Bipolar disorders are characterized by alternating periods of manic, depressive and normal states of mind. Each phase can last weeks or months. The diagnosis is made by clinical criteria. The treatment is a combination of mood stabilizers (eg., Lithium, certain antiepileptic drugs, psychotropic drugs), psychotherapy and antidepressants.
Bipolar disorder typically begin in the years between puberty and mid-20s in many children, the initial presentation is one or more depressive episodes.
Bipolar disorders are characterized by alternating periods of manic, depressive and normal states of mind. Each phase can last weeks or months. The diagnosis is made by clinical criteria. The treatment is a combination of mood stabilizers (eg., Lithium, certain antiepileptic drugs, psychotropic drugs), psychotherapy and antidepressants. Bipolar disorder typically begin in the years between puberty and mid-20s in many children, the initial presentation is one or more depressive episodes. Bipolar disorder is rare in children. In the past, bipolar disorder has been diagnosed in prepubertal children who were restricted by intense unstable moods. However, because such children proceed normally to a depressive rather than bipolar disorder, they are now classified as disruptive Stimmungsdysregulationsstörung (Depression in Children and Adolescents: Disruptive Stimmungsdysregulationsstörung). Etiology The etiology is unknown, but heredity is involved. A faulty regulation of serotonin and noradrenaline can be associated with it, as well as a stressful event. Certain substances (eg. B cocaine, amphetamines, phencyclidine, certain antidepressants) and environmental toxins (for. Example, lead) can aggravate the disorder or mimic. Certain diseases (eg. As thyroid disease) can cause similar symptoms. Symptoms and complaints The main feature of bipolar disorder is a manic episode. Manic episodes alternate with depressive episodes that can occur more frequently. During the manic episode, the mood of the young people can be either positive or irritable and change depending on the social circumstances between the two moods. Speaking quickly and pressed the sleep and reduces excessive self-assessment. The mania may psychotic proportions reach (eg. B. “I am one with God”). The judgment may be severely affected, and young people can show risky behaviors (eg. As promiscuity, reckless driving). Prepubescent children can experience dramatic mood swings, but the duration of these scenes is much shorter than in adults. Often they stop just a few minutes. The onset is typically insidious, and the report is always that the child had always been temperamental and difficult to handle. Diagnosis Clinical evaluation study on toxicological causes Diagnosis is based on history and the psychological examination. A number of diseases (eg. As thyroid disorders, brain infections or tumors) and drug addiction must be excluded by appropriate medical procedures. This includes toxicological studies on drugs and environmental toxins. The doctor should look (including sexual abuse and incest) after triggering events such as psychological stress. Forecast At puberty onset of bipolar disorder have a different prognosis. Patients with mild or moderate symptoms that respond well to treatment and are cooperative, have an excellent prognosis. Too often the response to treatment but insufficient, and the young people in terms of medication notoriously unreliable. For these young people, the long-term prognosis is not so good. Right now, nothing is known yet about the long-term prognosis in young children with bipolar disorder and highly unstable, changing and violent mood swings. Treatment mood stabilizers and antidepressants Psychotherapy Both teenagers and young children are treated during their manic and highly active phase with mood stabilizers while psychotherapy and antidepressants are used for the depressive phase. Mood stabilizers (see Table: Selected medication for bipolar disorder *) can be roughly divided into three categories: mood-stabilizing anticonvulsants mood-stabilizing antipsychotics Lithium all mood stabilizers can cause potentially dangerous side effects. Therefore, treatment must be individualized. Furthermore, drugs that have successfully worked in the initial phase, due to severe side effects, mostly weight gain, are no longer used as a long-term medication. Antidepressants can trigger a switch from depression to mania, and are therefore generally used in combination with a mood stabilizer. Selected medication for bipolar disorder * Compound Indication initial dose maintenance dose Comments Lithium Lithium with long-term effect, § Acute mania and stabilize 300 mg two times daily 300 to 1,200 mg two times daily dose titrated up to a blood level of 0.8 1.2 mmol / l antipsychotics Aripiprazol§ Acute mania psychosis Up to 30 mg once a day every day, limited experience in children chlorpromazine , § Acute mania psychosis 50-300 mg used 2-5 mg once 10 mg once daily 2 times daily rare because newer drugs have a more favorable side effect profile Olanzapin§ Acute mania psychosis 2.5-5 mg once daily Up to 10 mg 2 times a day caused weight gain, the administration may result in some patients limited be paliperidone, § Acute mania psychosis 3 mg once a day up to 3 mg two times daily Closely related to risperidone Very limited experience in children Risperidon§ acute mania psychosis 0.5 mg once up to 2.5 mg daily (daily in divided doses z. B. 0.5 mg 3 times daily) maintenance dose very variable at high doses increased risk for neurological side effects Quetiapin§ Acute mania psychosis 25 mg 2 times a day up to 200 mg 2 times a day caused sedation which limits the increase in the dose of olanzapine / fluoxetine in fixed combination, § Bipolar depression 6 mg / 25 mg once / day up to 12 mg / 50 mg once / day, limited experience in children Ziprasidon§ Acute mania psychosis 20 mg two times a day up to 80 mg 2 times Very limited daily experience in children anticonvulsants carbamazepine Acute mania and mixed episode 200 mg 2 times up to 600 mg two times daily Metabolic daily enzyme induction, may require adjustment of the dose Divalproex Acute mania 250 mg of 2- times a day up to 30 mg / kg 2 times a day in separate doses dose 25 mg titrated to a blood levels of 50-125 ug / ml lamotrigine long-term therapy once a day up to 100 mg 2 times Requires daily that information provided by the package insert followed exactly * These drugs represent a small but serious risk for a variety of major side effects. Therefore, the benefits must be weighed carefully against potential risks. The dosage instructions are approximate. The inter-individual variability in therapeutic efficacy and side effects is significant. This table is not a substitute for full drug information. These drugs have not been studied in children. §Diese drugs increase the risk of weight gain, negative effects on the lipid profile, increases in glucose and prolactin levels and QT prolongation.