Caution ! - Bipolar Disorder In Children

Most professionals in the care of children and young people aware of the pace with increases in children and young people, but the most important pre-pubescent children who have been diagnosed with bipolar disorder. Although estimates vary moments, it is interesting to note a series of statistics recently reported. The New York Times, an article was published in September 2007, said that 10 years ranging from 1993 to 2003, was forty times the speed with which these patients are diagnosed with bipolar disorder, while the more scientific article (Youngstrom, 2005 ) noted that the marked increase was found in number of diagnoses in children with Child Protective Services workers in Illinois. Other authors have referred to this strong growth rate, some positive (NOW 2007 and Papalos Papalos, 2006), while saying that there must be increased even more.

What drives us to diagnose bipolar disorder in children and adolescents?

For advocates of early diagnosis, one of the most cited reasons is prevention: preventing child poverty, the prevention of academic problems, social failure prevention, prevention of twigs, etc risk, advocates of the opinion that early diagnosis is the lack of action is a disservice to the child and for those involved in the child's life. This was the reason given the conduct of professionals like Dr. Dimitri papacy and his wife, Janice papal and others, and indeed any professional, with a little empathy has certainly considered when thinking about a case of bipolar disorder is possible in a child or adolescent.

What is this animal we call childhood bipolar disorder?

In adulthood, it is well accepted that bipolar disorder with discrete episodes of mania, and a different period of depression. Of course, there is a murky case of mixed episodes, although it is well accepted that such cases actually occur in adulthood. However, as you descend childhood retrospectively, the waters become more murky and murkier. What is bipolar disorder seem to adolescence? And prepubescence late? What about the young? Review of the literature (and Papalos Papalos, 2006, Youngstrom, 2005, Danner-Ogston, et al, in press, Geller, 1997, etc.) reveals the opinions, covering the spectrum of the very conservative (to keep things as they were), it is Very liberal (We diagnose childhood). Every opinion is justified by a kind of logical argument or another, but most of all, there is no consensus, and strong evidence of demand caution.

Conservative

The conservative approach to the diagnosis of bipolar disorder in children is to keep things as they are. In other words, the child / adolescent must meet the criteria for major depression, and mania, in terms of symptom severity and duration of mood. In this approach, the child needs evidence of severe depression for a week in most cases, and chronic mania would have to show for most of the week, before they could be considered for diagnosis. In cases where you thought it was a mixed episode, the duration criteria may be waived, but the criterion of gravity could not.

Others, however, expressed concern that large increase, and pleaded with the professionals to have a more cautious approach to the diagnosis of pre-adults. There is much debate in the hotly views opinions, and discord in the field caused by the huge gap between the most liberal and most conservative in terms of diagnosis. To some extent this difference is evident among psychiatrists and psychologists, and indeed, the article in The New York Times mentioned above suggests that 90% of bipolar disorder in children was conducted by psychiatrists. However, many other mental health professionals, psychologists and other psychiatric not popular on the floor, taking the liberal approach shared by many psychiatrists.

The liberal approach

In the more liberal approach, different opinions, but there is a general relaxation of the criteria duration and frequency to the point of the more liberal approach, children can ride by the minute! Also observed in the more liberal approach is a tendency to redefine including depression or mania in children with the more liberal approach to defining mania as essentially a chronic and severe irritation, anger, or general questions. Depression, in this approach is most evident as anger, or social withdrawal.

Provisional conclusion

The problem with the conservative approach for some professionals is that children who are potentially missing must have the diagnosis and treatment. And indeed, when a child or youth who have emotional or behavioral problems, and untreated, their lives do not usually go from bad to worse. The problem with the liberal approach is that treatment, which is run by the medical approach is the introduction of potentially toxic psychotropic drugs in the body of the child. Most psychotropic medications used to treat bipolar disorder in children and adolescents are prescribed "off label" without FDA approval, and without knowledge of the possible side effects of long-term treatment in the body and the development the brain.

Current Research

As the salience of this particular area of ​​mental health has been a lot of research over the past ten years or more. NIMH, NAMI, and other organizations have funded several studies to answer questions related to this topic. Books have been written for this, as the child bipolar infamous (and Papalos Papalos, 2006 and earlier editions), Guide to all the children of parents with bipolar disorder, and others. So what is the state of science? What do we know?

According Papalos Papalos and in an informal study, which involved voting parents had identified their child as bipolar was a great diversity in what could be seen in a child or adolescent with bipolar disorder. Papalos identified the features of mood, nightmares, sleep disorders, sensory integration difficulties, extreme crises, depression, food allergies, anxiety, hyperactivity, impulsivity, inattention, the features of Opposition and other features. Yes, they were of the mind that because bipolar disorder ranged from such a variety of symptoms (many of which were found in other mental disorders of childhood such as autism, Asperger syndrome, Despite the disorder, attention deficit hyperactivity disorder, post traumatic stress or PTSD, etc.), we should diagnose the disorder first, then consider additional diagnoses if the symptoms are not fully explained by the initial diagnosis.

