Neurology
Brain and Nervous System
There have been ongoing arguments about the cause of the bipolar disorder as a mental illness. Some individuals blamed personality and nurture (environment) and view mental illness such as bipolar disorder only as a consequence of poor parenting, negative thinking, or overemotional reactions. Genetics and nature (biochemistry) have also been blamed by others. They looked at mental illness only as a consequence of imbalanced chemicals. The arguments of both groups hold some merit, but neither explains the whole story. Life, more so the function of the brain is importantly more complex. Individuals who blame only environment or biochemistry overcome necessary factors that can assist in coping with the bipolar syndrome (Ito, 2004).
Currently, research alludes that mental illness such as bipolar disorder involves multiple causes. Some people have genetic predispositions, and biochemistry is truly involved. However, as with numerous other physical disorders, having a genetic predisposition does not mean one will be affected by it. The surfacing of the mental disorder bipolar depends on many other factors, such as; personality, stress, upbringing, trauma, and others. Understanding the nature of bipolar disorder helps a great deal to understand the basics of brain structure and how it relates to chemical imbalances in the brain. Understanding the aspects of the brain and the nervous system helps in knowing mood disorders such as bipolar syndrome (Ito, 2004).
The central nervous system has two main elements: the spinal cord, embedded within the spinal canal, running through the vertebrae in the back; and the brain, resting atop the spinal column. The spinal canal contains nerves that branch in the whole body and communicate with the brain constantly (Stump, 2008).
Although all areas of the brain are important, there are about eight important structures crucial to emotional functioning. These brain structures include the cerebrum, the folded wrinkly structure, the largest brain part. It’s divided by a deep rift into the right and left hemispheres; cerebral cortex, a thin outer layer of the tissue insulating the cerebrum (American Psychological Association (2000). It is the proactive portion of the brain as it facilitates thinking and learning; the prefrontal cortex affects the attention span, judgment, and impulse control, as well as organizing and problem-solving skills; cingulate gyrus, located within the prefrontal cortex offers the flexibility to move from one idea to another and to seek multiple options; the brain stem, which extends deep within the brain is the instinctive or reactive portion of the brain; the Pons, which connects the spinal cord with cerebrum and cerebellum inhibits muscle activity during rapid eye movement sleep, part of the sleep cycle during which we dream; the reticular activating system is a switching mechanism which toggles between the reactive and proactive brain portions. When one is emotionally charged, the reticular activating system shuts down his cerebral cortex, and instincts and training take control; and cerebellum coordinates movement with thinking and emotions (Ito, 2004).
Definition of Bipolar Disorder
Bipolar disorder is a severe psychiatric illness often recurrent that affects behavioral and functional aspects. The bipolar or manic disorder was first identified and recognized in 30 AD. However, the accurate definition of bipolar disorder began in earnest when schizophrenia was conceptually differentiated from other psychosis and panic disorders. Lithium therapy explains the biological origins of an effective technique of treating bipolar disorder. However, subsequent studies occasioned by these findings reveal bipolar disorder as a distinct diagnosable condition (Milkowitz, 2006).
Bipolar diagnosis is organized on the basis o characteristic symptoms of mood disorder. Mood disorder involves alternating episodes of extreme elevation of mood and severe depression. Elevated mood can be diagnosed if such as delusions, insomnia, hallucinations, and extreme excitement, and other depressive conditions are witnessed. Elevated mood can also be accompanied by physical and psychological symptoms and related impacts on social functioning.
Causes of Bipolar Disorder
Genetics
Studies suggest that bipolar disorders are created by interactions between susceptible genetic factors and environmental stressors. This causes actual biological changes at the genetic level that lead to the crossing of the neurobiological threshold for mood episodes over time. With the reoccurrence of each successive episode of mania or depression, these biological transformations are reinforced, causing more frequent and spontaneous episodes.
The risk factors of developing bipolar disorder have not been as well-delineated compared to risk factors for developing diabetes, for instance. Bipolar disorder development is currently linked to a family history of bipolar disorder agreed-upon risk factors. Bipolar disorder is among psychiatric disorders that vie with schizophrenia as being associated with genetic causes. Research has indicated a concordance rate of about 67% of bipolar disorder for monozygotic twins and a 25% concordance rate for dizygotic twins (Basco, 2008). This twin’s research shows that bipolar disorder is a highly heritable syndrome, albeit not one with a complete genetic cause.
