Bipolarity in Children and Adolescents

And it's important to, I think, start off with that bipolar is, is, it's not, it's not a different term for, for mood swings.

You know, somebody, you know, is happy in the morning and angry in the afternoon, uh, so they must be bipolar.

And, you know, someone changes their mind frequently, um, or in a relationship, they're, they're so bipolar.

And none of those things really establish bi- bipolarity because what, what the bipolar disorder is, uh, essentially involved is really like, uh, it's really pathological alterations in, in mood, in activity, in energy level, sleep, cognition, uh, motivation, judgment, impulse control, um, behavior, and just overall functioning.

And one of the most important points that I wanna stress is that bipolar disorder is fundamentally episodic.

Um, what it is is a meaningful and observable departure from someone's baseline functioning.

And, you know, I think w- from a historical context, you know, bipolar used to be called, you know, manic depressive disorder or manic depression, and I think those terms have, from at least my review, I think k- kind of been removed from our, you know, modern diagnostic terminology.

Um, but I think manic depression really captures something important, that it's not just simple emotional instability.

It was really talking about, you know, pathological mood states.

And, you know, there's this term spectrum, which is often associated with, um, with the f- um, well, I can think, think autism is, you know, there's bipolar I and bipolar II, cyclothymic disorder, uh, substance or medication-induced bipolar, um, bipolar disorder due to another medical condition, unspecified bipolar.

So we start with, like, bipolar I.

The defining feature is at least one manic episode in a person's lifetime.

So a person can have just one manic episode and never have another.

Um, usually that's with, you know, medication and, and psychotherapy.

And, uh, I think an important misconception is that a person d- doesn't need a history of major depressive disorder to qualify for bipolar I. Um, depression is extremely common in bipolar I, but the manic episode, it really establishes bipor- bipolar I.

Now, you flip to bipolar II, this is what is a hypomanic episode with major depression and no history of full-blown mania.

And, um, bipolar II doesn't mean, you know, um, this is the light and milder version.

Generally, the hypomanic episodes are less severe than manic episodes, but the depressive episodes in, in bipolar disorder, they tend to be much more severe and recurrent and disabling, and a s- there's a high association with a risk for suicide.

Um, and for bipol- for the bipolar disorders, um, the depression, at least how people have described it, uh, and I'm summarizing from a vast majority of patients that I've worked with, it's, it's, it's, it's much deeper, it's, it's much darker, um, than what, than what we, we call, like, you know, unipolar depression or just major depressive disorder.

And then there's, I think I said, you know, bipolar, both bipolar I and bipolar II have to have a, a major depressive episode.

Um, but with cyclothymia, this is, think, this is, you don't meet the full criteria for depression, and you don't meet the full criteria for mania or hypomania.

Um, but this is like chronic fluctuations, and it, it still can result, you know, fluctuations in mood- And it, it can definitely, um, create subs-substantial impairment.

And again, this is something that I, I, I diagnose, um, frequently.