User:Pmejia136/Bipolar disorder in children

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Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare and controversial mental disorder in children and adolescents that is mainly diagnosed in the United States, and is hypothesized to be like bipolar disorder (BD) in adults, thus is proposed as an explanation for extreme changes in mood and behavior shifting between periods of depressed or irritable moods and periods of elevated moods called manic or hypomanic episodes. These shifts in mood and behavior are sometimes quick, but usually are gradual. The average age of onset of PBD is unclear, but the risk increases with the onset of puberty. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.

Since 1980, the DSM  has specified that the criteria for bipolar disorder in adults can also be applied to children. However, the exact criteria for diagnosing PBD remains controversial and heavily debated. There are big differences in how commonly PBD is diagnosed across clinics and in different countries. There has been a rapid increase in research on PBD, but training and clinical practice lag behind.

Identifying bipolar disorder in youth is challenging because children often exhibit chronic rather than episodic mania periods. Almost always, these chronic problems have causes other than bipolar disorder. The criteria for PBD can also often be masked by developmental differences. Comorbid disorders make discerning which symptoms are signs of bipolar disorder and which are due to other disorders (e.g., OCD, ADHD, disruptive behavior problems) difficult, leading to complications in treatment. For example, a common treatment for OCD are serotonin re-uptake inhibitors (SRIs), however, SRIs can lead to mood instability and worsening bipolar disorder. The most common misdiagnosis for ADHD in the USA is pediatric bipolar disorder due to hyperactivity being described as prolonged periods of mania. Empirical research conducted in 2004 found that "bipolar disorder (in preadolescence) was initially misdiagnosed in 12 out of 24 youths" (Mahoney, 2004). This is a dangerous misdiagnosis due to the vastly different treatment forms. Firstly, ADHD does not require mood stabilizers like pediatric bipolar disorder. Secondly, the stimulants given to treat ADHD have been shown to cause psychosis and exacerbate mania in pediatric bipolar disorder (Wendling, 2009). This misuse of medication can lead to mood episodes, suicidality, and hospitalization.