An overly significant risk cannot be created by having any close relative with bipolar disorder. Having a first-degree relative with the bipolar syndrome may confer a 6.5% risk of developing bipolar disorder, and a 10% risk of contracting a major depressive episode, compared to 1% and 5% respectively, for controls. Having a biological parent with bipolar disorder may confer much greater risk; approximately 27% of such offspring develop bipolar disorder. In addition, a 27% chance of illness still does not confer an automatic presumption of the eventual development of the disorder (Miklowitz, 2002). Certainly, there are cases of patients with bipolar disorder who have no or only a very distant family history of mood disorders. Thus, other factors other than genetics that may identify those at high risk for the development of bipolar disorder need to be delineated. These additional risk factors may be neurobiological, phenomenological, or environmental.
Environment Associations
The psychosocial influences on bipolar disorder do not operate in isolation of a person’s genetic and biological predispositions. Instead, these factors interact in bringing about episodes of mood disorders or preventing their occurrence. Psychoanalysts believe that disturbed family dynamics play a causal role in the onset of bipolar disorder. Nevertheless, the nature of this causal relationship is not so clear. They base their conclusions on case studies with no comparison groups or other experimental controls, and all the patients they have observed already had bipolar disorder.
Statistics
Prevalence and Incidence
Bipolar illnesses are severe and persistent psychiatric disorders. Lewinsohn and colleagues in a large and well-designed population study of the incidence of mood disorders in adolescents reported an overall lifetime prevalence of 1% for bipolar spectrum disorders which included bipolar1 disorder, and bipolar II disorder American Psychological Association (2000). The largest group of the adolescent sample reported a distinct period of elevated or irritable mood similar to DSM-IV criteria of bipolar illness. The adolescent subjects had a prevalence rate of 5.7% accounting for 84% of Lewinsohn and colleagues’ total bipolar sample. The rates of psychosocial deficits and mental health service utilization like the bipolar I sample were found to be high. Lewinsohn (1996) reported that out of 262 children referred to psychiatric psychopharmacology clinics, 16% qualified DSM-IV criteria for mania. Bipolar disorder disrupts the lives of children and adolescents seriously with studies, depicting increased rates of both suicide and attempts completion; high rates of substance abuse; poor performance in academics; multiple admissions to hospitals; disturbed interpersonal relationships; and others (Milkowitz, 2006).
Experiencing a single manic episode or manic and depressive episodes will lead to a diagnosis of type I bipolar disorder by DSM-IV criteria. DSM-IV criteria explain manic bouts as a period when bipolar disorder experience irritable or expansive moods or manic disorders that last at least 7 days. Marked deficits in school and occupational functioning, social activities, relationship with others, or hospitalization are crucial during manic episodes to prevent the patient from harming self or others (American Psychological Association, 2000).
Molecular genetic reviews of children with bipolar disorder have been limited. Risk studies on families reveal that major depression early onset may be a more familiar form of disorder than adult-onset major depression disorder. Geller and colleagues reported two molecular genetic studies in children. Studies on structural magnetic resonance imaging of adults with BD have shown a variety of abnormalities including decreased prefrontal cortex volumes, raised volumes of amygdala and putamen, and larger ventricles (Geller, 2000). Structural MRI investigations on children and adults have also revealed neuro-anatomic abnormalities. This includes an increased incidence of subcortical white matter hyper-intensities, reduced inter-cranial volume and increased frontal and temporal sulcal size, and reduction in thalamic area (Geller, 1997).
Several reviews have also been done on older positron emission technology and single-photon emission computed tomography in bipolar disorders. Researchers in many of these studies did not report how subjects were diagnosed, how normality was determined in their comparison groups, and how necessary confounds like concomitant central nervous system (CNS) medication use were controlled for (Ito, 2004). Limitations notwithstanding, however, there were suggestions of the regional cerebral flow of blood abnormalities in both the frontal cortex, with a general trend for increased regional cerebral blood flow in these locations during mania and decreased regional cerebral blood flow during a depressive episode (Geller, 2000).
