![]() Researchers are still looking for the gene or genes that may cause the disorder. Which teens are at risk for bipolar disorder?Ī teen is at higher risk for bipolar disorder if another family member has it. What causes bipolar disorder in a teen?Įxperts don’t know the exact cause of bipolar disorder. That is why this disorder has two poles or symptoms. These episodes are countered by periods of major depression. A teen may have times of great elation, happiness, elevated mood, or irritability. These mood swings go beyond the day’s normal ups and downs. Persistent depressive disorder (dysthymia)Ī teen with bipolar disorder often has extreme mood swings. Substance UseĬonsider toxicology screening (with the patient’s consent) if you suspect illicit drug use.Bipolar Disorder in Teens What is bipolar disorder in teens?īipolar disorder is a type of depression. In any patient with psychotic features-even those who show common signs of bipolar disorder, such as grandiosity and other mood-congruent features-it is important to consider the possibility of a primary psychotic disorder such as schizophrenia. Although hallucinations and vivid perceptions are also common, the presence of hallucinations underscores the need to rule out organic causes as well as substance use. ![]() Psychosis often presents as a form of thought disorder (e.g., tangentiality). Mood-congruent delusions (e.g., grandiosity) and mood-incongruent delusions (e.g., paranoia) are the most common psychotic features. Psychotic features usually appear during manic rather than depressive episodes. PsychosisĪpproximately 50 to 95 percent of people with bipolar disorder experience psychosis. People with borderline personality disorder often have distal trauma (e.g., childhood adversity). The central and defining features of borderline personality disorder are an enduring and pervasive pattern of interpersonal relations that is chaotic and tempestuous, with subjective complaints of emptiness and attachment difficulties. Personality Disordersīorderline personality disorder is not a diagnosis of exclusion for bipolar disorder. Other psychiatric disorders and problems are described in the following sections. major depressive episode with prominent agitation/anxiety.Other psychiatric disorders and considerationsīipolar disorders share symptoms with other psychiatric disorders, including: In addition, laboratory screening for thyroid abnormalities is generally recommended. For example, a physical exam probing for neurological signs or evidence of head trauma may be warrant- ed. Organic pathology can be reasonably excluded by focusing on biological factors that may be associated with mania. Some non-psychiatric conditions can present with symptoms of mania. Manic responses, on the other hand, do not follow this pattern. Rather, this reaction would simply be considered a drug side-effect. Note that experiencing a hypomanic episode after starting an antidepressant does not indicate a bipolar diagnosis unless the hypomanic state outlasts the physiological effects of the drug. In previous versions of the DSM, mixed or manic/hypomanic episodes while taking an antidepressant did not count toward the diagnosis of bipolar disorder. ![]() If a patient manifests mixed or manic features while taking an antidepressant for depression or immediately upon discontinuing it, a diagnosis of bipolar disorder is made (this was a significant change made in the DSM-5). Mixed features is defined as a minimum of three pre-specified depressive symptoms while experiencing hypomania or mania, or three hypomanic symptoms while experiencing a major depressive episode. cyclothymic disorder: features continuous biphasic mood instability for two or more years, but never severe enough to meet criteria for a major depressive episode, mania or hypomania.Ī common clinical scenario in primary care is a manic/hypomanic presentation in a patient on antidepressant monotherapy who has no prior de novo manic or mixed features.People with this type often use health services when they are depressed and often fail to respond sufficiently to conventional antidepressants (a situation that masquerades as treatment-resistant depression). This is possibly the most common bipolar presentation in primary care. bipolar II disorder: features hypomania and depression.bipolar I disorder: features at least one manic episode. ![]() The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 American Psychiatric Association, 2013) categorizes bipolar disorders into three types: ![]() Text below adapted from The patient who has mania in Psychiatry in primary care by Roger S McIntyre, (CAMH, 2019). ![]()
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