Bipolar affective disorder

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes people to experience noticeable, sometimes extreme, changes in mood and behaviour.

Most people who are diagnosed with bipolar disorder, symptoms appear later in adolescence or early adulthood.

Bipolar disorder is not the same as the typical ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly.

Bipolar disorder symptoms can make it hard to perform well in school or get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide. Early diagnosis and treatment can lead to better functioning and well-being over the long term.

Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders. Early assessment, recognition and treatment are important. 

Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.

The exact causes of bipolar disorder are unknown, but several factors may contribute to the illness.

Genetic factors are important and there may be other family members who are also affected. Sometimes a stressful life event can trigger an episode.

Mood isn't the only thing affected. There may be less need for sleep, increased activity levels, racing thoughts, irritability, or impulsive and bizarre behaviours.

Children and adolescents with bipolar disorder may have manic episodes (high) , depressive episodes (low) , or “mixed” episodes.  These mood episodes cause symptoms that often last for several days or weeks.

Periods of depression may present as sadness, being tearful, excessive sleeping, irritability, low appetite, low energy, self harm and even suicidal thoughts or acts. 

The risks can escalate quickly and it's important to get help as soon as possible if you are concerned.

In most situations a young person presenting with a manic episode would probably be seen by A+E and the crisis CAMHS team. Community based care would probably not be appropriate to meet their needs in the early stages. Patient safety has to be the first consideration.

If you are not sure if your child has bipolar and their behaviour is possible to manage at home, then we would see you for an initial assessment appointment. We will ask you about mood, sleeping patterns, energy levels, and behaviour. There are no blood tests or brain scans that can diagnose bipolar disorder. 

It may be that physical investigations are needed if we suspect an underlying cause or if the change in their mental state has been sudden. We would take a full developmental and psychiatric history. It is important to consider other conditions that can overlap or look like ADHD such as emotion dysregulation disorders, ADHD, attachment issues and sometimes autism. 

If we think your child does indeed have bipolar we would recommend a referral into the NHS early intervention team. This is a multi disciplinary team that manages the early stages of such conditions. We would make the relevant referrals and keep you under our care until the transition is agreed. Treatment could be commenced in this time if necessary.

For adults who are concerned they may have bipolar affective disorder we would always recommend a consultation with an adult psychiatrist as the first step. 

Further useful information can be found here   Royal College of psychiatrists Bipolar leaflet

and here Royal College of psychiatrists Parents and Carer Leaflet Bipolar

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