Data on the outcome of children and adolescents with bipolar disorder are very limited. A prospective study that examined 86 pre-pubertal and adolescent patients with type I bipolar disorder over 4 years of treatment reported that they spent 57% of this time in hypomania, about 39% of the time in mania, and about 47% of the time in with depressive features (Geller, 2004). A follow up presided after 4 years assessed 86 patients whose rate of recovery was 87%. The rate of relapse after recovery was however 64%. Bipolar disorder recovery and relapse in these studies portrayed the absence of mania or hypomania for two weeks. It also involved having a complete DSM-IV process for mania or hypomania for two weeks as well. Vulnerability to bipolar disorder is not equal for everyone. Physical factors such as gender, race or ethnicity, age, and others are thought to be influential in an individual’s tendency towards bipolar disorder (American Psychological Association, 2000).
Gender
Both men and women are affected by bipolar disorder, however, slight differences exist in the manner in which gender manifests and handles it. Most likely, men are likely to seek treatment for mania and women are likely to seek treatment for depression. Studies reveal that men are likely to experience both type I and II bipolar disorder throughout a lifetime; about 4% of men become bipolar compared to 3% of women. Substantial evidence indicates also that men are more likely than women to have bipolar I than II by a rate of about 2 to 1 (American Psychological Association 2000).
Women suffering from bipolar are more likely to have developed an alcohol dependency and attempt suicide. Bipolar men at the same time are slightly more likely to have had a history of violence and legal problems. Nevertheless, both men and women can and do experience all of these conditions.
Bipolar Disease
Diagnosis
For diagnosis purposes, the critical feature of bipolar disorder is the manic episode. The diagnosis of bipolar disorder becomes obvious when a manic episode is experienced. Studies conducted by Lewinsohn and colleagues on 1709 adolescents reported 61% of the subjects reported having initial episodes of depression. A follow-up by Geller and associates did on 72 pre-puberty children with major depression, discovered 33% met the criteria for bipolar disorder type I and 15.3% met the conditions for bipolar type II (Lewinsohn, 1996).
The rate of bipolar disorder misdiagnosis is high among adults. In research in which Structured Clinical Interview for DSM-IV was given to patients who presented depressive episodes, 55% were found to suffer from the bipolar syndrome. About 60% of patients who acknowledged their illness to be bipolar disorder cited depression as their initial diagnosis (Hantouche, 1998). This was deduced from Hantouche (1998) from a survey of 400 members of the National Depressive and Manic-depressive Association.
A modified version of DSM-IV was applied by Ghaemi and associates to offer prospective diagnoses for patients referred consequently with bipolar illness. 40% in one sample and 54% in another had experienced misdiagnosis previously. 5.9 years was concluded to be the mean duration between the first contact with the mental health system and the accurate diagnosis among patients with type I bipolar disorder. On the other hand, the mean delay for type II bipolar disorder was much longer at 11.6 years (Ghaemi, 2000).
Misdiagnosis of bipolar disorder can be possible even when in circumstances where the first diagnosis is done meticulously and successfully. In a follow-up study of 559 patients with unipolar depression diagnosed initially with the DSM-IV, 3.9% were discovered subsequently to have type 1 bipolar illness and 8.6 had type II bipolar disorder. In situations when the initial presentation is depression and a clear history of mania or hypomania is not available, certain signs can help in diagnosis (Hantouche, 1998). A family history of manic depression is one of the signs available. In addition, subsequent development of bipolar illness can be associated with psychotic illness, pre-pubertal or postpartum onset of depression.
Neurological Examination
The examination of the status of bipolar disorder patients should consider tests of cognitive function, which includes; attention, concentration, and executive function. It is necessary to perform a physical examination to identify evidence of medical illnesses. It is also important to place careful attention to neurological examination.
Diagnostic Tests
Blood Tests
Patients with bipolar disorder need to have their blood tested regularly to prevent lithium toxicity. The bodies of BD patients on lithium dosage may accumulate lithium at very high levels. Toxicity signs include problems with balance and coordination, severe diarrhea, abdominal discomfort, blurry vision, slurring of speech, severe nausea or vomiting, and mental confusion or disorientation. This toxic state is extremely dangerous for the patient. It is, therefore, necessary to understand the signs for the blood level to check (tested).
