Harrington building

BIPOLAR AFFECTIVE DISORDER

Bipolar Affective Disorder is a severe biological brain disorder in which a young person will have extreme changes of mood (thoughts and feelings), energy and behaviour. They experience periods of being unusually 'high' (manic episode) and periods of being unusually 'low' (depressed episode). This condition is sometimes called 'manic-depression'. The symptoms of mania and depression can also occur simultaneously this is termed a 'mixed' episode. In the acute episodes of bipolar affective disorder the young person's life can be at risk.

MANIA

Mania can present as exaggerated feelings of well-being, energy and optimism. Such feeling can be so intense that there IS a loss of contact with reality - where the person can believe strange things about themselves, make bad judgments, behave in embarrassing, harmful and dangerous ways, thus making life hard to deal with in an effective way. Some signs of mania could include

Subjectively

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  Expression of being very happy or excited
  
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  Appearing to have or expressing high energy
  
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  Having lots of new/exciting ideas
  
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  Feeling more important than usual/defiance of authority
  
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  Irritability that others are not as 'happy' as them
  
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  Complaining of boredom
  
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  Expressing own abilities which defy the laws of logic e.g. believing they
  

have the ability to fly

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  Hearing voices that others do not hear
  

Objectively

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  Jumping very quickly between ideas
  
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  Overactive/moving very quickly
  
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  Speaking very quickly, making speech hard to understand
  
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  Agitation
  
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  Excessive involvement in multiple activities
  
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  Dare-devil behaviours
  
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  Inappropriate sexualised behaviour
  
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  Hostile, suspicious
  
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  Verbally or physically explosive
  

DEPRESSION

Depression presents as very low mood lasting for long periods, which makes it harder for the person to tackle daily living and everyday tasks. Some signs of depression could include:
Subjectively

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  Losing interest in things/unable to enjoy things
  
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  Finding decision making hard
  
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  Feeling tired and restless
  
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  Marked loss in self confidence
  
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  Feeling useless/inadequate & hopeless
  
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  Very little or no motivation
  
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  Expressing thoughts of self harm or suicide
  
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  Being mute
  

Objectively

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  Appearing very flat in mood
  
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  Speech is drawn out with no variation in pitch
  
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  No eye contact
  
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  Unresponsive to questions
  
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  Irritable
  
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  Pre-occupied
  
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  Wearing a puzzled bewildered look
  
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  Increasingly withdrawn
  
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  Poor self care
  
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  Isolating self
  
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  Physical symptoms for both mania and depression could include:
  
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  Little OR excessive eating
  
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  Weight fluctuation
  
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  Little OR excessive sleep
  
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  Unusual fast movements (as though startled)
  

Bipolar Affective Disorder is a chronic, lifetime condition that can be managed, but not cured, with medication, psychological and psychosocial interventions (a multi-modal treatment package aimed at the individual and their family).

PREVALENCE

Bipolar Disorder affects fewer than 1 in 100 people (Royal College of Psychiatrists 2004). It is extremely rare before puberty, but becomes more common in teenage and adult years. Although causes are not fully understood bipolar disorder tends to run in families and early onset could be triggered by particular life/stressful events, physical illness, substance use/misuse.

IMPLICATIONS for HEALTH

The exaggeration of thoughts, feelings and behaviour affects many areas of the young person's life, including

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  Family and social relationships
  
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  Interference with education
  
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  Behaviours that place the individual at significant risk
  
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  Loss of confidence and sense of control over their life.
  

Also consider the effects of long-term hospitalisation. High doses of medicine that can affect physical appearance and motor activity. Compliance to treatment is affected because of having an enduring or limiting illness and can be displayed as anger

SUGGESTED READING
Kowatch. A. et al. Treatment guidelines for children and adolescents with bipolar disorder. Journal of American Academy for Child and Adolescent Psychiatry, 44:3, 2005.
USEFUL WEBSITES
www.cabf.org - Child and Adolescent Bipolar Foundation
www.youngminds.org - Young minds Mental Health Charity

DEPRESSION

Depression describes a range of moods, from the low spirits that we experience, to a severe problem that interferes with everyday life’ (Mental Health Foundation, 2004). ‘Over the last few decades it has become widely accepted that children can suffer ‘adult-type’ depressive disorders.’ (Barker. P. 2004).
PREVALENCE

Whitaker and colleagues (1990) suggested that in 14-17yr olds the prevalence rate of major depression is about 4%, the rate in girls(4.5%) being higher than in boys (2.9%). The rate is lower in pre-pubertal children.

