Clinical Outcome Research Regarding Pediatric Bipolar Disorder

Bipolar disorder is a mood disorder known for severe persistent mood instabilities between mania and depression, . It causes unusual changes in mood, energy, and activity levels which makes ability to perform daily tasks very hard. (Concepts Advisory Panel [CAP], 2015). BPD affects more than 2.3 million adult Americans, or 1% of the population. (Guo, Patel, Li, & Keck 2010). There are four basic types of bipolar spectrum; All of them involve clear change in the mood energy, and activity levels (CAP,2015). These mood incidences’ ranges from periods of extremely high and energized behavior known as Manic episodes to very sad, or hopeless periods known as depressive episodes. Bipolar I disorder, the client has at least one episode of manic followed by major depression. Bipolar II disorder, the client has one or more hypomanic and major depressive episodes, the other not so severe and less diagnoses type of Bipolar is chronic mood disorder that lasts more two years with combination of hypomania and dysthymia. (CAP,2015). This paper will go into, Bipolar I, Manic episodes, the pathophysiology, Sign and symptoms, treatments, comorbidity, nursing intervention and nursing and patient therapeutic relationship.

Manic depression disorder, more commonly known today as bipolar disorder, is a mental illness that can affect any age, race, or gender. It is not prejudiced, and has a grim prognosis if the symptoms are not treated or controlled in some fashion. Bipolar disorder is, by Boris Birmaher as the presence of recurrent episodes of mania or hypomania with and without episodes of depression (Birmaher, 2013). As explained by Hockenbury and Hockenbury, a manic episode can be sudden and escalates the emotional state of the individual causing them to have extreme euphoria, as well as more excitement, physical energy, and a more rapid thought and speech process. A depressive episode can also come on suddenly and leaves the individual in a lost state, where they are tired, and no longer find enjoyment from activities that they once loved and could lead to suicidal thoughts or actions (Hockenbury & Hockenbury, 2014). A person does not mentally mature fully until about the age of 25. Meaning that a 25 year old has different brain processes than a 10 year old. Because of this, there have been many studies conducted on the controversy between whether or not bipolar disorder should be diagnosed in children and adolescents.

Bipolar disorder is a manic-depressive lifelong illness in the brain that causes shifts in mood, energy, activity, and the ability to carry out normal tasks, but efficient treatment helps people to manage these complications and normalize their daily lives. This illness is a very serious mental disease affecting about 2.6 percent of adults in the United States that has the power to cause risky behavior and even suicidal tendencies if not treated (www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml). It is more common in older teens and young adults, but it affects children as young as six years old. It affects men and women, all races, ethnic groups, and socioeconomic classes equally but women experience more periods of depression than

•Up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar

This source gives the readers an in-depth overview of Bipolar Disorder and the causes of having the mental health issue. There’s a great distinction between the ups and downs people experience and bipolar disorder. Due to the ups and downs teens and children experience, bipolar disorder is hard to diagnose during those early years. The National Center of Biotechnology Information’s research program is run by Senior Investigators, Tenure Track Investigators, Staff Scientists, and Postdoctoral Fellows which makes the source credible. The source contained

The two major types of Bipolar Disorder (BPD) set out in this paper are Bipolar 1 and 2. Bipolar 1 is diagnosed as guide lined by the DSM5. As the occurrence of a least one maniac episode preceding or post an episode of hypomania and/or Major depression. The DSM 5 highlights that Bipolar 2 is diagnosed by one major depressive episode in occurrence with one hypomanic episode with an absence of Mania. (Association:, 2013) Mania as defined by DSM5: “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day.” Hypomania being: “A distinct period of abnormally and

