Pediatric emergency medicine trisk 4191 4191
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Unlike adults, mania in childhood may not always include euphoric
mood; irritable mood is much more common. Emotional lability is
common and can be disorienting to parents, who cannot understand
why the child changes so much and so dramatically. Unlike the older
adolescent, the child often does not have a clear recovery from
identified episodes but rather may exhibit continued irritability.
Explosive, disorganized behavior may also be seen. True psychotic
features are rare and the course of childhood bipolar disorder tends
to be chronic and continuous, rather than episodic.
Symptoms of bipolar disorder in adolescents are more similar to
the adult form. Psychotic symptoms, suicide attempts, inappropriate
sexual behavior, and a “stormy” first year of illness may be typical of
adolescent mania. However, when compared with adults,
adolescents may have a more prolonged early course and be less
responsive to treatment.
The adolescent with mania has a distinct period of predominantly
elevated, expansive, and/or irritable mood ( Table 126.22 ). The
patient has a significant decrease in need for sleep, high
distractibility, hyperactivity, pressured speech, and emotional lability.
Patients may also exhibit flight of ideas. The manic patient may have
inflated self-esteem, self-confidence, and grandiosity which may
also include delusional ideas. The person may be aggressive and
combative, go on buying sprees, pursue other reckless behaviors, or
be hypersexual. Manic patients usually have a history of previous
depressive episodes, but may present with an acute manic episode.
A family history of psychiatric disturbance usually exists in patients
with manic–depressive disorder. Typically, manic patients report
feeling extremely well, and they are often brought to the ED against
their will.
Sometimes, patients present with mixed episodes and have
symptoms of both mania and depression. Irritability is usually the
prominent manic symptom. Mixed episodes are particularly
dangerous with a significantly increased risk for suicidal behaviors.
Initial Assessment
