Causes of Bipolar illness

Genetic - This is a strongly genetic condition. If a child has two parents who have had mood disorders, nearly every child will have a mood disorder (either a type of depression or a type of mania). If one parent has a mood disorder, about a quarter of the children will get a mood disorder. Drugs - a number of drugs can make a person manic or look like mania. Steroids (by mouth, not just inhalers) are the most common prescription cause. Street drugs can mimic mania. A few other rarely used medications can, too. However, the most important one to be aware of are the antidepressant medications. The drugs used for depression can make some people manic or hypomanic. In a recent study of Prozac in children for depression, about 5-10 % switched to mania. These were children who had not had mania before. Infections - in rare cases infections of the brain, AIDS, and a few other rare diseases can cause mania. This is very rare in otherwise well children. Hormones - Too much thyroid hormone can make you manic. This is also very, very rare in children. Other rare neurologic conditions - Strokes, Multiple Sclerosis, tumors, epilepsy, and a few other rare causes can cause mania in children. Diagnosing Mania in Children - There are two types of mistakes you can make in diagnosing any disease. You can think something is mania when it really is something else, for example, street drugs. Or you can think a disorder is something else when it is really mania. In children, the mistakes are almost always the second kind. Making sure you don't diagnosis something as mania when it really isn't - Besides a complete history and physical and talking to everyone involved, it is often times necessary to do other tests. Urine drug screens, CAT scans of the head, and blood tests are often used. If there is no family history of a mood disorder, then I am more aggressive in finding other causes. Making sure you don't diagnose something else when really it is mania - This is the hard part. Mania can look a lot like a few other psychiatric disorders. It can look like a Oppositional Defiant Disorder or Conduct disorder (personality characterized by persistent violation of the rights of other and their property). It can look like ADHD. Almost 90 % of children who get mania will also have ADHD. (See accompanying handouts for details on these) It can look like "stress". Mania can also look like schizophrenia. Pediatric mania is more often accompanied by psychosis than in adults. Also mixed states and a rapid cycling picture are more common. These atypical features (for adults) can remind people of adult schizophrenia. Usually by keeping two things in mind you can keep from missing mania. First, Conduct Disorders usually do not get suddenly ten times worse. Nor do they appear out of the blue over age 7. Second, mania is usually genetic. A strong family history of mood disorders, especially mania, makes me wonder about mania in any episode of wild and out of character behavior. Co-morbidity Co-morbid conditions are those that tend to run together. Diabetes and heart disease are a common example. In pediatric psychiatry, there is a huge amount of comorbidity. Bipolar disorders have a lot of co-morbidity. In fact, in children and younger adolescents, it is almost always preceded or accompanied by another disorder. What this means is that a child who is destined to get a bipolar disorder usually will show another psychiatric disorder earlier in his life. By far the most common one is ADHD. Over 90% of children who get manic had ADHD before they got manic or hypomanic. On the other hand, most children with ADHD never get mania. Other problems like oppositional defiant disorder and Conduct disorder are also common in children who get manic. This makes it even harder at times to tell if a person has a bipolar disorder as many of the signs and symptoms are the same as in ADHD. However, in ADHD alone, the symptoms do not dramatically increase for no apparent reason. Substance abuse is very common in teenagers with bipolar illness. About 65% of teenagers with severe mania were abusing substances at the time they became ill. This is even more likely if the also have ADHD or Conduct Disorder. Continuing to abuse substances is one of the most important predictors of a child getting ill again. (11) Course and Prognosis Bipolar disorders by their very definition are not one time illnesses. One of the most common questions I am asked about children who have been hypomanic, depressed or manic is, will this happen again? The sad answer is probably yes. Between 20-30% of children who have severe depression will become manic later in their lives. This is more likely if the depression came on suddenly, included psychosis, and a family history of bipolar illness was present. Pediatric bipolar illness is very severe and chronic. Almost all children will have another episode of mood disorder in their lives. Most will have another episode within the next five years. A number of things can be helpful in predicting this, but none is more important than a history of prior mood disorders, especially mania. The longer you have been ill with bipolar disorder and the more episodes you have had, the more likely you are to get it again. In other words, the longer bipolar illness goes on, the harder it is to stop. Here are some slightly less important predictors Features that make another episode of mania less likely No family history, medical causes present for mania (like steroids), no other neuropsychiatric disorders, sudden onset of mania after a stressor, a history of good functioning before illness, and above all, no prior episodes. Features that make another episode of mania more likely A strong family history of pediatric onset mania, numerous other co-morbid psychiatric disorders, poor functioning before illness, rapid cycling, mixed mania and depression, and above all, a long history of bipolar illness. Most of these factors can not be changed by doctors, families, or patients. However, keeping a bipolar disorder from recurring can be affected. That is why identification and treatment of bipolar illnesses is critical. The longer a child has bipolar illness, the more likely it is to go on and on.

How bipolar disorders screw up your life Disability during episodes - if you are more than a little depressed or have any degree of mania, you just can't do much of what you should be doing at a certain age. A child will not get along with his family. His friends will be fewer and not exactly the best kind of kids. It will make other family members have trouble themselves as this is so hard to live with. It can split up parents. In older children, serious crimes or accidents can occur during mania. School is very difficult to continue. Disability between episodes - When other children see a child who is manic or hypomanic, they don't forget it for a long time. These children are shunned once they are well and are not easily accepted back by their peers. Depression is less of a problem. The irritability which often accompanies pediatric depression can burn out friendships for a long time, even after it is gone. Self esteem and development- having multiple episodes of bipolar illness interrupts a child's normal psychological development. They end up in many ways immature for their age and in other ways older than their age because of all the suffering they have gone through. From the child's perspective, it is as if there is tornado going through their lives on a random basis. The child is willing to pick up the pieces and start over a couple of times, but after that, many will just give up and think or say, "what is the use of trying? It is all going to get wrecked before I get going by the next episode" Suicide - Obviously the worst outcome is this. It is not uncommon. In pediatric bipolar illness, 20% will make a serious suicide attempt. There are no quality studies of pediatric completed suicides in bipolar illness. In adults, about 19% of those with bipolar illness commit suicide.