Bipolar_Disorder_Among_Children_&_Adolescents

Bipolar Disorder Among Children & Adolescents COUN 5140 Psychopharmacology Abstract Bipolar disorder is a mental illness that will cause mood, energy and intellectual processes to cycle. Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. The diagnosis of children is often missed and children who have it may suffer needlessly for years or even decades. Bipolar symptoms that are not treated can have tremendous negative impact on the character of children and their social development. The cycles of bipolar disorder put children out of “sync” with others in terms of their mood, energy and intellectual processes. In the beginning, the changes are so minor that a parent might not notice. Many people conclude that early signs of Bipolar disorder are merely normal childhood or adolescent behavior. But for the bipolar child their experience is something else entirely. Bipolar disorder has been diagnosed in children under age 5, although it not common in this age bracket. At this age it can be confused with attention-deficit/hyperactivity disorder and depression, so careful diagnosis is necessary. Some cases of bipolar disorder have a late onset. Some people are not fully symptomatic until age 30 or so. In my paper, Bipolar Disorder Among Children& Adolescent, I will discuss the meaning of dipolar disorder, the four main subclass, and diagnosis of bipolar, symptoms, signs, medications, treatment and cognitive-behavioral techniques. If you want to be an effective counselor you need to have knowledge of all the different situations you may encounter in this field of helping other. Introduction What is Mental Disorder' A mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or cultures (National Alliance on Mental Illness, 1996-2009). Mental disorders are also medical conditions that disrupt a person thinking, feeling, mood, ability to relate to others, and daily functioning. Mental illness is medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. A mental disorder can affect people of any age, religion, or income. Mental illness is not the results of personal weakness, lack of character, or poor upbringing. Mental illness is treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. Young people can have mental, emotional, and behavioral problems that are real, painful, and costly (Mental Health Association of Westchester 2005). The problems often called “disorders” are sources of stress for children and their families, schools, and communities. The number of young people and their families who are affected by mental, emotional, and behavioral disorders are significant. It is estimated that as many as one in five children and adolescents may have a mental health disorder that can be identified and require treatment (Mental Health Association of Westchester 2005). Mental health disorders in children and adolescents are caused by biology, environment, or a combination of the two. Examples of biological factors are genetics chemical imbalances in the body, and damage to the central nervous system such as a head injury. Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person. Serious mental illness include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder. The good news about mental illness is that recovery is possible. In this paper I will focus on what bipolar disorder is and how it is affected among children and adolescents. I will also define the four different types of bipolar, focus on the diagnosis and symptoms of bipolar disorder, causes and medication used, treatments and cognitive techniques used in bipolar disorder, and how to manage the disorder. Also included in my paper is a summary of a case study that was conducted on a suicidal teenager with bipolar disorder, and my conclusion. Meaning of Bipolar Disorder & 4 types of bipolar subclasses Bipolar disorder, formerly known as manic depression, is a psychiatric diagnosis that describes a category of mood disorders defend by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania or, if milder, hypomania. Individuals who experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. These episodes are usually separated by periods of “normal” mood, but in some individuals, depression and mania may rapidly alternate known as rapid cycling (Liebert M.A. 2001). Extreme mania episodes can sometimes lead to psychotic symptoms such as delusions and hallucinations. The current term “bipolar” is of fairly recent origin and refers to the cycling between high and low episodes (poles). Long unrecognized and unheralded, bipolar disorder in children and is finally making a public appearance in both the scientific and lay literature. Bipolar disorder in children and adolescents is usually caused by either a chemical imbalance or heredity. Children and adolescents who demonstrate exaggerated mood swings that range from extreme high (excitedness or manic phases) to extreme lows (depression) may have bipolar disorder (Liebert, M.A. 2001). Periods of moderate mood may occur in between the extreme highs and