Bipolar Disorder

Bipolar disorders (formerly known as manic depressive illnesses) are a set of mood disorders in which patients experience phases or cycles of mood symptoms that create clinically significant impairment in daily functioning. Bipolar disorders are distinguished from unipolar depression by the inclusion of cycles that consist of unusually high, overly joyful, expansive, or irritable moods, denoted as manic episodes.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, bipolar disorders were classified as bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar disorder, and bipolar disorder due to another medical condition. The shared link of all of these disorders is the presence of episodes that include abnormally severe elevated and depressed moods. The primary difference between these specific disorders is the duration of episodes, timing, course, and etiology. The disorder, in all forms, is estimated to affect as much as 3.9% of the U.S. population.

In the early 20th century, German psychiatrist Emil Kraepelin studied the course of bipolar disorder and provide detailed descriptions of the condition in adults. Since that time, descriptions and conceptualizations have remained relatively consistent, and the focus of the disorder continues to be on adult-onset cases. Although the average age of onset for bipolar disorder is 18 years, symptom onset can vary and there has recently been an increased focus on adolescent- and childhood-onset forms.

Prevalence rates among adolescents are fairly similar to those observed among adults (1–2%), whereas prevalence rates among children are not well established. Despite increased attention to early-onset cases, common diagnostic criteria continue to focus on symptoms in adults. As a result, the diagnostic criteria are often challenging to apply to children. Strict adherence to the adult-based set of diagnostic criteria in children may miss some young individuals with bipolar disorder who have developmentally different symptoms, whereas extremely liberal application of the criteria may result in over diagnosing children with typical mood swings or other behavioral difficulties.

Due to episodic mood, behavior, energy, and sleep disturbances, there may be considerable social and educational challenges for children and adolescents who develop bipolar disorder with more significant impact with earlier onset. Due in part to the historic view of bipolar disorder as an adult disorder, treatment for bipolar disorders in youths has typically mirrored treatment for adults. Initial treatment is focused toward mood stabilization and behavior management. In addition, though, treatment often incorporates use of collaborative interventions that optimize family and educational strengths.

Students who have been diagnosed with bipolar disorder may qualify for special instruction and academic accommodations from an individualized education program or Section 504 plan, which allow for accommodations under the “emotional disability” or “other [Page 206]health-impaired” exceptionalities. With adequate supports at home and at school and from medical providers, many young people diagnosed with bipolar disorder may develop appropriate strategies to lead productive and educationally successful lives.