Mania is the hallmark of Bipolar Disorder. It is characterized by elevated, euphoric, and giddy mood (or irritability). A child may act silly or goofy or find things funny that aren't or may be remarkably irritable. It is accompanied by increased energy and decreased need for sleep. Thoughts may be rapid and scattered, sometimes even nonsensical. Grandiose thinking may be present (a child may think he is smarter than the teacher and tell the teacher how to teach, or may believe he can fly, or have exaggerated expectations or demands – for example instead of asking mom to push him higher on the swing he may demand "Mommy push me to the moon!") Excessive and fast past talking and over-activity may be present.
Bipolar disorder is relatively rare in preadolescent children but it does occur. Children who develop depression are at a higher risk for developing Bipolar Disorder later in life. A typical scenario is a child with depressions in grade and middle school who develops a manic episode in High School or college
There are some controversies about Bipolar Disorder in children with some thought that children may cycle in and out of depression and mania even over the course of hours. Children with such a presentation should have thorough medical and psychiatric evaluations.
What should I do if I suspect my child has a Mood Disorder?
A careful evaluation is critical. Untreated depression or mania increases the risk of future episodes and may make future treatment less effective. An evaluation is important to determine not only the correct diagnosis but also what contributed to the development of the mood disorder (genetic components, medical illness, family stress, school problems, social problems, etc).
What treatment is available for Mania and Bipolar Disorder?
Children and Adolescents with a manic episode should have careful pediatric and psychiatric evaluations to make sure there are no other medical problems that could be causing the problem. When Bipolar Disorder is present medication is the mainstay for mood stabilization and relapse prevention. Early treatment may reduce the severity of illness over time. The medications for this disorder are known as mood stabilizers. This class of medicine includes Lithium, Depakote, Tegretol, Trileptal, and Lamictal. More recently medicines including Zyprexa and Risperdal have been approved for treatment of Bipolar Disorder in Adults.
Unfortunately there is very limited research on the treatment of Bipolar Disorder in children and we have to base much of our treatment approach on what we known about adults.
Your child's psychiatrist should set aside ample time to talk with you about the diagnosis and treatment. You should understand the risks presented by the treatments proposed. You should also understand the risks associated with not taking medication for this potentially very disruptive illness. Psychotherapy aimed at helping the child and family to reduce conflict, face the developmental challenges all children face, and to learn about this illness in their life plays an important role in maximizing the child's adaptation and emotional growth.
This link to the Child & Adolescent Bipolar Foundation
www.bpkids.org may be useful for you.
Warren J. Steinmuller, M.D. 225 E. Kingston Avenue Charlotte, North Carolina 28203 (704) 376-7654 Child, Adolescent, and Adult Psychiatry
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