MedifocusHealth

When parents are interviewed, many report that their children seemed different already in childhood. They may have exhibited behaviors including:

• Being over-responsive to stimulation
• Difficulty settling down
• Sleep disturbances and night terrors
• Hyperactivity
• Difficulty making changes
• Anxiety
• Difficulty controlling anger
• Prolonged and violent temper tantrums

There are several conditions that present with similar symptoms to bipolar disorder which should be considered in the differential diagnosis or which may present simultaneously with bipolar. Conditions to be considered include:

• ADHD
• Conduct disorders
• Substance abuse
• Schizophrenia
• Anxiety disorders
• Tourette's syndrome
• Oppositional defiant disorder (defiance of authority, physical aggression and verbal abuse.

It is estimated that approximately 50-98% of children and adolescents who develop bipolar disorder also have signs of attention deficit hyperactivity disorder (ADHD). Some children also present with obsessive compulsive disorder (OCD), or some type of conduct disorder. In treating these children, it is important to treat the bipolar disorder first since stimulant medications which are often given for ADHD can have an adverse effect on bipolar disorder.

Some of the symptoms which bipolar disorder and ADHD share in common include destructiveness, temper tantrums, and behavior problems. Following temper outbursts, children with ADHD may settle down after approximately 30 minutes whereas children with bipolar may remain angry for several hours. Symptoms such as sleep disturbances, irritability, and night terrors from frightening dreams are associated with bipolar but not with ADHD.

Other symptoms which appear in children and adolescents include anxiety disorders and panic disorders (approximately 30%), substance abuse (approximately 40%), and suicide ideation (approximately 25%). Substances abused the most include:

• Alcohol
• Marijuana (cannabis)
• Cocaine
• Stimulants

It has been estimated that approximately 55% of children with bipolar disorder who recover from mania, experience relapse and up to 20% of the adolescents may attempt suicide. A strong predictor of recovery in children/adolescents with bipolar disorder is an intact family structure.

Lithium

Lithium carbonate is the most widely studied drug for bipolar disorder in children. The response rate ranges from 50-100%. Lithium is effective as a single agent and also when combined with other classes of drugs. Improvement has also been noted in studies involving youth with bipolar disorder and comorbid substance abuse as well as psychotic mania. Side effects of lithium in children are the same as for adults.

Divalproex Sodium

Studies of children with manic, hypomanic or mixed symptoms reported that approximately 60% of the children and adolescents improved with divalproex. Some studies indicate that divalproex sodium may be even more effective than lithium but there are no definitive conclusions. Side effects of divalproex sodium in children and adolescents with Polycystic Ovary Syndrome (PCOS) are similar as for adults.

Other medications for children with bipolar disorder that may be used include those used as second-line treatments for adults.

Electroconvulsive Therapy (ECT)

Results of a small study reported in the American Journal of Psychiatry indicated that approximately 80% of adolescents under the age of 18 with signs of mania who were treated with ECT responded positively and had significant symptom improvement.