Mania In Children And Adolescents

Manic depression, which was once known as bipolar disorder, is a mental illness that results in severe mood swings, including despair and manic or hypomanic highs. Feeling down or hopeless, as well as losing interest in or enjoyment from most activities, are symptoms of mania. You may experience mania or hypomania, which are less severe forms of mania, along with exceptional irritability or feelings of euphoria and vigour. Emotional fluctuations can impact sleep, exertion, judgement, conduct, and cognitive function.¹

A manic episode in children or teens might cause them to exhibit high irritation or a short attention span mixed with long periods of tremendous happiness or silliness. They struggle to go asleep without feeling exhausted and frequently speak quickly on a wide range of subjects. These people could find it difficult to focus and discover their thoughts are constantly racing. They may exhibit reckless behaviour and bad judgement, as well as an excessive amount of interest in or involvement in enjoyable but dangerous activities. They could also have an exaggerated belief in their own strength, intelligence, and abilities.²

Classification and presentation

There are two types of bipolar disorder: bipolar I disorder, which involves mania, and bipolar II disorder, which involves hypomania but does not involve mania. The degree of mania and hypomania differs: mania is often linked to substantial impairment in social and occupational functioning, while hypomania does not always result in impairment. Both positive and negative mood polarity episodes are typically quite crippling and have a detrimental impact on relationships, work, and education. Furthermore, subsyndromal symptoms can lower quality of life and happen in between acute episodes. Examples of these symptoms include worry and sleep disturbance. Severe episodes of either mood polarity may give rise to psychotic symptoms. These are usually mood-congruent, e.g., grandiose illusions during mania or nihilistic delusions during extreme sadness, believing one to be dead.³

Prevalence and epidemiology

With a frequency of between 1% and 2% of the global population, bipolar disoder (BD) is very prevalent. There is no indication of racial or ethnic disparities in prevalence at this time, and both males and females are equally affected. For BD-I and BD-II, the average onset age is 18 or 20 years old, respectively, throughout adolescence or early adulthood.

In the UK, it currently takes an average of 9.5 years to diagnose bipolar disorder. When a patient presents with depression, it is important to determine if they have a history of (hypo-/)manic symptoms in order to make an appropriate and early diagnosis. This is especially crucial since, unless they are specifically asked, people frequently fail to disclose hypomanic symptoms and fail to link them to mental disease.³

Causes and Risk Factors

Causes

Although the precise origin of bipolar illness is uncertain, a number of factors, including:

• Biological variations : The brains of those who suffer from bipolar disorder seem to undergo physical alterations. Although the importance of these changes is still unknown, they may eventually aid in identifying the root causes.
• Genetics : Individuals with a parent or sibling who has bipolar disorder are at a higher risk of developing the condition themselves. Scientists are searching for genes that could contribute to the development of bipolar disorder.¹

Risk Factors

The following factors may raise the chance of getting bipolar disorder or serve as a catalyst for the first episode:

• Having a parent or sibling who is a first-degree relative and has bipolar disorder
• Times of extreme stress, like when a loved one passes away or experiences another traumatic event
• Abuse of drugs or alcohol¹

Symptoms

• Having an unusually high energy or activity level
• Feeling ecstatic, overjoyed, or even euphoric
• Not sleeping, or sleeping for a short while but feeling rejuvenated
• Being chattier than normal. talking without stopping and at a pace that prevents interruptions
• Racing thoughts, or having many ideas on many different subjects at once
• Being quickly drawn away from things that are irrelevant or unimportant
• Having a fixation on and total immersion in a task
• Demonstrating aimless motions, such pacing your house or place of work or fidgeting while seated
• Acting impulsively, which might result in making bad decisions like shopping sprees, careless sex, or careless business ventures⁴

