In adolescents, bipolar disorder may resemble any of the following classical adult presentations of the illness.
In this form of the disorder, the adolescent experiences alternating episodes of intense and sometimes psychotic mania and depression.
Symptoms of mania include:
- Elevated, expansive or irritable mood
- Decreased need for sleep
- Racing speech and pressure to keep talking
- Grandiose delusions
- Excessive involvement in pleasurable but risky activities
- Increased physical and mental activity
- Poor judgment
- In severe cases, hallucinations
Symptoms of depression include:
- Pervasive sadness and crying spells
- Sleeping too much or inability to sleep
- Agitation and irritability
- Withdrawal from activities formerly enjoyed
- Drop in grades and inability to concentrate
- Thoughts of death and suicide
- Low energy
- Significant change in appetite
Periods of relative or complete wellness occur between the episodes.
In this form of the disorder, the adolescent experiences episodes of hypomania between recurrent periods of depression. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy that last 3-4 days. Bipolar II disorder is 5-10 times more common than Bipolar I disorder.
- Adolescents with this form of the disorder experience periods of less severe, but definite, mood swings between mild euphoria and depression that last a year or more.
Bipolar Disorder NOS (Not Otherwise Specified)
- Significant mood symptoms suggestive of bipolar I, II or cyclothymia but not sufficient duration or severity to meet criteria for these disorders.
For some adolescents, a loss or other traumatic event may trigger a first episode of depression or mania. Later episodes may occur without any obvious stresses, or may worsen with stress. Puberty is a time of risk. In girls, the onset of menses may trigger the illness, and symptoms often vary in severity with the monthly cycle.