What is Bipolar Disorder?

Everyone can relate to the word ‘mood’. We are all happy, excited, sad, depressed, anxious at some point in our lives. Bipolar Affective Disorder (Manic Depressive Illness) is a biochemical imbalance that causes gross mood changes from the high reaches of mania to the lows of severe depression. For the 2.6 percent or twenty million Americans who have this condition it can mean hospitalizations, a lifetime of medication, disability at an early age and the reduced income associated with it.  Bipolar Affective Disorder can be life threatening.

What is COBPD?

COBPD is the abbreviation for Childhood Onset Bipolar Disorder. Bipolar Disorder is an illness of mood, or affect.  In adults mood swings usually last for weeks or months before remitting or changing to the opposite pole (this the term bipolar: having two poles).  Children often cycle many times during one day, a condition known as ultra-ultra rapid cycling.

What Causes Bipolar Disorder?

The exact cause of bipolar disorder is unknown. Recent studies have shown that heredity plays a major role.

Diagnosing COBPD

Diagnosing COBPD can often be a difficult process.  Attention-deficit/hyperactivity disorder (ADHD), Obsessive-compulsive disorder (OCD) and Oppositional defiant disorder (ODD) present many of the same symptoms. In addition, fifty to eighty percent of those individuals diagnosed with COBPD have concurrent ADHD.  The symptoms of Bipolar Disorder are not the same as those in adults other than the alternating mood swings, and these may be overlooked.

The following symptoms are often seen in BOTH ADHD and COBPD.

  • Hyperactivity, easily distracted, attention deficit
  • Lack of attention to details,  restlessness, irritability
  • Difficulty waiting one’s turn, angry, depression symptoms, anxiety
  • Interrupting, intruding on others, disturbance or agitation
  • Motor restlessness, anxiety symptoms, difficulty falling asleep
  • Destructiveness, misbehavior, complaining, bullying, bad habits, anger management issues
  • Physical outbursts, yelling, temper tantrums, behavioral problems, antisocial behavior, developmental disorders, learning disorders or disabilities
  • In addition, the mood fluctuation, sleep disturbances can become night terrors and nightmares seen in COBPD but not ADHD.

What is the difference between COBPD and ADHD

Although many of the symptoms of the two disorders are the same, their origins differ. A child with COBPD often seems to intentionally misbehave and destroy, while an ADHD child with the same symptoms appears to be careless and inattentive. Physical outbursts and temper tantrums seem triggered by sensory and overstimulation in an ADHD child, but a simple “NO” (limit setting by a parent) will cause the same effect in a child with COBPD.

Children with ADHD usually calm down within 15-30 minutes, while it may take the COBPD kid, child or teen several hours to be relieved of his or her anger. In addition COBPD children often show remorse for their physical outbursts, temper, or behavioral problems and express that they were genuinely unable to control themselves.

Treatment of COBPD

Due to the difficulty in diagnosing COBPD, caution must be taken with prescription medications. Some drug prescribed for ADHD (stimulants like Dexedrine, Adderall, and Ritalin) may escalate mood fluctuations, especially in a child who is genetically predisposed to bipolar disorder.

The COBPD must be treated first by stabilizing the child’s mood and treating any sleep disorders and psychotic symptoms present.  Once the child is stable, therapy to help him understand the nature of the illness and how it affects him is critical.

Medications used for stabilizing mood include Lithium, Depakene and Tegretol.  New mood stabilizers such as Neurontin, Topamax and Lamictal are currently being tested and used for children.  Psychotic symptoms and aggressive behavior are often treated with anti-psychotic medications such as Risperdal, Zyprexa, Mellaril, Trilafon and HaldolKlonopin and Ativan are also used to treat anxiety, induce sleep and slow rapid cycling.

Antidepressant medications are very risky and not recommended as they may induce mania and hypomania in children with bipolar disorder.

– by Frank Doberman, PhD

Dr. Frank Doberman is Co-Founder of Karner Psychological Associates (KPA) and is a leader in the fields of clinical psychology, is a Licensed Psychologist, Certified in School Psychology, Educational Administration and is a regular contributor to News 10 WTEN.

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