Bipolar symptoms and emotional brain in youth

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Recognition of bipolar symptoms and bipolar disorder in adolescents is now clearly established. However, whether bipolarity exists in children remains controversial despite numerous studies that have been conducted on this topic in the last fifteen years.

Since the diagnosis of bipolar symptoms or bipolar disorder in children has been rising for the past ten years, clinicians, researchers, parents, and others who care for children are left wondering what accounts for this dramatic increase in diagnosing paediatric bipolar disorder (Dickstein, 2010): is it better recognition of an important psychiatric disorder or is it due to overdiagnosis, misdiagnosis, or a diagnostic trend?

In response to this increase, both clinical and research interest in paediatric bipolar disorders have surged, including a re-examination of the diagnostic criteria for this condition based on developmental and neurobiological findings.

Bipolar disorder is a clinically severe affective disorder, in which mood typically swings from the manic pole of euphoria and/or extreme irritability to depression and loss of interest or pleasure. Mixed illness episodes are characterized by both manic and depressive symptoms.

In recent years, a considerable increase in the number of children and adolescents evaluated, diagnosed and treated for bipolar disorder has been noted.

Bipolar-like symptoms are quite frequent in prepubertal children, but the age at which bipolar disorder can first be diagnosed remains controversial. Current neurobiological findings have advanced our understanding of emotional function and dysfunction in youth.

Developmental aspects and environmental factors are crucial regarding the onset and progression of bipolar disorder in children and adolescents. From a developmental view, bipolar disorder in adolescents and so-called ‘paediatric bipolar disorder’ are not the same disorder or two disorders related in a common continuum.

Differential diagnosis is important to distinguish bipolar disorder from Attention Deficit Hyperactivity Disorder (ADHD) or conduct disorders in children and adolescents.

Treatment of bipolar disorder in youths comprises pharmacological and non-pharmacological strategies. Differences in the tolerability profiles of medications should be considered in making treatment decisions and optimizing the benefice/risk ratio.

In coming years, recognising and diagnosing bipolar disorder in children should be more strongly based on biological markers such as brain structure and neural circuits. Combined with clinical history, this approach is expected to result in improved, more specific and accurate diagnosis and treatment.

Source: European College of Neuropsychopharmacology, France

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