MHM Magazine

10 | MENTAL HEALTH MATTERS | 2022 | Issue 6 MHM decreased need for sleep. 6. Depression may be the presenting episode, and there is a challenge in identifying unipolar vs bipolar depression. The following are factors that may predict onset of mania in children who are depressed: • Rapid onset of depressive symptoms • Psychomotor retardation • Depression with psychotic features • Family history of affective disorders especially bipolar mood disorder • Switching to mania / hypomania after treatment with an antidepressant Bipolar in children is distinctly different from bipolar in adults and the table below illustrates the differences Bipolar in Children Bipolar in Adults Onset Pre-pubertal, early adolescence Late adolescence or early twenties Nature of Symptoms Longer symptomatic stage. Chronic difficulties regulatingmood, emotions and behaviour Episodic in nature. Clearly demarcated phases of mania/hypomania/depression Mixed Episodes (concurrent depressive/manic symptoms) Very common Relatively less common Psychotic Symptoms Less common More common Family history of bipolar mood disorder Common Common- less common than in children with bipolar ADHD comorbidity 60-90% Relatively less common CLINICAL PRESENTATION OF BIPOLAR MOOD DISORDER IN CHILDREN Mania Symptoms of mania can include the following: • Elevated, expansive or irritable mood • Easy distractibility • Decreased need for sleep • Racing thoughts • Pressure to keep talking • Grandiose delusions • Excessive involvement in pleasurable but risky activities, poor judgement and in some cases hallucinations Depression Symptoms of depression can include: • Pervasive sadness and crying spells • Sleeping too much or inability to sleep • Agitation • Irritability • Withdrawal from activities previously enjoyed • Drop in academic performance • Inability to concentrate • Thoughts of death and suicide • Low energy and significant changes in appetite In children with elevated mood, they may laugh hysterically and act infectiously happy without any reason at home or school. Grandiose behaviours in children include acting as though rules don’t pertain to them, for example they believe they’re so smart they can tell teachers what to teach and other students what to learn. Flight of ideas is when children jump from topic to topic in rapid succession when they talk, and it happens even in the absence of a special event. For flight of ideas ask whether topics of discussion change rapidly, in a manner confusing to anyone listening. Racing thoughts are expressed in a more concrete way in children. They may say ‘It’s hard to do anything because my thoughts keep distracting me’. A decreased need for sleep is manifested in children who sleep only three to five hours a night and don’t feel tired the next day. Whereas children with other forms of insomnia (due to inadequate sleep hygiene, excessive environmental stimuli, anxiety, depression, or ADHD) may lie in bed trying to sleep, children in a manic state may be on the computer, talking on the phone, rearranging furniture in their rooms, or watching television. Hypersexuality can occur in children with mania without any history of physical or sexual abuse. Hypersexual behaviour in mania has a more pleasure seeking quality to it, whereas the hypersexual behaviour of children who have been abused is often anxious and compulsive in nature Manic children show an increase in goal directed behaviour , such as increased drawing, building elaborate Lego, writing poems or books in a short period of time. In addition to the core symptoms, hallucinations and delusions can be present in children. A distinct feature of irritability in children with bipolar is extremely aggressive and/or self-injurious behaviour. Children with bipolar have frequent extreme rages or meltdowns over trivial matters ( e.g. a 1-2hour tantrum after being asked to tidy up their rooms). CO-MORBIDITY Co-morbidity is the rule rather than the exception in children and adolescent psychiatric disorders which complicates the diagnosis as there are many overlapping symptoms. The two commonest co-morbid conditions are ADHD and conduct disorder BIPOLAR MOOD DISORDER AND ADHD ADHD is a common comorbid disorder with ADHD and some studies report rates of up to 90% comorbidity in children and up to 23% in adolescents. It’s important to recognise the comorbid disorders as this has