lows. During manic phases, children or adolescents may talk non-stop, need very little sleep, and show unusually poor judgment. At the low end of the mood swing, children experience severe depression. Bipolar mood swings recur throughout life. Adults with bipolar disorder (about 1 in 100) often experienced their first symptoms during their teenage years (National Alliance on Mental Health, 1996-2009). Bipolar Disorder has been subdivided and the DSM-IV-TR classification distinguishes between bipolar I, bipolar II, cyclothymia, and bipolar disorder unspecified. Bipolar I Disorder is one or more manic or hypomanic episodes with one or more major depressive episodes generally constitute the diagnosis of bipolar I disorder (Preston, J.D.,O’Neal, J.H., Talaga, M.C. 2005). A depressive episode is not required for the diagnosis of Bipolar I but frequently occur. Bipolar II Disorder is defined as one or more depressive episodes and at least one episodes of hypomania (Preston, J.D., O’Neal, J.H., Talaga, M.C., 2005). For many reasons bipolar II is difficult to diagnose. First many patients subjectively do not recognize periods of elevated mood as dysfunctional or may even deny the existence of such periods because of the predominate depressive elements. Second, the patient may primarily manifest irritability rather than classic mood and behavior symptoms of hypomania. Finally, there is considerable variation between individual clinicians’ ability to reliably asses for hypomania (Preston, J.D., O’Neal, J.H., Talaga, M.C., 2005). The features of cyclothymia include periods of alternating depression and elation, of at least two years’ duration, that do not meet criteria for either major depression or mania (Preston, J.D., O’Neal, J.H., Talaga, M.C., 2005). The main point here is that there is low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning. The last sub-class is known as Bipolar Disorder Unspecified. Disorders with bipolar features that do not meet any specific bipolar disorder criteria fall into this category (Preston, J.D., O’Neal. J.H., Talaga, M.C., 2005). Diagnosis of Bipolar and Symptoms and Signs Since 1980, criteria for diagnosing bipolar disorder in adults have also been used to diagnose mania in children, with some modification to adjust for age. Similarly, to diagnose a child or adolescent with bipolar disorder, there need to be at least one period of abnormally and persistently elevated, expansive or irritable mood, lasting one week or any duration if hospitalization is required (Cogan, M.B. 1999). Diagnosis is based on the self reported experiences of an individual as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a psychiatrist, nurse, social worker, clinical psychologist or other clinician in a clinical assessment. Counseling helps the person make sense of all the different thoughts and feelings that are experienced by talking about the situation with a professional. Since there aren’t any blood tests that are helpful with diagnosing bipolar in children and adolescent a physician will make a diagnosis based upon historical behavior of the patient. There are lists of criteria for someone to be diagnosed. This depends on both the presence and duration of certain signs and symptoms. Assessment is usually done on an outpatient bases; admission to an inpatient facility is consider if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorders are from the American Psychiatric Association’s Diagnostic, the current version being DSM-IV-TR, and the World Health Organization, International Statistical Classification of Disease and Related Health Problems, currently the ICD-10 (Cogan, M.B. 1999). On average people with Bipolar Disorder spend ten years seeking treatment before finally getting diagnosed. One survey found that as many as 70% children and adolescent with Bipolar Disorder are initially diagnosed with a different condition. Often, this is because people only tend to seek treatment during a depressive episode and neglect to discuss manic symptoms with their healthcare professional. Bipolar Disorder does tend to run in families although having a family history of the condition doesn’t necessary mean a child or adolescent will develop bipolar. By being open and detailed about their symptoms, people can help their healthcare professional arrive at a correct diagnosis. Early diagnosis and proper treatment can help. Living with a child or adolescent who has the symptoms of bipolar disorder can be difficult at times. Manic symptoms are recognized as a barometer of psychopathology severity in children and adolescents and have been correlated with greater psychosocial impairment. One of the biggest challenges has been to differentiate children with mania from those with attention deficit hyperactivity disorder (ADHD). Both groups of children present with irritability, hyperactivity and distractibility. Elated mood, grandiose behaviors, flight of ideas, decreased need for sleep, and hypersexuality occur primarily in mania and are uncommon in ADHD. Other symptoms may include loss of interest