We present the second and final part of the article ‘Bipolar Disorder in Child and Adolescent Population’ by Stephanie Vizuette and María Jesús Rojas. In the first part, an introduction to bipolar disorder and its detection in childhood was provided, while this second part will offer a detailed description of the symptomatology of child and adolescent bipolar disorder.
Description of Symptoms
Regarding mood alteration, irritability is the most frequent in children and adolescents. It is an episodic irritability, in most cases without a specific or minimal trigger, which presents with significant aggression and violence. During these episodes, the child may throw objects, utter insults, shout or raise their voice in a very hostile manner, make sarcastic comments, and occasionally assault or hit others. These episodes have a short duration, and afterward, children often show great remorse, cry, and say phrases like “I just couldn’t stop”, “it was as if I had a force inside that I couldn’t control”.
Children with euphoria, present less frequently than irritability, appear excessively happy, laugh a lot without a specific reason, jump continuously, throw themselves on the floor, laugh and roll around on it without any other cause.
Regarding their cognitions and ideas, children with grandiosity symptoms believe they have more capacity than others to decide and know what needs to be done. For this reason, they do not recognize authority and are demanding and even defiant with both their parents and their teachers. They utter phrases like “I already know what to do”, “you don’t have to tell me what to do”, which are totally inappropriate for the child’s age and the circumstance being referred to.
Regarding their physical activity and behavior, children with mania or in an episode of mood exaltation talk a lot, always tend to give their opinion, do not allow interruptions, and are obstinate in their discourse, frequently changing its content (accelerated thinking) and sometimes failing to finish any of the topics they have discussed (flight of ideas), moving from one topic to another and forgetting what they were previously saying. Speech is often rapid, sometimes with a certain pressure or tension due to the immediate desire to express their opinion. Sometimes they feel full of energy and are capable of doing many things in a short time. Furthermore, they do not feel tired and have a reduced need for sleep, sleeping fewer hours than usual for them and normal for their age, and do not feel tired upon waking. They may show a greater interest in activities of a sexual nature (hypersexuality), tend to touch others or masturbate, and make inappropriate comments of an obscene nature.
Bipolarity in Adolescents
In adolescents, a reduced awareness of risk and the consequences of their actions stands out. They appear socially uninhibited, lose shyness, and, at times, modesty. This fact, along with impulsivity, makes them more prone to engaging in risky and delinquent behaviors. Sometimes, emotional episodes are accompanied by behavioral problems. Adolescents may take many more risks, such as driving too fast or spending a lot of money. Some adolescents suffering from bipolar disorder think about suicide more frequently and intensely than other types of adolescents. Some forms of expression during the depressive phase include: feeling very sad, complaining a lot about pains, such as stomachaches and headaches, feeling guilty and useless, eating very little or too much, having very low energy, and lacking interest in fun activities.
Children with bipolar disorder present specific learning difficulties in a higher proportion than the general population; furthermore, up to 80% of them have ADHD associated with the mood disorder. This fact increases difficulties in academic performance and, consequently, frustration and demotivation in the child. On the other hand, these children have a dysregulation in the control and cognitive processing of emotions, meaning a neutral stimulus can be interpreted by them as hostile, and they may act disproportionately and thoughtlessly as a result. Given these difficulties, it is easy to expect a significant deterioration in social relationships with their peers or in their environment, to the point where the child may feel alone and rejected (Pavuluri et al., 2005, 2007) (as cited in Tomàs Vilaltella, Bielsa Carrafa, & Rafael Linares, 2013).
Differences in Bipolarity between Children, Adolescents, and Adults
It is important to note that bipolar disorder in children and adolescents differs from adults not only in the presentation of symptoms but also in the course of the illness, presenting mood variations that are better appreciated as the subject’s age decreases, mainly in the prepubertal age, where, for example, the tendency to rapid or ultrarapid cycling (abrupt changes from depression to mania in a time frame of less than 24 hours) is more frequent.
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