Symptoms
Physical
Headaches
Brain structures have serotonergic and noradrenergic, pathways that are involved in mood, which suggests that deregulation in this system, may underlie depression and various headache disorders. Headaches in patients with severe depression could be side effects of psychotropic medications, such as selective serotonin re-up-take inhibitors. Traditional antidepressants are helpful in the treatment of patients with migraines. Migraine is the most common headache in patients with Bipolar Disorder. Many patients with an initial diagnosis of unipolar mood disorder had BD. The prevalence of migraine in BD patients ranges between 20 and 40% and is more prevalent in type II Bipolar Disorder (Olesen, 2006). Better prognosis is correlated with younger age and education rather than with migraine. Other physical symptoms of bipolar disorder include; back pain, muscle aches, joint pains, chest pains, and digestive problems There has been considerable interest in the possibility that diet problems might be important, both as symptoms and as a possible cause of BD. Patients with bipolar disorder require an energy-controlled diet if their medications may cause obesity, or weight gain (Stump, 2008).
Psychological Symptoms
Understanding Depression and Mania Diagnostic symptoms in Children
Bipolar disorder in childhood refers to a severe and often psychiatric condition in children that affects their behavioral functioning. The symptoms of bipolar disorder are similar to Attention Deficit Hyperactivity Disorder (ADHD) in children (Zakriski, 2005). Common symptoms of mania such as talkativeness, psychomotor agitation, and distractibility are present in both bipolar and ADHD disorders. Children meet guidelines of manic symptoms if they have euphoric mood swings. In addition, they meet these guidelines if they manifest three to four symptoms. Specific manic symptoms include decreased need for sleep, elated mood, aggressive behavior, hypersexuality, and uninhibited social interactions. However, children with ADHD differ from those with bipolar disorder in several ways. ADHD children do not exhibit some of the symptoms present in bipolar disorder children, such as persistent mood liability, excessive tantrums and rage, grandiosity, intentional aggression, suicide tendencies, and others (Zakriski, 2005).
Many children diagnosed with bipolar disorder meet the guidelines of mania. They may also exhibit symptoms associated with ADHD symptoms. Children with bipolar disorder with coexisting ADHD presents severe consequences with a probability of psychotic symptoms. Kids exhibiting bipolar disorder normally experience problems in learning, particularly if they also have ADHD syndrome. In addition, half of the kids who experience depression and anxiety tend to develop bipolar disorder. Bipolar disorder children can be volatile, short-tempered, and difficult to manage generally. In essence, bipolar disorder in children has strong symptoms that overlap other psychiatric disorders (Zakriski, 2005).
Treatment
A multifocal approach is necessary for the psychosocial management of children and adolescents with bipolar syndrome. The family, school, and environmental stressors can influence mood and treatment in children and adolescents and therefore, must be assessed and enjoined in the treatment. Consideration must also be placed on the type of mood disorder, co-morbidity incidence, and the level of the patient’s development when establishing a treatment plan for patients with BD. The primary treatment objectives are to decrease the period of mood disorder, reduce the negative effects of depression or mania episodes and restore optimal functioning. To attain this, several important areas of intervention may assist patients with BD. These include the use of; medications, mood stabilizers, atypical antipsychotic medications, psychotherapy, and other treatments such as electroconvulsive therapy and sleep medications.
Medications
Medications that can effectively control systems of depression and mania, mood swings, anxiety, irritability, and sleep problems are the cornerstone of managing illnesses such as bipolar disorder. Bipolar disorder is a biological disease that causes changes in the way the brain processes the chemicals the body naturally produces. Medications are meant to correct bipolar disorder by providing these chemicals or neurotransmitters when they are lacking or by assisting the brain use them more efficiently (Basco, 2008).
Mood Stabilizers
Mood stabilizers are administered during the acute phase of bipolar disorder and continued during the maintenance phase of treatment. For a medication to qualify as a mood stabilizer, it has to be effective in treating manic or depressive episodes of BD; and must prevent relapse during long-term maintenance (AKiskal, 1983). Mood stabilizers must not worsen the BD or cause rapid recycling. Antidepressants such as fluoxetine are not considered mood stabilizers because they affect only depression, not mania and because they can cause rapid recycling. Commonly used mood stabilizers currently include; lithium carbonate, and the anticonvulsants such as divalproex sodium or carbamazepine (Tegretal) (El-Mallakh, 2000).
