Pediatric Pain Scale

Pediatric bipolar disorder, like its adult form, involves episodes of mania and depression. Unlike its counterpart in adults, however, the rate of diagnosis of PBD increased dramatically over the last ten years, and his current diagnosis is attended by much controversy, even among experts in the field. Below, I will summarize what is diagnosed, diagnosed according to the American Psychiatric Association and Statistical Manual of Mental Disorders (DSM-IV TR, APA, 1994), and describe current controversies in the field of diagnosis and treatment of PBD.

Official studies have shown that PBD, diagnosed by traditional criteria for diagnosis, compromises the normal functioning and can produce extreme changes in mood and energy, risk behavior, and interpersonal problems. Historically, it was considered relatively rare among young people, with rates ranging from 0 percent to 1.2 percent (Carlson and Kashani, 1988; Lewinsohn, Klein, and Seeley, 1995; Shafferet al., 1996). Investigators using looser criteria, however, indicate a rate as high as 7% (Carlson and Kashani, 1988). PBD often show a lot of co-morbidity and symptoms overlap with other psychiatric disorders such as hyperactivity with attention deficit, conduct disorder, oppositional defiant disorder, anxiety and depression, which makes diagnosis difficult.

According to DSM-IV-TR, a manic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood for at least 1 week. For a diagnosis of bipolar disorder, a youth must make the experience of three of the following symptoms (with expansive mood) or four of the following symptoms (with irritable):

> Swollen> self-esteem or grandiosity
>> Reduced need for sleep
>> Difficulties with speech
>> Leakage ideas or racing thoughts
>> Distractibility
>> Psychomotor agitation
>> Excessive involvement in pleasurable activities that have a high potential for painful consequences

Children and young people with bipolar disorder may also experience episodes of depression formal. Sometimes, symptoms of mania and depression occur together, creating a mixed state which can also be characterized by excitement. Depression is diagnosed when a person suffers at least five of the following symptoms for a period of two weeks or more:

>> Feeling sad or losing interest in activities that were once enjoyable
>> Feeling hopeless and worthless
>> Energy fell
>> With the changes in sleep and eating habits
stirring>> Having psychomotor retardation or
thoughts>> Having death or suicide

All these criteria have been developed for use in adults and may not adequately represent bipolar disorder in children, and that is where the controversy begins. For example, some researchers argue that young people with bipolar disorder is characterized by severe irritability (Biederman et al., 2000), rapid cycling (Geller et al., 1998), and chronicity (Geller et al., 1998), d especially as its counterpart in adults. To operationalize the variety of clinical presentations diagnosed or misdiagnosed as bipolar disorder, investigators have developed a system of classification of phenotypes mania in close, intermediate, and large (Leibenluft, Charney, Towbin, Bhangoo, & Pine, 2003 ). standardized rating scales such as the Young Mania Rating Scale (YMRS, Young, Biggs, Ziegler, & Meyer, 1978; Youngstrom, Danielson, Findling, graceful, and Calabrese, 2002), may be useful in clinical practice for support diagnostic decisions and to monitor response to treatment. Although the controversy is still very present, a conservative approach (which I think is more sensitive than we have more data) to describe and diagnostics.