What causes pediatric bipolar disorder?

There's no single cause of bipolar disorder. Research demonstrates that the illness is the result of a variety of factors.

It's well recognized that bipolar disorder often runs in families, and research clearly indicates that there is a strong genetic component or contribution. Twin, adoption, and family history studies have demonstrated a 4 - 6 fold increased risk in first degree relatives of parents and siblings with bipolar disorder. As with other mental illnesses, bipolar disorder is not caused by a single gene. It’s likely that there are multiple genes involved in determining a person's overall risk of developing the illness.

We also know that genes are not the whole story. Studies of adults with identical twins clearly indicate that there are other factors involved. Specifically, research suggests that if one identical twin has bipolar disorder, there’s approximately a 70% chance that the other twin will eventually develop the illness, as well. This is 2 - 3 times the rate reported for non-identical twins, providing additional strong evidence of a genetic etiology. However, if the condition were caused entirely by genes, we'd expect all identical twins of people with bipolar disorder to develop the illness. The fact that this doesn't occur demonstrates the existence and importance of other biological, social and/or emotional variables which can either precipitate bipolar disorder or serve as protective factors in people who are genetically “at risk” or predisposed.

Research and clinical experience also suggest that trauma or stressful life events can trigger an episode of bipolar disorder in people who are genetically vulnerable. However, many episodes occur without an obvious or identifiable cause.

Research also demonstrates that young people with bipolar disorder actually use their brains in fundamentally different ways than their peers. Specifically, they have neuropsychological deficits in the area of executive functioning which involves judgment, planning, and impulse control. As a result, they are more likely to act on instinct without stopping to think things through or fully consider the consequences of their actions. We’ve also learned that these deficits or differences are independent of the child’s mood state. In other words, they exist even when there are no signs of mania or depression.

 

What are the signs and symptoms of bipolar disorder?

The classic symptoms of bipolar disorder include manic episodes usually alternating with periods of depression and relatively normal moods.

Episodes of mania include symptoms of:

  • expansive or irritable mood
  • persistently increased activity or energy
  • decreased need for sleep
  • racing thoughts
  • rapid or pressured speech
  • inflated self-esteem or grandiosity
  • excessive involvement in pleasurable but risky activities
  • increased physical or mental energy or activity
  • hallucinations or delusions
Episodes of depression in children and adolescents may be characterized by a combination of the following:
  • frequent sadness, tearfulness, or crying
  • hopelessness
  • decreased interest in activities, or inability to enjoy previously favorite activities
  • persistent boredom
  • decreased energy
  • social isolation, poor communication
  • low self esteem or guilt
  • extreme sensitivity to rejection or failure
  • increased irritability, anger, or hostility
  • difficulty with relationships
  • frequent complaints of physical illnesses such as headaches and stomachaches
  • frequent absences from school or poor performance in school
  • poor concentration
  • major changes in eating or sleeping patterns
  • talk of or efforts to run away from home
  • thoughts or expressions of suicide or self destructive behavior

No one symptom indicates bipolar disorder, however if a child has number of symptoms listed above, and they are interfering with functions at home, school, and friends, have them evaluated by a professional.

Bipolar disorder is not the easiest diagnosis to make, particularly in young children. Many of the symptoms are similar to those associated with other disorders, including attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, depression, and conduct disorder. Children and adolescents with bipolar disorder can also have signs and symptoms of a second disorder, such as substance abuse or anxiety disorders. This is why it’s particularly important to get a comprehensive evaluation by a mental health professional who has specific training and expertise in the diagnosis and treatment of complex child psychiatric disorders.

What are the consequences of bipolar disorder?

Bipolar disorder can have serious short-term and long-term consequences. Children with bipolar disorder are more likely to have problems in school, at home, and with friends. Adults with bipolar disorder are at increased risk for divorce, unplanned pregnancies, legal or financial difficulties, and conflicts at work.

Up to 60% of people with bipolar disorder abuse alcohol or drugs at some point in the course of their illness. Research also suggests that people with bipolar disorder have an increased incidence of heart problems, diabetes, migraine headaches, and hypothyroidism.

Tragically, research also confirms that bipolar disorder is associated with a significant risk of suicide. One in four people with bipolar disorder will attempt suicide, at least once, and one in ten will ultimately die by suicide.

Fortunately, research also demonstrates that effective and appropriate treatment can reduce the risk of serious short and long-term consequences for children, adolescents, and adults with bipolar disorder. However, we also know that intervention is most effective when the signs and symptoms are recognized as early as possible, and when treatment is comprehensive, ongoing, and individualized to the needs of the child, adolescent, or adult and his or her family.

What types of treatment are available?

Although there is no cure for bipolar disorder, medicine along with psychosocial treatment can play a critical role in helping manage the symptoms of this illness. It also can help make your child’s behavior more stable and predictable.

While medication may lessen the symptoms of bipolar disorder, psychosocial treatment in the form of family and individual therapy are equally as important in helping the child manage their illness. In fact, a study of adults with bipolar disorder found that people taking medications to treat bipolar disorder are more likely to get well faster and stay well longer if they also receive intensive behavioral therapy.[i] Most doctors agree that the same conclusion holds true for children, especially for those with significant emotional and behavioral issues.

One of the objectives of psychosocial treatment is to educate the family about the illness. This helps ensure the child stays on the treatment program. Therefore, psychosocial treatment is a key element in helping to prevent a relapse and promote healthy emotional growth and development.

In most cases, psychosocial treatment includes teaching parents techniques to recognize the symptoms of bipolar disorder. It also includes teaching parents techniques to redirect their child’s behavior toward more positive outcomes.


[i] National Institute of Mental Health, Systematic Treatment Enhancement Program for Bipolar Disorder. National Institute of Mental Health, Bethesda, MD. Available at: http://www.stepbd.org. Accessed 8/2/08.