Mood stabilizing medications change over time, both in time and dosage. In the real sense, no single medication can function to remove bipolar disorder symptoms over an individual’s lifespan (El-Mallakh, 2000). It is also likely that the patient will be treated with more than one mood stabilizer medication at some point or on an ongoing basis. Many patients with BD experience an additive therapeutic benefit from taking more than one mood stabilizer. This may be as a result of agents such as lithium and Depakote having different but complementary effects on brain mechanisms.
Use of Mood stabilizing medication in children
Parents make absolute decisions about the treatment of their affected children. Normally, children with bipolar disorder find no problems with their moods or behaviors and therefore no requirement for treatment. Attempts to explain the nature of the disorder and treatment purpose to children should always be made as permitted by their cognitive capacities and medical status. The final decision to begin treatment rests on the child’s parents (Hallfor, 1998).
Treatments of children with bipolar disorder are based on clinical guidelines. These guidelines are informed by expert advice and in part with research studies, which are few in children with bipolar disorder. These guidelines provide a general guide to doctors with knowledge that there may be wide differences in the way individual patients are treated. These treatment guidelines may be subject to change based on emerging new information from progressive research (Heflinger, 2008). Clinicians should inform parents of the current state of treatment of bipolar disorder and be made to know that, despite an expert agreement that children with bipolar disorder get pharmacological medication to stabilize mood, the effectiveness of treatment in preventing recurrence and enhancing prognosis remains not documented. Since the response to treatment is highly variable across patients, getting an effective treatment remedy is much a process of trial and error. Parents and their patients must know these limitations (Gureasko-Moore, 2005).
Parents contribute essential information in the diagnosis process of bipolar disorder. Besides making these contributions, parents are also responsible for: implementing prescribed treatment; monitoring the adverse effects occasioned by treatment; and reporting both benefits and potential limitations to the attention of the medical practitioner. These functions are necessary provided some of the medications used in the treatment of bipolar disorder have a narrow therapeutic index or can cause infrequent but serious adverse effects. Clinicians must inform the parents about the potential benefits and harms of treatment. They should also inform parents about the monitoring procedures that need to be implemented during treatment to reduce risks. Therefore, time and effort require to be committed to parent education (Shaw, 2010).
Clinicians are not supposed to prescribe treatment to children without evidence of the capacity of parents to supervise. Some family situations, as a result of environmental stressors, constrain the orderly approach to treatment. Currently, there are no general guidelines available for these circumstances. Each case has to be dealt with depending on individual needs and characteristics. When children reach the adolescent stage, they are expected to be actively involved in the treatment decision-making process. They gradually take responsibility for their care. Legally, parents remain responsible for treatment decisions, but the active participation of the adolescent in the decision process to treatment is necessary. However, bipolar disorder often affects insight and judgment. Adolescents may turn down treatment or refuse to follow the laid down prescription. Adolescents with bipolar disorder are in great danger of engaging in alcohol and substance abuse (Olfson, 2006). They also risk engaging in other risk behaviors, such as, an irresponsible sexual activity which makes the adolescent vulnerable to dangers of infection, and unplanned pregnancies. Again several mood stabilizers can cause harm to a developing fetus since they are teratogenic. These elements make the management of the bipolar disorder in adolescents difficult (Shaw, 2010).
Adolescents find it problematic to undergo involuntary treatment, unlike younger children. Adolescents cannot exercise their full rights to self-determination because they are under the legal age of 18. Therefore, evaluation, treatment, or release of information require permission from parents unless waived by law. For most adolescents, parents are responsible legally for their decisions for treatment. Differences between adolescents and their parents can be the source of considerable disruption and greatly impacts successful treatment implementation (Conor, 2006).
Atypical Antipsychotic Medications
The complex nature of diagnosis on the early onset of bipolar disorder in most cases present significant treatment challenges, leading to the application of polypharmacy. For instance, relative to the onset form of bipolar disorder on adults, bipolar early onset is linked with rapid cycling, mixed mood states, chronic irritability, and higher rates of psychosis, all of which are linked with poor or moderate reaction to traditional mood stabilizers (El-Mallakh, 2000). In essence, the complex nature of the diagnosis of bipolar in children and adults has enhanced the need for additional pharmacotherapeutic options. Atypical antipsychotic medications have therefore displayed an expanding function in the management of youths with bipolar disorders.
