Bipolar disorder in adolescence

Bipolar disorder is a serious mental disorder (MDS). Traditionally, three types of MDS have been identified: schizophrenia, bipolar disorder, and disorder borderline of personality. Consequently, the diagnosis and intervention of bipolar disorder during adolescence requires extensive clinical expertise.

Fortunately, the pace at which we are doing studies in this field is high and so is the quality of the training received by those professionals who want to specialize in the sector.

However, controversy over defining the central features of this disorder in children and adolescents remains a fact even today. The search for consensus and effective intervention guidelines are currently marking the lines of research.

Better understand bipolar disorder

The American Psychological Association (APA) understands that bipolar disorder exists when there is an episode of mania or mixed symptoms (with or without a history of depressive episodes) or when there is a depressive episode accompanied by at least one hypomanic episode. But what is a manic episode? The APA considers it a manic episode when it meets the following criteria:

• Unusually good mood for at least a week.
• In addition to the above, the adolescent has exaggerated self-esteem which can be described as “grandiose”; a marked decrease in the need for sleep; his speech has no end or measure, it is beborrheic; may present flight of ideas and motor agitation; and may engage in high-risk pleasurable activities with serious consequences.

The mixed episode is characterized, according to the World Health Organization (WHO), by the mixture or rapid alternation of manic and depressive symptoms. These cycles occur almost every day for at least two weeks.

In general, we can say that in mania, symptoms appear opposite to those that occur in depression, but there are two exceptions: both mania and depression share symptoms such as sleep problems or appetite disturbances.

Bipolar disorder in adolescence

Adolescence, for the psychologist Stanley Hall, is a ” personal period of contradictory tendencies”. It is that, in and of itself, it poses its own challenges; In this sense, bipolar disorder can not only create new ones, but also make the already natural ones more complicated.

In adolescent population, BD can manifest itself in the form of ” storms affective” in which the tantrums are longer and more intense. In this population it is more common to find irritability than euphoria.

Luby, a psychiatrist at the University of Washington, described a number of behavior patterns characteristic of BD in these populations:

• Hypersexual behaviors which can consist of touching others or even masturbating in inappropriate places.
• Euphoria. It is the overly cheerful mood accompanied by unprovoked laughter and constant jumping.
• Grandeur. They do not recognize the authorities, they are rebellious, socially very uninhibited and do not measure the risks of their actions or the consequences they entail.

Adolescent tuberculosis is usually diagnosed between the ages of 13 and 18, uniformly in boys and girls. It is usually abrupt: it gives no indication of its beginning.

Differences between adolescent TB and adult TB

How adolescent-onset bipolar disorder progresses from adult BD may differ in several respects.

• They have a higher rate of fast or ultra-fast cycling. A rapid cycle is considered to occur when there are at least 4 manic or depressive episodes in 12 months. In adolescents, the changes can be very sudden on the same day.
• They have more psychotic symptomsmainly auditory hallucinations.
• The prognosis is worse because it is believed that there is a greater neurobiological alteration.
• Recovery after each episode is worse. In periods without manic or depressive symptoms they function even worse.
• It is a highly heritable disorder : there are more relatives who have suffered from the disorder.
• Suicidal ideation is greater compared to adult BD and death plans tend to be more structured.

BD adolescence usually begins with a depressive episode leading to a manic episode. This is contrary to what happens in adult tuberculosis.

Poor prognostic factors

Several factors have been isolated which, when they appear, worsen the prognosis and course of BD. They make it even worse. For example, it has been seen that the lack of maternal affection produces a more rapid development of relapses.

Family history of mood disorders also plays a role, since, as we mentioned, adolescent BD is thought to be highly sensitive to genetic influence. Low socioeconomic status is also a factor hindering the improvement of minors, as well as the appearance of symptoms that may be resistant to treatment.

Dysfunctional family interactions also play a key role. Among others, adolescent BD has in some cases been related to traumatic events such as early childhood sexual abuse.

Treatment of bipolar disorder

Interventions aimed at adolescent bipolar disorder treat the disorder from pharmacological, psychological, and psychosocial perspectives. Among the most used drugs are lithium, antiepileptic drugs with mood stabilizing properties, such as valproic acid, or antipsychotics.

Psychological interventions seek to promote disease awareness, improve management of both manic and depressive symptoms, and provide coping skills that enable adolescents and their families to combat BD and improve social and family relationships.

Among the most relevant interventions are psychoeducation, interpersonal and social rhythm psychotherapy, dialectical behavior therapy or family interventions.

Bipolar disorder: conclusions

To conclude, some authors have argued that adolescent bipolar disorder is overdiagnosed. In other words, there are more teenagers with the bipolar disorder label than there should be.

Although adolescent BD is thought to account for up to 15% of affective disorders in childhood and adolescence, there is still a need to continue researching and conducting new lines of scientific evidence in this regard.

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