, sleeping very little but not feeling tired, having trouble staying focused, and acting very silly or happy that is uncharacteristic. (NIMH 2015)

Features of bipolar disorder, according to the Centre for Clinical Interventions, are:

Hypomania is a more moderate form of the elevated mood where the person remains in touch with reality. It is usually managed without the need for hospitalization.

Mixed Episodes is when both depressive and manic symptoms are present nearly every day for a period of time.

There are varying diagnoses of bipolar disorder listed in the Diagnostic and Statistical Manual (American Psychiatric Association, 2013):

Bipolar I is the most common diagnosis, which includes the severe manic and depressive episodes.

Bipolar II includes experience of severe depressive episodes and episodes of hypomania.

Cyclothymic Disorder includes frequent short periods of mild depressive symptoms and hypomania.

Causes of Bipolar Disorder

According to the Centre for Clinical Interventions, there are three main contributors to the symptoms of bipolar disorder: genetic, biological and socio-environmental.

Children of bipolar parents are at an eight percent risk of developing bipolar disorder, as opposed to one percent of the general population. Additionally, they face a 12% risk of developing depression. There is also an imbalance of brain chemicals that makes a person susceptible to experiencing mood episodes (Centre for Clinical Interventions 2016).

Socio-environmental stressors, whether stressful or positive, can increase demands on a person leading them to be vulnerable to feelings of anxiety, frustration and sadness that can trigger an onset of a mood episode.

All of these factors can combine to trigger the onset of symptoms.

Myths and Stigmas of Bipolar Disorder 

Bipolar disorder is just mood swings.

Most teenagers experience hormonal changes and conflicts with parents or peers, but only about five percent of teens exhibit bipolar symptoms (Radovini 2014). The symptoms of bipolar disorder are more extreme than regular mood swings. The periods of depression usually last at least two weeks, while mania lasts at least a week (TherapistAid.com).

Bipolar disorder is a harmful label to give a teenager.

A diagnosis of bipolar disorder helps to identify appropriate treatment. If not diagnosed, treatment can be prescribed that can be harmful for the child (Goldstein as stated in, Radovini 2014). Additionally, a lot of relief can come from a formal diagnosis and help the child and their family understand what is happening to them.

People are happy during their manic episodes.

People with bipolar do feel happy, but it can also be a scary experience. Mania often includes feelings of irritability and loss of control (TherapistAid.com).

Anti-Depressants will cause manic episodes.

This is a case-by-case basis and a decision should be made with the treating doctor. Anti-depressants can be a vital part of treatment and its benefits may outweigh the risks (TherapistAid.com).

Medication is the only way to manage symptoms.

Psychotherapy can also be effective, and it is found that a combination of both psychotherapy and medication is the most effective treatment. Learning as much as one can about the symptoms and developing coping strategies is very helpful in managing symptoms as they start (J., A. 2014).

Bipolar disorder only affects certain people.

Bipolar can impact all different types of people regardless of gender, age and race. In the past, children were not diagnosed until the age of 18, however, younger children are now being diagnosed, as those under 18 often find it harder to manage their symptoms (J., A. 2014).

Managing Signs and Symptoms

The following information is a synopsis of the Mood Disorders Association of Ontario’s "Guide to Mood Disorders for Teens" (2012):

Managing your child or youth’s bipolar disorder is multi-faceted. A combination of therapy, medication, and day-to-day coping strategies can be the most helpful in effectively managing symptoms. Treatment is ongoing, and should not only be used when exhibiting active symptoms.

Cognitive Behavioural Therapy (CBT) is a common therapy used for the treatment of Bipolar Disorder. Other therapies used include supportive therapy, interpersonal therapy, family therapy and group therapy.

The three types of medications that are typically prescribed for people with Bipolar Disorder are mood stabilizers, anti-psychotic drugs, and anti-depressants. Mood stabilizers smooth out mood swings, reducing the high of mania and the low of depression. Anti-psychotic drugs are used to treat agitation, hallucinations, and delusions, and assist with severe anxiety, tension, restlessness and disrupted sleep. Anti-depressants lessen the depressive symptoms and prevents their recurrence and should be used in conjunction with mood stabilizers.

There are alternative therapies that combined with the other treatments listed above, can assist children and youth with their mood imbalances and lower depression levels. They include acupuncture, massage therapy, art therapy, music therapy, dance therapy, relaxation therapy (i.e. yoga or meditation) and exercise.

