A decreased need for sleep is a hallmark of mania. There areno other diagnoses where a child has a greatly decreased amountof total sleep (compared with age-appropriate norms) and is notfatigued. Sleep deprivation, substance abuse, and antidepressants may trigger mania. BD onset often begins with an episodeof depression. It is estimated that 33% of youth will develop BD
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)
B. During the period of mood disturbance, three or more of the following symptoms have persisted (four if the mood is only irritability) and are present to a significant degree: 1.
2.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3.
More talkative than usual or pressure to keep talking 4.
Flight of ideas or subjective experience that thoughts are racing 5.
Distractibility (i.e., easily drawn to unimportant or irrelevant external stimuli) 6.
Increased goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation
C. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., unrestrained buying sprees, sexual indiscretions, or foolish investments)
D. The symptoms do not meet criteria for a mixed episode.
E. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning, usual social activities or relationships with others or to necessitate hospitalization to prevent harm to self or others, or with psychotic features.
F. The symptoms are not due to the direct physiologic effects of a substance or a general medical condition. Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy) should not count toward a diagnosis of bipolar I disorder.
within 5 years of a depressive episode. Features associated withswitching include early-onset depression, psychomotor retardation, psychosis, mood lability, seasonal pattern, family history ofBD or mood disorders, and antidepressant-induced hypomania.A mixed episode requires 1 week of symptoms of both a manicand major depressive episode. Dysphoric mania is another term used to describe periods of mania that are accompanied by “badfeelings.” Hypomania is used to describe a period of more than 4but fewer than 7 days of manic symptoms. It also is used less specifically to describe less intense mania. The prevalence of psychosis in adolescence (often auditory hallucinations) is 16% to60%. Although high, it is still less than its prevalence in adult BD.
Bipolar II disorder includes at least one full major depressive episode and at least one period of hypomania. Bipolar disorder not otherwise specified is used to describe prominent symptoms of BD that do not meet full diagnostic criteria or when historical information is unclear.
Cyclothymic disorder is characterized by 2 years or more (1 year in children) of numerous periods of hypomania and depression that do not meet full criteria for either a manic or a major depressive episode.
BD occurs in up to 4% of the general population. It is estimated that 1% of children and adolescents meet diagnostic criteria for BD. According to retrospective studies, 60% of BD onset occurs before 20 years of age. Although BD in adults tends to be gender neutral, it is estimated that prepubertal BD is almost four times more frequently diagnosed in boys. This may be because aggression is the main reason for referral for psychiatric services.