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The emotional brain in youth
Date:9/4/2011

fecting 3𔃃% of the general population, bipolar disorder is a significant health problem due to its early onset and its chronic, life-long, and relapsing course associated with great impairment. In children and adolescents the illness results in considerable functional limitations and high rates of psychiatric hospitalization (Axelson et al., 2006). According to retrospective studies, 20󈞨% of adults with bipolar disorder had their first symptoms before the age of 20 years (Lish et al., 1994; Perlis et al., 2004).

Diagnosis

To diagnose bipolar I disorder in adolescents, adult criteria (DSM-IV) are used except that (NICE Guidelines, 2006):

  • Mania must be present.
  • Euphoria must be present most of the time (in the course of the past 7 days).
  • Irritability has to be noted if it is episodic, severe, results in impaired function and is not in character or is out of keeping with the context.

The specific phenomenology of bipolar disorder in adolescents is characterized by (Birmaher et al., 2006; Carlson et al., 1994):

  • More mixed episodes than pure manic ones
  • Frequent irritability and aggressive behaviour
  • Psychotic features in 30󈞞% of the acute episodes (which may lead to diagnosis errors in 50% of the cases)
  • More often observed rapid cycling profile
  • Sexual disinhibition,
  • High rates of comorbidities such as Attention Deficit Hyperactivity Disorder (ADHD), substance abuse, conduct and anxiety disorders

Clinical features such as euphoria, grandiosity, hypersexuality, racing thoughts, and decreased need for sleep are typical for mania associated with primary bipolar disorder in order to distinguish it from patients with primary ADHD (Birmaher et al., 2006).

The younger the child, the rarer is the condition of bipolar disorder. However, there is no disputing that a substantial number of pre-adolescents have symptoms of mania, usua
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Contact: Sonja Mak
s.mak@update.europe.at
431-405-5734
European College of Neuropsychopharmacology
Source:Eurekalert

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