Although Papalos Papalos and the findings were by far the most extreme, there are many scientists who believe that the more liberal interpretation of what bipolar disorder in children is necessary, even if you do not go to extremes, and that Papalos Papalos do. The consensus seems to be that children with bipolar disorder is not the same frequency and duration of action indicated in adulthood. Diagnostic liberals argue that children and young adolescents to "cycle on a daily basis, and can not show the traditional obsession, and that their depression is not necessarily debilitating. Diagnostic liberals also argue that the irritability is part of what could be a history of mania, and bipolar children seem serious anger issues. The questions that can not be definitively answer focused on the differential diagnosis (this is a bipolar disorder, or PTSD, or both? Etc..).

What if "liberals" are right?

If a liberal approach to accommodate the control of time and research, then there is a lot of children who have received the attention and care, and rightly so, that can prevent future problems. This proactive approach could improve the public's mental health, but also, and can be targeted to increase funding for mental health problems, insurance, or the recognition of mental health problems.

What if the "conservatives" are right?

If the Conservatives are right, then we potentially have a public disaster on our hands. The treatment of children and young adolescents with bipolar medicine is not proven, sometimes inefficient and often marred by numerous side effects and potential long-term damage that might occur. Bipolar medications can cause agitation, increased behavioral problems, depression, weight gain, tremor, fatigue, and potentially more serious problems such as polycystic ovary syndrome, a sometimes fatal skin disease, tremors, convulsions and death. In addition, it can be to teach a child they have less control over their emotions and behavior of a typical child, or they have no control, could cause them to abandon and worst in their behavior. There are also some who think that spread of drugs on children at a young age instilled in them a strong belief that drugs are the answer to their problems ...

How are we doing this?

Given all the concerns is how do we do? What is known about the effectiveness of the more liberal approach to diagnosis and therapy? Literature review, the results are not encouraging. For example, Dr. March of Duke University will point out that we have no idea if the children diagnosed at the age of 5-7 actually be bipolar when they get older. In the NYT article, it should be noted that most research suggests that these children are more prone to depression as they age, instead of bipolar disorder. Generally, it appears that the drug often does not solve most of the symptoms and it seems that their strongest effect in the category of sedation, which is a double edged sword. Specifically, adolescents or young child is more manageable and less volatile, but they also may be less able to concentrate on their studies, and may experience personality changes with major negative effects on their social success.

Because if so, then a child to pass through childhood without phrases appropriate treatment to lower future, who among us would hesitate to act? The problem is that it is not entirely clear that we got this right, and it is certainly not clear what appears to be bipolar disorder in children will follow the child into adulthood.

Are we missing something?

Scientist meets Martin Teicher, MD, Ph.D., (2000), early trauma, whether sexual, physical or verbal, is a potentially long-term impact on brain development. In fact, his research shows that such trauma, and in particular (interesting), verbal abuse, the effects of long-term changes in the corpus callosum and precuses, as well as the hypothalamus and other regions. The corpus callosum, it is important to balance the left and right brain, and those who have an underdeveloped body of glue are usually highly reactive and unbalanced approach to their problem-solving skills (interpretation: too emotional, and emotionally reactive, in other words ... is more likely to be angry, violent or irrational). Those who have an underdeveloped precueses usually less logical, less integrated in their personality, and usually are adapted to their reactions.

Conclusion:

There is much debate about the frequency with which childhood bipolar disorder occurs in children and adolescents. There is no doubt the conclusion that it is an important area to explore, as the implications of this disorder during the life of a person is serious. But we need to get there, because otherwise we have case was diagnosed as permanently change the child / youth chances of success, or will we have more children medicated hard to make progress under the weight of the side effects of unnecessary drugs. Ultimately, it is a science that should clear the air ... Ideally, repeat the science will show us that bipolar disorder probably look like if it really exists in children. Until we have a scientific consensus, but caution seems advisable, and the more conservative approach would be to consider other, less long conceptualisations of play the child's symptoms.

and how far down the road is the belief that drugs can be the answer?

Mood stabilization is often elusive goal, even if heavy action of psychotropic drugs, and in some cases, the mood becomes unstable during treatment. Side effects often come to the question and of themselves, require more medications, dietary changes, changes in academic approaches, and even require changes in the expectations of the child's ability to function in their world. In some cases, medications make the child may receive disability benefits because of the debilitating effects they have on their activities.

Therefore, in his opinion, many behavior problems and mood can be seen in prepubertal children or post-puberty may be the result of these experiences in early childhood. In other words, it is something that doctors in the first line of thinking all the time: make a child abuse tends to be aware of personality changes, and often violent and emotional. If Dr. Teicher effect at the end of the day, it is very possible that we thought that childhood bipolar disorder was actually a trauma. And the implications of the following: The difference between the labeling of children as potentially weakened temporarily or permanently altered.

Moreover, in many cases, pharmacological interventions to control the overload of work and overwhelmed by children and young psychiatrists, who can not spend the time to fully assess the child and their needs, and often put pressure on the pharmacological, directly and indirectly to require any specific medication or identify a certain part of their workload as a two-way. All in all, even if we accept without thinking that bipolar disorder in children and adolescents is under diagnosed, and that they were treated with the drugs, the result is often a partial failure of the complete problem.