in activities that were once enjoyable, feeling like life is hopeless, feeling guilty, changes in appetite, and thoughts of suicide. If untreated the suicide rate is high at 20%. Bipolar Disorder in children and adolescent can be seen though behavior changes. Parents should watch for extreme changes such as agitation, violent behavior, impulsive tendencies, relationship problems, and substance abuse. Cause and Medication for Bipolar Disorder While the causes of bipolar disorder are still unknown, the symptoms are thought to be triggered by an imbalance of some key chemicals in the brain. The cause of bipolar disorder may vary between individuals. The brain is made up of billions of nerve cells that move a constant stream of information from one cell to another. To keep the information flowing, these cells release chemicals known as neurotransmitters that are needed for brain function (http:www.abilify.com). Many scientists believe that when the levels of these neurotransmitters are too high or low, this may result in symptoms of bipolar disorder. Genetic studies have suggested many chromosomal regions and candidate genes appearing to relate to the development of bipolar disorder (http:www.abilify.com). Some limited long-term studies indicate that children and adolescent who later receive a diagnosis of bipolar may show subtle early traits such as sub-threshold cyclical mood abnormalities, fuel major depressive episodes, and possibly ADHD with mood fluctuation. Life events and experience plays a big development of bipolar disorder. It has been shown in consistent evidence from prospective studies that recent life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes, as they do for onsets and recurrences of unipolar depression. There is nothing specifically that someone does to get bipolar disorder, nor is it anyone fault. Bipolar Disorder is a disease like other disease that may occur in certain people. Medications are the primary treatment modality for bipolar disorder. Until recently the US Food and Drug Administration only approved lithium for treatment of mania in adolescent and approved of no pharmaceutical treatment for children. Lithium is the first known mood stabilizer used to treat bipolar and was found to be effective in preventing manic relapse. Some studies shows it appears that adolescents with dipolar disorder tend to have more mixed or rapid cycling presentations, which as been associated with poor response to lithium. Antipsychotic medication such as Quetiapine, Olanzapine, and Chlorpromazine is also used for bipolar disorder. For the maintenance of bipolar disorder Quetiapine and Olanzapine have been approved as effective monotherapy. With some studies reporting a worse outcome with their use triggering manic, the use of antidepressants has been debated (http://en.wikipedia.org). Rapid cycling can be made worse by antidepressants, unless there is adjunction treatment with a mood stabilizer (http://en.wikipedia.org). Since children and adolescent bipolar disorder is a lifelong illness, parents and patients need to understand that even though there will be times when the child or adolescent is felling better, medication and therapy shouldn’t be maintained even when the patients’ thinks they no longer need to do so. Treatments and Cognitive Behavioral Techniques It is important that the entire family receive counseling and therapy so that they can learn to deal with children and adolescent bipolar disorder. Since this condition can be an inherited condition and may not have understood or realized that it wasn’t normal. The most important thing to realize is that treatment is available and is usually very successful. Parents need to be patient with treatment because often times several different types of medication may be tried before finding the right one and anti-depressants and anti-anxiety medication may take a while to become truly effective (Waltz, M. 2000). It may take more than one medication and include a combination of different kinds of treatment. Most counselors will recommend participation in an ongoing support groups, because even with treatment there may be times when episodes are still unbearable. Though evaluation and treatment are essential. A biopsychosocial approach to intervention that incorporates psychoeducation and school intervention is warranted. Psychoeducation should incorporate child, adolescent and parent (Waltz, M. 2000). The counselor should discuss treatment options that include medication and psychotherapy. Another effective treatment for bipolar disorder for children and adolescent is family-focused treatment. Family-focused is a 9-month, 21 session outpatient intervention (12 weekly, 6 biweekly, and 3 monthly sessions) that includes patients of any age and their parents or stepparents, spouse, siblings or adult children (Miklowitz, D.J., Taylor, D.O., 2006). FFT commences with an assessment period in which areas of family conflict and/or lack of communication are identified. Cognitive-behavioral therapy is used to treat many mental disorders