Atypical antipsychotic medications have been utilized in adjunctive treatments of the bipolar syndrome (mania) in adults. However, their applications beyond the acute phase have been limited to their serious side effects. In contrast, atypical antipsychotics’ positive side effects profiles signal their ability for long-term administration in the treatment of mood disorders. In addition, the outcomes of treatment research appear to support the notion that the atypical antipsychotics share mood-stabilizing elements absent among atypical antipsychotic counterparts (Milkowitz, 2006).
Antipsychotic medications have been utilized to treat the agitation, aggression, and psychosis associated with severe mania in adults. Over and above tranquilization used for chemical restraint, conventional antipsychotics show true anti-manic effects. Nevertheless, the anticipated benefits of conventional antipsychotics in bipolar disorder are often offset by serious treatment-related side effects.
Antidepressants
Managing bipolar disorder is quite challenging. The initial aim of any pharmacotherapy is to deter the reoccurrence of mania and depression. Mood stabilizers are quite suitable for the treatment and prevention of manic disorders. However, mood stabilizers are suboptimal to treat depression. This is a drawback as the majority of people with bipolar disorder seem to be affected with depression than mania (Ghaemi, 2000).
Statistics reveal that 29.8% of outpatients with bipolar disorder are more susceptible to being depressed compared to only 7.9% of those with mania. They are also less likely to respond to either mood stabilizers or antidepressant treatment. About 49% of bipolar disorder patients are found to be depressed at all times compared to 12% for those suffering from manic disorders (Lewinson, 1996). This was shown in a study of 27 patients with bipolar disorder type I, 11 patients with bipolar type II, and six patients with otherwise unspecified bipolar disorders (Ghaemi, 2000).
Most commonly, individuals with bipolar disorder get a diagnosis of unipolar depression along with an antidepressant prescription. Despite antidepressants’ appearance to be effective, they are also thought to be not infrequently linked with adverse effects for the cause of bipolar disorder. Therefore, it is necessary to keenly diagnose mood disturbances, for close treatment observation, and to be kept informed of emerging new data (Ghaemi, 1999).
Psychotherapy
Specific situations warrant the use of psychotropic medications. There are some specific circumstances in which it is advisable to use psychotropic medications in children. These medications should only be recommended to children with emotional or behavioral symptoms when the expected benefits of treatment exceed the dangers (Conor, 2006). Normally some of these conditions are severe and persistent, thus, can cause serious challenges to children if left untreated. This may follow when psychosocial treatment may not be effective. Research is not available which confirms the safety and efficacy of psychotropic treatments in children. Parents are encouraged to be more inquisitive and evaluative with the assistance of the doctor on the dangers of commencing and continuing children on psychotropic medications. They must be acquainted with all medical prescriptions prescribed for children. Parents must learn which side effects are tolerable and those that are risky. They should also bear in mind the aim of a particular medication, such as specific behavioral change. Parents and clinicians must avoid at all costs prescribing multiple psychotropic medications to children unless it is very necessary (Conor, 2006).
The use of psychotropic medications affects children differently compared to adults. This explains variances in dosage. There is always rapid growth in children’s brains compared to adults. Researches on animals reveal the development of neurotransmitter systems that are sensitive to medications. Substantial studies are required to discover the impact and advantages of psychotropic treatment (American Psychological Association, 2000). It is also important to note that serious untreated mental disorders can negatively retard or damage brain development in a child (Gureasko-Moore, 2005).
Bipolar disorder together with other mental disorders such as depression and anxiety were believed to begin only after childhood. However, the facts are that they can commence in early childhood. In the US, approximately 1 out of 10 children and adolescents have a mental disorder (. Attention deficit hyperactivity disorder (ADHD) is the most diagnosed and treated as a childhood mental disorder (Gureasko-Moore, 2005).