An important process in managing symptoms of Bipolar Disorder is to recognize signs that symptoms may appear. In order to self-monitor, keeping mood journals, charts and records are often encouraged. These journals can assist with recognizing patterns within the mood cycle, possible problem times within the year, and triggers. Being able to self-monitor can help prevent episodes, make more informed decisions about treatment and improve quality of life. In addition to monitoring mood, symptom monitoring is just as important.

The following has been shown to be effective in managing bipolar disorder:

Source: TherapistAid.com, "The Causes of Bipolar Disorder", 2015

Parenting a Child with Bipolar Disorder

Parents play a significant role in the process of helping to manage their child’s bipolar disorder. The first step is ensuring your child receives help. Ensure your child is evaluated by a professional who understands the disorder, and comply with treatment recommendations (NIMH 2015).

Tips for families considering adopting a youth with bipolar disorder:

  • Seek out psychoeducation. Prospective families should learn as much as they can about the illness.
  • Be aware of your own experiences of trauma, loss and mental health issues. A lot of families bring their own triggers or biases with them.
  • Do research on services available in your area.
  • Ensure you have emotional support from family and/or friends.
  • Explore the challenges that may come with parenting a child with a potential mental illness. Do what you can to prepare yourself and seek support of a professional, if needed.
  • Remember that mental illness is not curable, however it can be treated. Recovery is possible. People with bipolar disorder can live rich, meaningful lives while managing their illness.

Self-care for Families

Caring for a child or youth with bipolar disorder can be stressful. Their mood changes, suicidal thoughts or actions, or risky behaviours are challenging for their caregivers and those around them. It is important to recognize that and seek out your own assistance, which could include attending support groups and psychotherapy of your own. Keeping healthy, developing a support system, and developing realistic expectations are crucial in caring for someone with bipolar disorder (NIMH 2015).

Educational Considerations

Families should be prepared that children with bipolar disorder will also have a more challenging time in school, due to an increased likelihood that they have also been identified as having learning disabilities and problems with attentiveness (Papolos & Papolos 2002). Children’s energy levels, ability to manage transitions throughout the day, attentiveness, and social and behavioural factors can complicate their day-to-day routine in school. They could require special accommodations in school, such as an Individualized Education Plan, that makes the school aware of the child’s needs, and makes adjustments to how the child is taught and what supports need to be put in place. Familiarizing yourself with what services your child’s school is legally obligated to provide, as well as what additional supports are out there, is extremely vital for advocating for the needs of children with bipolar disorder.

Advice for Prospective Families

Below are some tips from youth and families living with bipolar disorder. The youth perspective are from those living with bipolar disorder and are meant to give you a glimpse of what they need to succeed. The family perspective is from families living with youth who have bipolar disorder on how they learned to support their child.

Helpful Links and Resources

Provided by the Mood Disorders Association of Ontario

CrestBD:

Includes research and webinars on bipolar disorder treatment and self-management strategies.

CrestBD’s Bipolar Wellness Centre:

Focused on self-management strategies.

Bipolar Caregivers:

Includes link to an extensive downloadable caregiver’s guide.

International Bipolar Foundation:

Includes link to Healthy Living with Bipolar Disorder downloadable free book.

Depression and Bipolar Support Alliance:

Includes guides for coping, wellness, and dealing with a crisis.

References

A Guide to Mood Disorders for Teens (2012). Mood Disorders Association of Ontario. Toronto, Ontario.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Centre for Clinical Interventions (2016). Keeping Your Balance: What Causes Bipolar Disorder. [Training Module] Northbridge, Western Australia.

National Institute of Mental Health (2015). Bipolar Disorder in Children and Teens. Bethesda, Maryland.

J., A. (2014) Five Myths About Bipolar Disorder. Retrieved from http://www.ibpf.org/blog/five-myths-about-bipolar-disorder

Papolos, D. & Papolos, J. (2002). The Bipolar Child: The Definitive and Reassuring     Guide to Childhood’s Most Misunderstood Disorder. New York, NY: Broadway Books.

Radovini, N. (2014) Five Myths About Bipolar Disorder – Debunked. Your Health Matters. Retrieved from http://health.sunnybrook.ca/mental-health/youth-teens/bipolar-disorder-myths-seasons/

The Causes of Bipolar Disorder. (2015). Therapist Aid. Retrieved from https://www.therapistaid.com/therapy-worksheet/causes-of-bipolar-disorder

Waddell, C., Shepherd, C., Schwartz, C., Barican, J. (2014) Child and Youth Mental Disorders: Prevalence and Evidence-Based Interventions. Children’s Health Policy Centre, Vancouver, Canada.

What is Bipolar Disorder? (2015). Therapist Aid. Retrieved from https://www.therapistaid.com/therapy-worksheet/what-is-bipolar