Childhood Bipolar and Atypical Mood Disorders Q and A
Irritability-Anger-Rage and the Sad-Bad-Mad Triad of Childhood-Unstable Mood Disorders
Irritability, Anger, and Rage: Childhood Bipolar Disorder
“Sad, Mad, Bad” and Mood Disorders
From the series” I want you to know what I know.”
How does Bipolar and Unstable Mood Disorders show themselves in childhood?
Mood disorders in childhood, often present with behavioral problems and marked irritability, anger and rage out of proportion to situation. The sad, mad, bad triad, is first seen with mad rageful moods in the preschool child, and when older bad behaviors that at times just don’t make sense like stealing and lying in an otherwise well socialized and moral child. The sad part often isn’t seen until in later childhood or adolescent, sometimes not until medication is used. One of the complaints of the teen on mood medication is now though their anger is much better, they are having problems with their new found sadness, not real depression, but a sadness , that may be accompanied by increased sympathy, empathy, guilt and remorse.
Is this the only way that is presents?
Though this is this more common developmental sequence, that is the mad, bad, sad, there are children at a very early age that have just too much sadness, approaching the kind of depression usually reserved for the older teen or adult. These children often go miss diagnosed as having a major depression or Unipolar depression, and given antidepressant medication, that though may be initially helpful may actually make matters worse. What is missed and underappreciated in these children are the quiet mood swings, and other symptoms that are seen in a bipolar type of mood disorder. The family and personal history may also hold a key in making the right diagnosis.
What exactly does it mean to be Bipolar, or have such features as in the Atypical Unstable Mood Disorders?
Bipolar has two poles, opposite sides of the same coin usually rapidly alternating, in the younger person, sometimes within hours or even minutes. In adult terminology this would be called Mixed Bipolar, Ultra Rapid Cycling The high energy, nasty, mean, angry states, with elevated self esteem, and doing well at school, changing to a lower energy state either normal mood, or a sadder, less expansive excitable mood, relative apathy, and a I don’t care attitude, with lower self esteem or evaluation if not frank negativity, doing poorly at school. Sometime this lower energy part of the pole is represented by physical symptoms like severe headaches, increased need for sleep, an increase of symptoms of some psychosomatic problem like asthma, allergies, stomach and intestinal upset.
How does this compare with the one pole, of the stable depressive disorders called Unipolar?
This up and down pattern, driven by mood changes and swings, usually has been occurring throughout the child’s development, with similar problems found in the family history, distinguishes the bipolar pattern over the Unipolar pattern. In the Unipolar pattern there is not the up and down of the moods, nor the nasty mean nature of the emotions, reflecting in functioning at home and school. The mood in Unipolar depression are more stable and persistent and pervasively on the sad, low energy side, with lack of interest, or decreased pleasure, and the irritability though present is not as intense , dramatic, or ever changing . There is more consistency , less changeability in all the symptoms including sleep disturbance, self evaluation, in energy level, in concentration, and thinking problems. The Unipolar person evokes sympathy, while the bipolar evokes irritation and annoyance, as with the moods the relationships are ever changing, angel to devil, Dr Jeckle & Mr. Hyde. There is both a qualitative and quantetative difference in the moods and feeling, besides the changing poles, with the bipolar being more intense, and frequent in its symptomatic presentation, as seen in relationships, and physical symptoms.
What are the other symptoms that must be present to make the diagnosis?
Other symptoms of bipolar must be present though they may be episodic and driven by moods, including distractibility, poor sleep patterns, often requiring very little sleep with normal or even high energy during the day, grandiosity showing itself with an overly positive self image, needing to be the boss, in charge, in control, able to get away with things like stealing and lying, fast tangential, sometime loose speech, racing thoughts interfering with concentration and sleep, increased need to do many goal directed activates, being thoughtless and impulsive, cognitively, behaviorally, and socially, getting involved in high risk behaviors. Unstable Mood Scales Historical Markers, Treatment Scale, Symptom Picutre,
How is ADHD and Bipolar type of mood disorders related?
The triad of impulsivity, that is the thoughtlessness, poor concentration , and hyperactivity seen in ADHD is present in the Bipolar child and this triad of symptoms must not be confused for the disorder, or the wrong medication will be chosen with delay in treatment of the proper and primary diagnosis. If one is not sure one should treat the Bipolar process first, and that may help clarify the diagnosis, with always the option of adding a specific medication for the focus and concentration, if needed. ODD,ADHD or Mood
What does family and personal history tell us about this disorder?