Diagnosis

Your doctor will inquire about your past medical history, your family's medical history, any herbal products or supplements you take, as well as any current prescriptions and over-the-counter medications. To rule out other diseases that could mirror manic episodes, your provider could prescribe blood tests and body scans. Hyperthyroidism is one such illness. Your healthcare practitioner might recommend you to a mental health professional if all other illnesses and ailments are checked out.⁴

Your mental health professional may use the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, published by the American Psychiatric Association, as a guide when diagnosing manic episodes. What they consider to be a manic episode is:

• You have an unusually high level of energy and activity that is present for the majority of the day, almost every day, and an abnormally prolonged increased expression of emotion. These symptoms persist for a minimum of one week.
• If your mood disturbance is severe enough to seriously impair your ability to function in social, professional, or academic settings, or if you have psychotic symptoms such as delusions or hallucinations, you may need to be hospitalised to keep yourself or others safe.
• The effects of drugs or alcohol, or any other medical condition, cannot be the cause of the manic episode.⁴

Management and Treatment

Treatment for manic episodes includes medication, talk therapy, self-care, and support from friends and family.

Medications

Your doctor may recommend an antipsychotic drug, such as aripiprazole (Abilify®), lurasidone (Latuda®), olanzapine (Zyprexa®), quetiapine (Seroquel®), or risperidone (Risperdal®), if you are experiencing mania alone.

Your doctor might prescribe a mood stabiliser if your mood disorder includes manic episodes. Lithium, valproate (Depakote®), and carbamazepine (Tegretol®) are a few examples. Valproate shouldn't be prescribed to those who are capable of becoming pregnant because it raises the risk of learning deficits and birth problems.⁴

Psychotherapy

• Psychotherapy employs a range of methods. If you have been diagnosed with bipolar I disorder, you will speak with a mental health professional during psychotherapy who will assist you in identifying and resolving potential triggers for your mania and/or sadness.
• With the aid of cognitive behavioural therapy, you may be able to modify false beliefs about the world and yourself.
• Family therapy is crucial because it helps your loved ones understand your behaviour and how they can support you.⁴

Other treatments

In rare instances, people with extreme mania or depression (if bipolar), may be candidates for electroconvulsant therapy (ECT). Your brain is exposed to short bursts of electric current during ECT.⁴

Research and Future Directions

Precision medicine

Interest in combining genetic and neuroimaging biomarkers for BD with clinical data to forecast who will get the illness and how well people who already have a diagnosis would fare has increased since the biomarkers were discovered. Machine learning has been applied recently to create prediction models that compute individual risk assessments. Prediction models may be utilised in the future to provide customised treatment for BD in the vein of "precision medicine." Nevertheless, there are still challenges, such as concerns about accuracy, viability in practice, and ethical acceptability.³

Circadian rhythm disruption

Due to the rhythmic processes whereby sleep, activity, mood, and cognition are driven by circadian function, there is interest in the pathophysiology of BD caused by circadian rhythm disturbance. People with the illness, as well as those who are very susceptible to it, exhibit abnormalities in their activity levels, melatonin and dopamine secretion, and sleep/wake cycles. Moreover, in animal studies, lithium seems to resynchronize disturbed circadian rhythm. Future studies seek to comprehend the neurobiological mechanisms by which disturbance of the circadian rhythm is associated with BD, and to apply this understanding to create clinically beneficial chronotherapeutic strategies.³

Summary

One of the most important aspects of bipolar disease is mania, which is characterised by extreme mood fluctuations that include irritation, excessive happiness, quick speech, and risky behaviour. A child's or adolescent's social, academic, and personal life can be severely harmed by untreated episodes, therefore early detection and intervention are essential to managing this illness efficiently. Improving results requires prompt diagnosis and thorough treatment strategies that include medication, psychotherapy, and support from friends and family. To create more accurate and individualised therapies, more studies must be done to comprehend the genetic, biochemical, and environmental components that contribute to bipolar disorder. Making sure people receive the care they require also requires lowering stigma and increasing awareness.