including bipolar. A number of different techniques may be used for in cognitive-behavioral therapy to help patients uncover and examine their thoughts and change their behaviors (www.bipolar.cognitive-behavioral-therapy.com). Some of these techniques that can be used for children and adolescent with bipolar include: Behavioral homework assignment, Cognitive rehearsal, Journal, Modeling, Conditioning, and Systematic desensitization. Behavioral homework assignments may consist of real –life “behavioral experiments” where patients are encouraged to try out new responses to situations discussed in therapy sessions. Cognitive rehearsal is where the patient imagines a difficult situation and the therapist guides him though the step-by-step process of facing and successfully dealing with. Journal is where patients are asked to keep a detailed diary recounting their thoughts, feelings, and actions when specific situation arise. Modeling, the therapist and patient engage in role-playing exercises in which the therapist acts out appropriate behaviors or responses to situations. With Conditioning the therapist uses reinforcement to encourage a particular behavior. The last Cognitive Behavioral technique that can be used is Systematic desensitization. Patients imagine a situation they fear, while the therapist employs techniques to help the patient relax, helping the person cope with their fear reaction and eventually eliminate the anxiety altogether. Summary of a Case Study I reviewed and summarized a case study conducted on a suicidal bipolar teenager where the clinician focused on family-focused treatment. Clare who is a 17 year old single female who was diagnose with bipolar disorder(Axis I: 296.4) in early adolescent but never responded well to mood stabilizing or atypical antipsychotic medication, at least partly due to poor compliance. Clare was referred to a clinician who practices FFT at a university-based outpatient clinic. She was being maintained on a regimen of lithium carbonate (1175mg) and Quetiapine (400mg). During the pretreatment assessment phase, the clinician learned through an individual interview that Clare thought about suicide almost daily, even when she was not depresses. She had two prior attempts, both by overdosing on pain relievers and other medications she had found in her parents’ medicine cabinet. Surprisingly, neither of these attempts had come to the parents’ attention. Clare denied that she currently wanted or intended to kill herself, but she thought about it frequently but had mixed feelings about it, imagining the act as an escape but fearful of the practical details required to carry it out. In the session it revealed that both of her prior attempts had involved an interpersonal loss experience. Many of those losses include that she had broken up with her boyfriend, her parents had briefly separated, and her only friend moved away. By the end of treatment, Clare remained mildly depressed but had not made any more suicide attempts. She had become more compliant with her lithium and quetiapine regimen and reported a better alliance with both parents. Treatment was ended at 9 months, but trimonthly maintenance sessions accompanied by telephone coaching were undertaken. In conclusion, Bipolar is a mental disorder that can affect persons of any age, race, religion, or income. As an employee at South Carolina Department of Mental Health I have dealt with children and adolescents whom are diagnose with bipolar disorder. Bipolar is formerly known as manic depression, it’s a psychiatric diagnosis that describes a category of mood disorder defined by the presence of one or more episodes of abnormally elevated mood. In this paper I have discuss the meaning of bipolar disorder and the four major subclasses of bipolar. Those four sub-classes are: Bipolar I Disorder, Bipolar II Disorder, Cyclothymia, and Bipolar Disorder Unspecified. I also discuss the Diagnosis of bipolar, Symptoms and Signs, Causes and Medication, Treatments and Cognitive-Behavioral Techniques. Also included in my paper was a case study conducted on a 17-year-old suicidal bipolar patient. Reference Page Cogan, M.B. 1999. Diagnosis and Treatment of Bipolar Disorder in Children and Adolescent. Psychiatric Times. Vol. 13 No.5. Foster, M. Mental Health Association of Westchester. 2005. Westfair Communications, Inc. Liebert, M.A 2001. Journal of Child and Adolescent Psychopharmacology. Vol. 13 No. 13, pg. 435. Miklowitz, D.J., D.O., 2006. Family-focused Treatment of the Suicidal bipolar. Vol 8 Pg. 641-642. National Alliance on Mental Illness (NAMI). 1996-2009. What is Mental Illness' Mental Illness Fact. www.nami.org. Preston, J.D., O’neal J.H., Talaga, M.C., Talaga, M.C. 2005. Handbook of Clinical Psychopharmacology for Therapist. Oakland, Calif.: New Harbinger Publications. Waltz, M. 2000. Bipolar Disorder: A Guide to Helping Children and Adolescents. Sebastopol, Calif.: O’Reily & Associates Publications. Http://en.wikipedia.org/wiki/Bipolar_disorder Http://www.abilify.com www.bipolar.cognitive-behavioral-theapy.com