The treatment of individuals under the age of 19 (children) with bipolar disorder in usual practice presents ethical and regulatory challenges. Some of these challenges are common to general pediatric treatment or the use of psychotropic medications in children. This section addresses issues that are relevant to the treatment of bipolar disorder in children. Children are usually brought to medical treatment by responsible adults under their care. The relationship between medical practitioners and children is mediated by the parent, that is, purely from a legal and ethical perspective. The establishment of diagnoses of bipolar disorder in children depends on the parents as the source of information (Blader, 2006). Currently, diagnostic biological indicators of bipolar disorder are not available. Therefore, diagnosis relies on careful medical evaluation. It is not always easy for clinicians to directly observe the child displaying the signs of bipolar disorder. Young children lack the insight or cognitive skills to report symptoms of bipolar disorder. Thus, parental information plays a significant role in the bipolar disorder diagnosis process (Heflinger, 2008).
The majority of parents regard psychotherapy as the most appropriate treatment of mental disorders. According to Pappaport (2000), parents agree on pharmacotherapy only when behavioral and psychological treatments have failed to materialize the expected changes. They then under the duration of grief and agreement on psychotropic medication may coincide with psychiatric diagnoses agreement. This provides parents the final proof of their fears. They later discover that their children experience some chronic mental disorder that might continue to affect the child to adulthood (Heflinger, 2008).
Other Treatments
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is the administration of a controlled electrical current through electrodes attached to the scalp. This treatment is most suitable for people who cannot take antidepressant medications because of medical problems, or do not respond with psychotherapy or drugs. Electroconvulsive (ECT) remains the safest and most effective treatment. It is estimated that about 70 to 90% of depressed individuals improve after electroconvulsive therapy (Miklowitz, 2006). Experimental new techniques are applying electrical and magnetic stimulation to treat depression.
Psychotherapy Medications in Children
Documented empirical studies on psychotherapy medications are lacking. This creates adverse effects on the treatment of behavioral disruptions in children and adolescents. It also limits the provision of sufficient services to children and adolescents with behavioral conditions such as bipolar disorder. As a result children and adolescents with these disorders receive inadequate care and treatment based on limited scientific evidence of medication safety. Scientific evidence related to treatment work appropriately for particular diagnoses and patients. Other factors that may result in many children being diagnosed with psychiatric disorders such as bipolar are; reduced medical funding, poor mental health reimbursements for mental health services, and others. These factors cause children to undergo medication when there is little efficacy and safety for use of psychotropic medication in children (Olfson, 2006).
There are genuine concerns by many over-prescription of psychotic drugs on children. The available studies are insufficient and much more research needs to be done to provide insight into children who are treated with drugs of all kinds of disorders. Much research is also required in the mental health field to determine appropriate treatments for children with emotional and behavioral disruptions. Children are constantly experiencing change and growth during their periods of development. These changes must be put into consideration when the diagnosis and treatment of mental illnesses are examined (Hallfor, 1998).
It is advisable for parents to promptly seek professional assistance for their children. This is because some of the children’s emotional and behavioral disruptions are mild and short-term, thus requiring no treatment; other mental problems persist for some time and take serious proportions, thus requiring parents to seek professional assistance immediately. Situations occurring every day can result in changes in behavior. Such behavior adjustments must be recognized and differentiated from symptoms of serious conditions. Much attention should be focused on conditions that are severe, persistent, and affect the daily functioning of children. Parents should seek professional help at once if, for instance, they notice conditions such as changes in the child’s social withdrawal, lack of sleep or appetite, fearfulness, and other disruptive conditions (Zakriski, 2005).
Symptom observations assist in diagnosing BD and other mental disorders in children. These signs and symptoms must be considered by qualified clinicians given the child’s level of development, socio-physical environments, information from parents, and teachers (Conor, 2006). Qualified clinicians then make their assessments based on guidelines established by professionals. The task of diagnosis is quite challenging in children as they cannot display their thoughts and feelings appropriately. In general, severe and persistent mental conditions that affect the daily functioning of children must be referred to a child psychiatrist. Much care should be exercised to assist a suffering child since mental or behavioral disorders can affect the way a child grows (Zakriski, 2005).
Conclusions
In sum, bipolar disorder treatment includes the prescription of psychotropic medications. These prescriptions involve; mood stabilizers and antipsychotics. Studies related to the use of psychotic medications in children are scanty. Much of the developed professional criteria of bipolar disorder are based on studies done on adults and not children. It is significant to note that the severity of symptoms diagnosed in children with bipolar disorder necessitated psychotropic treatment (Shaw, 2010).
