Cambridge Independent Neuroscience and Psychiatry Services
Bipolar disorder & Mania

What is BAD?

Everyone has 'mood swings'; feeling fine, happy or excited the one moment or day, and sad or anxious the next moment or day. Feeling 'up' and 'down' can be part of life, but when these 'swings' become extremely severe and start interfering significantly with daily functioning at school, work or with friends, this can cause concern.
What are the signs of Bipolar Affective Disorder?

Bipolar Affective Disorder is a complex and difficult diagnosis to make in children and young people.  
It is extremely rare before puberty, research indicates prevalence in children at more or less 2/1500.
In general, Bipolar Affective Disorder is very rare in children.  Lifetime prevalence is estimated at 1%.  

Young people may describe episodes of mania as 'feeling high' or 'manic'.  It is important to know that these feelings can be normal.  Diagnoses of Mania are only considered when severe and generalised functional impairment is detected.

Some symptoms and signs of BAD:
Extreme irritability, excitement, elation or suspicion
Difficulties with concentration
Rapid speech; it is often very difficult to interrupt 
Rapidly changing topics of speech
Neglect in personal care
Sleep disturbance; chronically requiring very little sleep
Change in appetite; requiring little food
Change in energy levels; very high sustained energy levels
Individuals may appear very effective, but overall function deteriorates
Social withdrawal from friends and family
Excessive sociability (meeting or contacting new and sometimes high profile people)
Bizarre ideas, beliefs and experiences
Preoccupations, delusions and hallucinations (please see Psychotic Disorders for more information)
Inflated ideas about self, role and ability
Low mood and symptoms relating to Depression (please see Depression for more information)
Socially inappropriate, reckless, hyperactive or impulsive behaviour such as overspending, gambling, taking risks with physical safety, getting into trouble with authorities and sexual promiscuity

Children and young people with Bipolar Affective Disorder are often at risk of developing other mental health problems or disorders (problems can be complications that occurred due to Bipolar Affective disorder, or they can co-exist as comorbidities).

Developmental and neurodevelopmental problems such as ADHD
Anxiety disorders
Substance abuse problems

This list is not comprehensive. 

What causes Bipolar Affective Disorder?

The causes for BAD are not yet fully understood.  Causes can be similar to Depression.  

BAD has a genetic component, which means it can run in families. 

Physical illness or stressful events may trigger the illness in susceptible individuals.

Medical problems or side-effects to some medications may look similar to BAD (differential diagnoses).

Differential Diagnoses (problems that look like BAD, but that is not BAD):
Nutritional problems for instance relating to Vit B12
Infections such as encephalitis
Inflammatory or neoplastic disorders
Neurological disorders such as Wilson's disease
Endocrine problems such as Cushings disease or thyroid problems
Haematological and biochemical problems such as relating to kidney disease
Medication such as adrenergics
Intoxication relating to for instance alcohol, amphetamines, cocaine, hallucinogenics, opiates 
Mood, anxiety and psychotic disorders
Neurodevelopmental problems such as ADHD

This list is not comprehensive. 

How is Bipolar Affective Disorder diagnosed?

It is important to request that your GP refer you to a Consultant Child Psychiatrist with your concerns as soon as possible.  The Psychiatrist will, through a detailed history and mental state examination, rule out possible differential diagnoses and make a diagnosis if appropriate.  Risk assessment is also an important part of the assessment.

How is Bipolar Affective Disorder treated?

Medication usually plays a key role in treatment.  

Not only is medication used to treat symptoms, such as hallucinations, but also to prevent the illness from returning.  Therefore, with the medication, we aim to enable the individual to lead a healthy and functional life.

Child Psychiatrists will consider antidepressant and/or antipsychotic medication.

Mood stabilisers are medications often used if an individual has experienced more than one episode of the illness.  This can reduce the risk of further episodes.

The Psychiatrist will need to see the individual regularly, to make sure the medication is effective and that there are no harmful side-effects.  They will also need to follow up on whether the symptoms are controlled and to assess risk.

The risk of possible side-effects needs to be balanced with the risks that this illness can pose for patients; health, safety, well-being and general functioning.

It is especially important to talk about the risks of taking the medication during pregnancy and breastfeeding.

Psychoeducation (information and discussion about the illness, treatment and prevention) is a very important part of the treatment.

Family work and individual work can and should also be offered by the CAMHS (Child and Adolescent Mental Health Service) teams.

Please see Helpful Links for more (mostly non-medical) support.  

The content of these pages is intended for general information purposes only.  These pages do not constitute any form of consultative or diagnostic tool or process.  The assessment, diagnosis and treatment of mental health difficulties, particularly in children, is a complex and specialised process and should only be undertaken by individuals with appropriate training and sufficient experience, such as qualified mental health professionals.  If you are concerned about the mental health of a young person, please seek appropriate advice from your General Practitioner, local Child and Adolescent Mental Health Service or Social Care.  Research findings and conclusions can vary between sources, and can change over time. 
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