Bipolar Disorders in Children and Adolescents

Naomi A. Schapiro, RN, MS, CPNP

Disclosures

J Pediatr Health Care. 2005;19(3):131-141. 

In This Article

Etiology and Pathophysiology

Although the specific genes moderating the expression of BPD have not been confirmed, studies of adult monozygotic twins have found that 60% of the variance in bipolar disorder was attributable to genetic factors (Faraone, Glatt & Tsuang, 2003). Adoption studies reviewed by the same authors showed an increased prevalence of BPD in the biologic, but not in the adoptive, parents of adults with BPD. Studies of pediatric-onset BPD seem to indicate that the earlier the onset, the stronger the association with increased prevalence among relatives, but there is a paucity of twin and adoption studies of pediatric probands (Faraone et al., 2003). Studies of the children (≤ 21 years) of bipolar parents show increased incidence of mood, anxiety, and disruptive behavior disorders (DelBello & Geller, 2001). Genetic researchers are also exploring the possibility of "anticipation" in BPD, in which illness severity increases in subsequent generations (Kusumakar et al., 2002).

Researchers suggest that BPD is characterized by severe fluctuations in state, encompassing not just mood, but also changes in behavior, cognition, and level of arousal, such as the decreased need for sleep and grandiosity present during manic episodes, and generalized impairment in problem-solving (Leibenluft, Charney, & Pine, 2003; Pavuluri, Graczyk, Henry, Carbray, Heidenreich, et al., 2004). Brain structures implicated include the frontal and prefrontal cortex, the amygdala, hippocampus, and basal ganglia (Leibenluft et al.) Functional magnetic resonance imaging studies show abnormalities in adults with BPD such as asymmetry in the prefrontal cortex (Kusumakar et al., 2002; Leibenluft et al.), but these results have not been duplicated in adolescents. Practical obstacles to imaging manic children, as well as the ongoing development of the prefrontal cortex during adolescence (Pine, 2000) add to the challenges of future research.

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