Bipolar Disorder

Bipolar Disorders

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Definition:

Bipolar is actually an umbrella term for three types of bipolar disorders. These disorders are grouped on the basics that they all are characterized by shifting emotions, with manic periods (Kring). The three specific bipolar diagnoses are Bipolar I, Bipolar II and cycothymia. You may know bipolar by its old name of manic depressive disorder. The most distinguishing feature of Bipolar disorders is the experience of both mania and depressive symptoms. These mood swings vary in intensity based on the specific form of bipolar. BP I is the most severe case, where people vary from intense bouts of major depresive episodes to extremely high manic episodes. BP II is less severe with many features of hypomania not a full blown manic period that only needs to last a few days rather than a week or more) and bouts of depression. It is possible that these bouts are not as severe or debilitating as those experienced in BP I. Cycothymia is the least severe from of bipolar. The emotions still tend to vary without apparent environmental causes but they do not have the same level of intensity as other bipolar disorders.

All people experiences mood shifts. If you think of normal as a calm ocean, then BP I is like a hurricane, BPII is like a tropical storm, and Cycothymia is like a bad storm.

The DSM-IV-TR defines Bipolar as:

The distinguishing figure of BP is episodes of Manic or Hippomanic episodes. DSM-IV defines mania as having four of the following symptoms:

-increase in goal-directed activity or physical restlessness

-unusual talkativeness; rapid speech

- flights of ideas or subjective impressions that thoughts are racing

-decreased need for sleep

-inflated self-esteem; belief that one has special talents, powers or abilities

-distractiblitiy; attention easily diverted

-Excessive involvement in pleasurable activities that is likely to have undesirable consequences, such as reckless spending, sexual behavior or driving.

For a manic episode:

-symptoms for at least 1 week or requiring hospitalization

- Symptoms causing significant distress or functional impairment

For hypomania episodes

-symptoms lasting at least 4 days and functioning is unequivocally different, but not markedly impaired. (Kring et al)

Example of how it looks in a child

Children with bipolar often have a range of symptoms but some included the following:

Crying for no apparent reason

Expansive or irritable moods

Depression

Rapid changes in mood lasting anywhere from a few minutes to days

Explosive destructive rages

Hyperactivity

Agitation

Changes in sleep

Night terrors

Excessive involvement in multiple projects

Impair judgment

Impulsivity

Racing thoughts

Dare devil behavior

Inappropriate or precocious sexual behavior

Grandiose beliefs

Acting with no apparent concern for the consequences of behavior

Children with bipolar are frequently anxious and have very low frustration tolerances. The lifetime mortality rate of bipolar disorders (from suicide) is higher than some childhood cancers (CABF, 2007). Bipolar in children is often hard to diagnose as it often seems like different things. In addition to these symptoms children with bipolar also have unique characteristic in the classroom. The brains of people with bipolar are actually different than normal children. This is why people with bipolar have many challenges in school ranging from problems with executive functioning. concentration.,often these symptoms are also caused by medication meant to treat the disorder. Children with bipolar are uncommonly bright and creative but have very high rates of commorbied learning disabilities that only intensify their problems at school. Bipolar effects; paying attention, remembering and recall, thinking critically, categorically, or in an organized fashion, they have problems employing problem solving skills. Their medication can also cause cognitive dullness, physical discomfort and nausea. (CABF, 2007)

Case

Rachel is currently a college student who was diagnosed with Bipolar her sophomore year of college. She is currently married and doing well but this is what she says about living with bipolar

Living with bipolar is one of the hardest challenges a person can go through. Being a student with bipolar brings up many unforeseen issues that many people don't understand. Most often, there is the issue of attendance. Between doctors' appointments which can only be scheduled on a weekday, and unexpected mood swings, it can be hard to get to class sometimes. Everyone has days where they don't want to get out of bed, but when someone has bipolar, their depression can cause symptoms that make it impossible to go anywhere. Homework doesn't get done; studying for tests isn't an option. Another problem is the tinkering doctors do with medications. While adjusting to different cocktails, there are a lot of side effects. That can be anything from severe fatigue to lack of concentration to even blurry vision and other physical impairments. It’s really hard to read two chapters in a book when you can't stay awake or concentrate. It’s even harder when you can't read the words on the page. Most side effects are temporary and if the meds are changed, the side effects usually go away. However, there is always the risk of medications causing suicidal side effects. This is especially true right before people are diagnosed with bipolar. People are usually first diagnosed with depression, and thus given anti-depressants. If this happens, people with bipolar usually become suicidal. Then there are hospital stays and the student might miss days or weeks at a time. It takes a dedicated teacher to work with bipolar students to make sure they learn while accommodating their disease.

Prevalence

All Bipolar disorders are thought to have about a 1% prevalence rate in the general population, , though many go undiagnosed (Kring et al, 2007). It is also estimated that at least one million school aged children have one of the bipolar disorders (CABF, 2007). Traditionally, bipolar was only seen in adults, with the average age of on set in the 20’s (Kring et al, 2007). But in the last decade doctors have seen a rise in childhood bipolar. Many psychiatrics believe that “severe ADHD” is simply undiagnosed bipolar which could account in the rise of bipolar cases in the last decades (CABF, 2007).

Long term out comes prognoses

Unfortunately bipolar is one of the most severe emotional disturbance diagnoses. Bipolar is more often than not a lifelong diagnosis and battle. Most people with this disorder find that treatment includes a life of daily medication. There is no cure for any form of bipolar disorder. Children diagnosed with bipolar do not grow out of this disorder, in fact approximately 10-15% of adolescents diagnosed with major depression will be diagnosed with bipolar as adults (www.mental-heath-today.com/bp/bil/htm) . Bipolar is one of those disorders that can be devasting to hear to a parent or a child. The sad and long term nature of this disorder is often first accompanied by grief, when this is combined with different cultural perspective it can be very hard to accept. I believe strongly that the only way to make this disorder more manageable is to talk about it. Bipolar in whatever form is a medical conditions just like diabetes. Medication is not a sign of weakness but a quality of life issue. As my mother says to people when they question her acceptance of me taking medication is this, “If my child has cancer I wouldn’t think twice about giving her a drug would make her glow in the dark if it helped her, the drugs my daughter takes of her psychological disorders have 10x less side effects and still make her life better so why wouldn’t I give them to her”. I believe this statement couldn’t be more true and really puts all psychological disorders into a new more effective light.

Treatment

Having a child with bipolar in your classroom is hard, there is no question of that. Even if your child is medicated and in therapy because children are still growing the medication often stops working very suddenly and is seemingly constantly being changed. The single best piece of advice I could give a teacher who has a bipolar student is see the world through their glasses, no matter how hard it is for you to deal with this child, you are not the one whose mood violently shifts, who has to take medication that causes unimaginable side effects, who literally has to fight with their own brain every day. That being said, there are some more concert things you can do when working with a child with bipolar. (CABF, 2007)

- Be flexible, being able to change your lessons a little based on the child’s mood that day is essential, the child in a manic state needs something very different then the child in a suicidal depression

-Be patience; chose your battles ignore the small stuff and always dwell on the positives, Stay calm; this is essential children with bipolar don’t naturally know how to regulate their emotions, you must be the example of how to stay calm and deal with situation even when they upset you

--Work with them on conflict management skills, these children need to be taught how to de-escalate a situation, they need positive behavior options to dealing with conflic.

-Work in conjunction with parent’s psychiatrist, therapist, OT, and anyone else the child works with. These children work with a variety of specialist, someone probably has a solution to the problem you’re having, working closely with all of these people with also help you know when medication is being changed or a new behavior technique is being tried that you can be a part of.