Antipsychotic treatment is used to control psychotic symptoms, such as hallucinations and delusions, to stabilize mood and reduce agitation. Psychotic medication in children can be tricky given the limited amount of studies and complexity surrounding its diagnosis. The few available studies report short-term results. There are no long-term investigations on psychotic medications used in children that have not been thoroughly investigated. Psychotropic treatments are used as the first mode of treatment before psychosocial intervention efforts due to extreme mood liability present in children with bipolar disorder. For instance, mood stabilizers are used to eliminate symptoms of mania and to control mood cycling (Shaw, 2010). These mood stabilizers take a few weeks to effectively function, including lithium, Divalproex, and others. However, lithium has been approved by the Food and Drug Administration for children older than 12 years of age only.
Reference List
Akiskal, S., Walker, P., & Puzantian, R. (1983). Bipolar Outcome in the Course of Depressive Illness. Journal of Affective Disorders, 5, 115-128.
American Psychological Association (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington: Author.
Basco, M. (2008). Cognitive Behavioral Therapy. New York: Guilford Press.
Blader, C., & Carlson, A. (2007). Increased Rates of Bipolar Disorder Diagnoses among US Child, Adolescent, and Adult Inpatients. Biol Psychiatry, 1996-2004, 62 (2):107-14.
Conor, F., & Meltzer, M. (2006). Pediatric Psychopharmacology. New York: Norton.
El-Mallakh, S. (2000). An Open Study of methylphenidate in Bipolar Depression. Bipolar Disorder, 2, 56-59.
Geller, B., & Luby, J. (1997). Child and Adolescent Bipolar Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1168-1176.
Ghaemi, N., Boiman, S., & Goodwin. (2000). Diagnosing Bipolar Disorder and the Effect of Antidepressant. Journal of Clinical Psychology, 51, 143-156.
Ghaemi, N., Sachs, G., Chiou, M, et al., (1999). Is Bipolar Disorder still undiagnosed? Journal of Affective Disorders, 52, 135-144.
Gureasko-Moore, D., DuPaul, J., & Power, J. (2005). Stimulant Treatment for ADHD. School of Psychology Review, 34, 232-245.
Hallfors, D., Fallon., T., & Watson, K. (1998). An Examination of Psychotropic Drug Treatment for Children with Serious Emotional Disturbance. Journal of Emotional and Behavioral Disorders, 6, 56-64.
Hantouche, G., Akiskal, S., & Lancrenon, S. (1998). Systematic Clinical Methodology for Validating Bipolar II Disorder. Journal of Affective Disorder, 50, 163-173.
Heflinger, A., & Humpfrey, L. (2008). Identification and Treatment of Children with Oppositional Defiant Disorder. Psychological Services, 5, 139-152.
Ito, M. (2004). Nurturing the Brain as an Emerging Research Field Involving Child Psychology. Brain and Development, 26(7), 429-433.
Lewinsohn, M., Klein, N., & Stanley, P. (1996). Bipolar Disorders in a Sample of Older Adolescents. Child and Adolescent Psychiatry, 34, 454-466.
Miklowitz, D. (2006). The Bipolar Disorder Survival Guide. New York: Guilford Press.
Miklowitz, D. (2002). The Bipolar Disorder survival Guide. New York: Guilford Press.
Olesen, J. (2006). The Headaches. Sydney: Wolter Kluwer Health.
Olfson, M., Blanco, C., Liu., L., Moreno., & Lage, G. (2006). National Trends in the Outpatient Treatment of Children and Adolescents with Antipsychotic Drugs. Archives of General Psychiatry, 63, 679-685.
Pappaport, N., & Chubinsky, P. (2000). The Meaning of Psychotropic Medication for Children, adolescents, and their Families. J AM Acad Child Adolesc Psychiatry, 39, 1198-1200.
Shaw, S., & McCabe, P. (2010). Psychiatric Disorders. New York: Corwin Press.
Stump, S. (2008). Nutritional Diagnosis Related Care. Sydney: Wolter Kluwer Health.
Yatham, L. (2010). Bipolar Disorder. New York: Wiley & Sons.
Zakriski, A., Wheeler, E., Burda, J., & Shields, A. (2005). Justifiable Psychopharmacology or Overzealous Prescription. Child and Adolescent Mental Health, 10, 16-22.