The DSM-5(2013) section on Bipolar and related disorders includes diagnoses for Bipolar I disorder, Bipolar II disorder, cyclothymic disorder, substance/medication induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder and unspecified bipolar and related disorder there is no classification for pediatric or early onset bipolar disorder. Though there is the following statement “the recognition that many individuals, particularly children and, to a lesser extent, adolescents, experience bipolar-like phenomenon that do not meet the criteria for bipolar I, bipolar II, or cyclothymic disorder is reflected in the availability of the other specified bipolar and related category. Indeed, specific criteria for a disorder involving short-duration hypomania are provided in Section III in the hope of encouraging further study of this disorder.” (American Psychiatric Association, 2013) . For DSM-5(2013) diagnosis purposes pediatric bipolar disorder would seem to fall under 296.89 Other Specified Bipolar and Related Disorders presentation 3 which is Hypomanic episode without prior major depressive episode. This presentation describes clients who have had one or more manic episodes but has not met the full criteria for a major depressive or manic episode. Fristad & MacPherson (2014) discuss that Bipolar disorder once was thought to be a disorder of adulthood but recently research has suggested

Psychiatric mood disorders of such as Bipolar are often complex to diagnosis. Bipolar I is differentiated from Bipolar II by a history of at least one manic episode in a person’s life, with Bipolar II being diagnosed and characterized by a history of major depression with at least one episode of hypomania (Sadock, Sadock, and Ruiz, 2015). Bipolar is often misdiagnosed as major depression, especially in the presence of a dual diagnosis of substance use disorders. Individuals with Bipolar often have a history of self-medicating their mood symptoms of mania and

For an episode to be categorized as manic, the patients’ mood has been irritable or abnormally elevated for at least 1 week. A person must also exhibit at least 3 of the following symptoms (4 if the mood is only irritable): extreme feelings of personal greatness; a decreased need for sleep, marked talkativeness; distractibility; extreme focus on a goal-directed activity; reports of ‘racing’ thoughts or a flight of ideas; or excessive involvement in pleasurable activities that have a high potential for painful consequences (i.e. sexual indiscretions or unintelligent business investments). As in the criteria for a depressed episode, the DSM-IV specifies that these symptoms should not be better explained as being a side effect of a drug or illness to qualify as a manic episode. These symptoms must interfere with the person’s normal functioning and must not meet the criteria for a mixed episode. As with adults, childhood-onset bipolar disorder has many faces. Children with Bipolar I Disorder have episodes of mania and episodes of depression, sometimes there are long periods of normal moods between episodes. Adults usually tend to have more depressed episodes than manic episodes. However, some children will have chronic mania (symptoms of mania lasting for long periods of time or marked by frequent recurrence) and seldom experience a depressed episode.

Bipolar disorder is an affliction that affects many Americans. Children who live with parents who have this disorder often are neglected. Children are often not able to have a voice within their homes. The quality of life, emotional stability and childhood necessities are impacted by children raised by bipolar parents.

Children exhibit behaviors that are associated with Bipolar Disorder (BPD) as early as 2 years of age. However, many children are not diagnosed until older due to the subjectivity of diagnosing children with mental disorders while their brains are still developing. This leads to a prolonged delay in diagnosis and treatment. However, with recent research, we are able to view and compare brain structures of those with BPD to those who are not affected by BPD. By MRI and fMRI scans, there are regions in the brain that are associated with BPD at certain sizes and activity levels. Individuals with Bipolar show decreased brain volumes in emotion related neurocircuitry, such as the amygdala and the prefrontal cortical regions (Marrus, Bell, & Luby, 2014). With being able to see structural abnormalities within the brain we are also able to determine if treatments for these disorders are effective. With the use of proper medication, volumetric differences occur in the regions of the brain that are associated with BPD and therefore provide evidence that brain structure abnormalities can be “normalized” with medication. However, even with treatment, individuals with BPD tend to follow the trend that they are still more susceptible to drug abuse, aggressive behavior, and binge drinking later on in life (Swendsen et al., 2010). Additionally, BPD used to always be considered the sole mental illness an individual had but recently it has been shown that BPD is comorbid with other diseases,