Depression can affect anyone, of any culture, age or background. Causal factors include

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  Genetic factors.
  
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  Stressful events.
  
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  Insecure attachment.
  
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  Separation experiences, losses and bereavement.
  
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  Other psychiatric conditions.
  
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  Physical illnesses and drugs.
  

SYMPTOMS
Emotional Tearfulness.

Hopelessness and helplessness.

Low self esteem.

Worthlessness.

Anxiety.

Disproportionate guilt.

Dejection.

Irritability.

Anger.

Feeling flat and “empty” (anhedonia)
Physiological Lethargy, psychomotor retardation

Agitation psychomotor over activity

Sleep disturbances

Vomiting

Un-explained physical illness e.g. chest pain

Loss of libido

Over/under eating

Catatonia (in extreme cases)

Cognitive Confusion.

Difficulties with concentration.

Indecisiveness.

Uncertainty.

Pessimism.

Ambivalence

Incongruous emotional response

Rumination, self-blame, self deprecation

unhelpful thoughts
Social and behavioural Aggression

Substance misuse

Intolerance

Withdrawal

Poor personal hygiene

Drop in activity levels.

Isolation

Over dependency/rejection

TREATMENT
Using the stress vulnerability model, looking at relevant stressors in the persons life and devising a coping strategies “toolkit” as well as alleviation of certain stressors using environmental manipulation
Antidepressant medication.

Cognitive behaviour therapy (CBT).

SUGGESTED READING
Barker, P. (2004). ‘Basic child psychiatry’. Oxford: Blackwell Science Ltd.
Whitaker, A., Johnson, J., Shaffer, D., Rapoport, J.L., Kalikoe, K., Walsh, B.T., Davies, M., Braiaman, S. & Dolinsky, A. (1990). ‘Uncommon troubles in young people’. Archives of General Psychiatry, 47, 487-496.
Graham, P, Hughes C, (1995). ‘So Young, So Sad, So Listen’. London: Gaskell.
USEFUL WEBSITES
http://www.mentalhealth.org.uk/page.cfm?pagecode=PMAMDP

ANXIETY
Anxiety is the body's natural response to situations that evoke 'fear' in us. At various ages children experience different fears that require the child to adjust their anxieties, this is part of development. For example - At 2-4 years imaginary creatures, intruders or the dark are the most common causes of fear. In early childhood animals, earthquakes or injuries are the most common. Between ages 8-11 not doing well at school / sports can cause such feelings and in adolescence exclusion by peers is most significant.

Children are most often referred to services for help with anxiety when a fear becomes irrational or anxiety dysfunctional. Anxiety can cause the child to not want to attend school or to stop socializing with their friends.
CAUSES

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  Peer relationships - whether these are positive or negative is very important.
  
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  Conditioning Process - if a child has been frightened by something, the same thing can bring about the same reaction again at a later date.
  
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  Traumatic life events.
  
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  Genetics - anxiety disorders often run in families.
  
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  Parenting and family emotional environment parents/ caregivers’ behaviours and family processes influence a child’s anxiety level and coping skills.
  
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  Problems with attachment - anxious and troubled attachments from parents/caregivers can lead to insecurity and anxiety in the child.
  

TYPES

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  Specific phobia (fear of a particular object/ situation)
  
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  Generalized anxiety (many aspects of the environment are perceived as threatening)
  
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  Separation anxiety (separation from an attachment figure results in anxiety)
  

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  Panic disorder (panic attacks occur as a result of anxiety)
  
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  Obsessive Compulsive Disorder (obsessions/compulsions are engaged in as a way of attempting to avoid anxiety)
  
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  Post Traumatic Stress Disorder (a traumatic event which occurred has resulted in prolonged or delayed anxiety response)