The family history is positive for mood, drug and alcohol problems, the personal history has many issues and problems that represent the underlying excitability and irritability , with infantile colic, extreme tantrums and separation anxiety, many psychosomatic complaints interfering with school, family and leisure time, fluctuating academic and behavioral problems at school, at home and with peers.
What else can help make the diagnosis?
The suffering can be immense in the young child or teen, who may not understand what is happening to them, and if they could don’t have the verbal abilities to let others know, even when asked. Often non verbal communications like play, art work like clay figures, drawings, paintings, writings, music, songs, poems may have the representations of their pain, suffering and turmoil, that can’t be expressed in everyday conversation.
What are the some serious complications and why?
Suicide risk and drug and alcohol use is highest in bipolar because of the intense episodic shifts in mood, thinking, perception, and as they get disorganized by these their awareness and reality testing.
This seems crucially important can you explain this in detail?
Mood and thinking can shift as follows. One minute feeling normal, then very good, then sad, perhaps passing through an irritable state, hating the ones they love, loving what they just said they hated, one minute mind in fast , with sharp concentration, thoughts coming with ease, the next, thoughts too slow, or not at all, cant concentrate, feeling on top of the world all is great, I am powerful great, I should get away with things, I right, now I feel bad, every thing I do is bad, I so sorry for the bad I did, I don’t even understand how I justified it, I deserve puhishment, feel so good, could live for ever like this, next down , low, worthless, hopeless, negative useless, better off dead, all the energy I need, with extra reserve, next low or no energy, cant even get out bed, after sleeping so long, and deep, maybe too deep, don’t need much sleep, now I cant sleep enough, I love my self, I hate my self, thoughts just right, too loud, sounding like voices, too quiet and sounding like voices, many good ideas, now too few or no ideas, every thing seems great wonderful., now everything sucks, and is a pain to do, I care about every body and lot, now I care about nobody, not even my self, don’t care about anything, nothing bothers me, everything bothers me, on top of the world, I could go on forever, now I hit bottom, why go on at all, all within a short period of time, and it repeating itself, multiple times a day, day after day, week after week, why not see if some drug or alcohol will stop the pain and suffering, why not think about suicide, the cycles will never end.
Why is it so important to make the distinction between Unipolar vs. Bipolar types of depressions?
This picture is much different than one sees in Unipolar mood states, and so is the treatment. To make matters more complex and difficult is the fact many times in children, though this is less so yet can occur as with adults what first brings a person for treatment is depression that may look like a Unipolar depression. Though this may be what first brings the person in, if one carefully takes a history one would fine many other signs and symptoms from the present , past, and family history that would in fact point to a depression, but in a Bipolar Disorder. This is critical to determine because treating a Unipolar depression when one should be treating a Bipolar depression can have catastrophic outcomes.
What is the treatment for Unipolar type?
The medication used in treatment of Unipolar depression are one of the traditional antidepressant medications that work on serotonin like Prozac, or on serotonin and norepinephrine like Cymbalta, or on dopamine and norepinephrine like Welbrutrin. These medications may initially help a depression in a Bipolar process which give one a false confidence that the diagnosis and medication choice is correct only to stop working, and the dose is increased until the negative effects outweigh the positive . The worse negative effect is the fueling of increased cycling and worsening of the whole picture, and leading to possible psychosis, and suicidal and homicidal thinking, and behaviors. AntiDepressantWorsenSymptoms
What is the medication treatment for the Bipolar types?
The treatment of choice for a depression occurring in a Bipolar Disorder is the same as treatment for the high energy excitable irritable angry euphoric Manic state, that is one of the mood stabilizing medications, a neuroleptic like Risperdal, and anticonvulsant such as Depakote, or lithium carbonate.
What is you not sure what kind of depression you are dealing with?
If one is not sure if the depression is Unipolar or Bipolar it is best to err on the side of safety and use one of the mood stabilizing medications. The atypical neuroleptics, like Risperdal in low doses have very good antidepressant effects, without the risk of immediately or in the long run making matters worse by fueling increased cycling. Also in low doses used for a short time none of other negative effects are likely to occur, but still the risks benefits must be addressed by all concerned before treatment is started. It has been hypothesized that even short term use of the antidepressants can have consequences for the future, by altering and sensitizing brain chemistry in a very negative way in the Bipolar brain. One needs to look not just at the presenting symptoms, and problems but the possible brain chemistry that may be at the cause of the depression and treat it with the right medications. Bipolar and Unstable Mood Disorders