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Article Excerpt
Until recently, bipolar disorder was rarely diagnosed in adolescence. Due to developmental issues and overlapping symptoms with other disorders, diagnosing bipolar disorder is often a confusing and complex process. It is a serious, but treatable mental illness that is characterized by recurrent episodes of depression and mania. These episodes are manifested by unusual and extreme shifts in moods, energy, and behavior that interfere with effective functioning. There is limited empirical data about the efficacy and safety of the use of psychotropic medications and psychotherapy with adolescents. If bipolar disorder is not diagnosed or is left untreated, the effects on the patient, family, and community can be devastating.
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A few years ago, mental health counselors and other professionals rarely diagnosed bipolar disorder in adolescence. The American Academy of Child and Adolescent Psychiatry reports that up to one third of the 3.4 million children and adolescents with depression in the United States may actually be suffering from the onset of bipolar disorder. In addition, it has been estimated that one third of the children and adolescents diagnosed with attention deficit hyperactive disorder (ADHD) may be suffering from emerging bipolar disorder (Papolos & Papolos, 1999). School absenteeism, poor academic performance, impaired social functioning, and a greater risk of substance abuse are associated with bipolar disorder in adolescence (Hussain, Chaudry, & Hussain, 2001). Left untreated, the disorder can lead to suicide, expensive hospitalizations, legal difficulties, and disastrous consequences for families (Waltz, 2000). Early intervention may aid in preventing future symptoms or serious consequences (Hussain et al.).
DIAGNOSTIC CRITERIA
The criteria for diagnosing bipolar disorder in adolescence are the same as those for adults. Defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV; American Psychiatric Association 1994) are several variations of bipolar disorder which vary in combinations of mood strength and frequency of mood shift (Lynn, 2000). In the bipolar I form, the individual experiences one or more manic episodes, or mixed episodes and possibly one or more major depressive episodes. There can be periods of relative or complete wellness between the episodes. Mania is defined as an elevated, expansive, or irritable mood that is both abnormal and persistent and lasts for at least one week. Symptoms of mania include elevated or irritable mood, a decreased need for sleep, racing speech, grandiose delusions, excessive involvement in pleasurable but risky activities, increased physical and mental activity, and poor judgment. In severe cases, hallucinations and/or delusions may be present often causing marked impairment in functioning and necessitating hospitalization.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR; American Psychiatric Association, 2000), depressive symptoms include pervasive sadness nearly every day for a 2-week period (in children and adolescents this can be identified as an irritable mood); notable diminished interest or pleasure in all activities for most of the day; sleeping too much or an inability to sleep; weight loss when not dieting or weight gain (in children and adolescents this can be considered a failure to make expected weight gains); psychomotor agitation or retardation; fatigue or decreased energy level; feelings of worthlessness or excessive guilt; the inability to make decisions or concentrate; and recurrent thoughts of death and suicide. A mixed episode lasts for at least one week, and the criteria for both mania and depression are...
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