MHM Magazine

Issue 6 | 2022 | MENTAL HEALTH MATTERS | 11 MHM significant implications for treatment and recovery. The overlapping symptoms of bipolar mood disorder and ADHD are: • Distractibility • Increased motor activity • Impaired attention • Poor impulse control • Rapid or pressure of speech • Irritability It’s however difficult to differentiate ‘pressure to keep talking’ (mania/ hypomania) and ‘often talks excessively (ADHD) and psychomotor agitation (mania/hypomania) and ‘often runs about or climbs excessively (ADHD), and distractibility which occurs in both. In order to make a diagnosis, clinicians should be able to rely on the periodic nature of the disorder as a way to distinguish the disorders, as ADHD is not an episodic illness. However, a review of relevant studies, show that bipolar mood disorder in children presents with a chronicity of symptoms as illustrated in the table above. Symptoms like grandiosity, elevated mood, flight of ideas, decreased need for sleep, hypersexuality, and increased goal directed activity occur exclusively in mania/hypomania and are important features in distinguishing between the two disorders. Family history of bipolar mood disorder is also very important. SYMPTOM BIPOLAR MOOD DISORDER ADHD Elevated Mood Common with grandiosity Late adolescence or early twenties Irritable mood Very prominent Episodic in nature. Clearly demarcated phases of mania/hypomania/depression Flight of ideas/Racing Thoughts Could be present Relatively less common Psychotic symptoms Common More common Hypersexuality Common Common- less common than in children with bipolar Self-injurious/suicidal behaviour Common Relatively less common Family History Bipolar mood disorder and depression common ADHD BIPOLAR MOOD DISORDER AND CONDUCT DISORDER Conduct disorder is a common and often ignored comorbid diagnosis in bipolar disorder children. Studies report up to 74% of children with bipolar disorder have comorbid conduct disorder. The overlapping symptoms are; • Irritability • Hostility • Impulsivity Interestingly in adolescents with overlapping symptoms of hypersexuality and impulsivity, these symptoms are more often interpreted as inappropriate sexual behaviour or disinhibited social interaction and are more likely considered as part of a conduct disorder rather than a bipolar disorder. The main difference between conduct disorder and bipolar disorder is the long prodrome period in conduct disorder with progression from less to more severe rule-breaking, whereas mania presents as an abrupt onset of impulsive behaviour. CONCLUSION Bipolar mood disorder is a challenging diagnosis in children and adolescents, but despite the challenges and controversies, it’s possible to diagnose bipolar mood disorder in children and adolescents. Developmental stage and co-morbidity need to be taken into account when making a diagnosis. The presentation is mostly atypical in children compared with the classic adult disorder and it’s important to consider these differences in a clinical setting. Children and adolescents with bipolar mood disorder typically present with rapid fluctuations in mood and behaviour and are often associated with co-morbid ADHD and disruptive behaviour disorders. This atypical but common presentation seems to be related to developmental differences in manic symptom expression and the evolving picture of the disorder in children. The following steps are useful in the evaluation of bipolar mood disorder in children: 1. Ask families to keep daily logs for at least 2 weeks and track: • mood, • activity level, • energy, • sleep • Frequency, Intensity, Duration, Triggers of tantrums • Check functioning at home, school and with peers 2. Review past medical records, take a good history and order appropriate investigations(as needed), which can include EEG, brain scan, toxin screen, and basic blood work 3. Important to gather information frommultiple informants. Pay special attention to a family history of mental illness. During evaluation pay special attention to the cardinal symptoms like elevated mood, grandiosity, racing thoughts, decreased need for sleep, psychosis, and hypersexuality, also note the intensity of irritable mood and level of aggression. Assess safety issues. References available on request.