Can bipolar develop later in life

What are the signs and symptoms of bipolar disorder?

What is the treatment for mania, hypomania and depression?

You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence (NICE) website.

NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at:
www.nice.org.uk.

The NHS doesn’t have to follow these recommendations. But they should have a good reason for not following them.

What medications are recommended?

Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.

The mood stabilisers we talk about in this factsheet are:

Lithium

Certain antipsychotic medication
Certain anticonvulsive medication
Certain benzodiazepine medication

Mania and hypomania
You should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as ‘antimanic’ medication.

If you are taking antidepressants your doctor may advise you to withdraw from taking them.

You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:

Haloperidol
Olanzapine
Quetiapine
Risperidone

If the first antipsychotic you are given doesn’t work, then you should be offered a different antipsychotic medication from the list above.

If a different antipsychotic doesn’t work, then you may be offered lithium to take alongside it. If the lithium doesn’t work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication.

Sodium Valproate shouldn’t be given to girls or young women who might want to get pregnant.

Your doctor should think about giving you benzodiazepine medication short term.

Your doctor will suggest different dosages and combinations to you depending on what works best for you. Your personal preferences should be listened to.

Depression
Your doctor should offer you medication to treat depressive symptoms. You may be offered the following medication:

Fluoxetine with Olanzapine
Quetiapine
Olanzapine or
Lamotrigine

Fluoxetine is an antidepressant. Lamotrigine is an anticonvulsant medication.

Your doctor can prescribe the above medication alongside:

Lithium, and
Sodium valproate.

If you would like to take medication, doctors will use different dosages and combinations depending on what works best for you. Your personal preferences should be listened to.

You can find more information about:

Mood stabilisers by clicking here.
Antipsychotics by clicking here.
Antidepressants by clicking here.
Benzodiazepines by clicking here.
Medication – choice and managing problems by clicking here.

What psychological treatments are recommended?

If you have an episode of depression you should be offered medication and a high intensity talking therapy, such as:

cognitive behavioural therapy (CBT), or
interpersonal therapy.

What is cognitive behavioural therapy (CBT)?
CBT is a talking therapy that can help you manage your problems by changing the way you think and behave.

What is interpersonal therapy?
Interpersonal therapy is a talking therapy that focuses on you and your relationships with other people.

You can find more information about ‘Talking therapies’ by clicking here.

What are the long-term treatments for bipolar disorder?

Bipolar disorder is a life-long and often recurring illness. You may need long term support to help manage your condition.

What medication options are there?

Your doctor will look at what medication worked for you during episodes of mania or depression. They should ask you whether you want to continue this treatment or if you want to change to lithium.

Lithium usually works better than other types of medication for long-term treatment. Your doctor should give you information about how to take lithium safely. If lithium doesn't work well enough or causes you problems, you may be offered:

Valproate,
Olanzapine, or
Quetiapine.

Your doctor should monitor your health. Physical health checks should be done at least once a year. These checks will include:

measuring your weight,
blood and urine tests,
checking your liver and heart, and
checking your pulse and blood pressure.

What psychological treatments are recommended?

You should be offered a psychological therapy that is specially designed for bipolar disorder. You could have individual or group therapy.

The aim of your therapy is to stop you from becoming unwell again. This is known as ‘relapse.’ Your therapy should help you to:

understand your condition,
think about the effect that your thoughts and behaviour have on your mood,
monitor your mood, thoughts and behaviour,
think about risk and distress,
make plans to stay well,

make plans to follow if you start to become unwell,
be aware of how you communicate, and
manage difficulties you may have in day to day life.

If you live with your family or are in close contact with them, you should also be offered ‘family intervention.’

Family intervention is where you and your family work with mental health professionals to help to manage relationships. This should be offered to people who you live with or who you are in close contact with.

The support that you and your family are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family should get support for 3 months to 1 year and should have at least 10 planned sessions.

Is there any other support?

Your mental health team should give you advice about exercise and healthy eating.

If you want to return to work, you should be offered support with that including training. You should get this support if your care is managed by your GP or by your community mental health team.

You might not be able to work or to find any. Your healthcare professionals should think about other activities that could help you back to employment in the future.

Your healthcare team should help you to make a recovery plan. The plan should help you to identify early warning signs and triggers that may make you unwell again and ways of coping. Your plan should also have people to call if you become very distressed.

You should be encouraged to make an ‘advance statement.’ This is an instruction to health professionals about what you would like to happen with your care if you ever lack mental capacity to make your own decisions.

What is the Care Programme Approach?

You may be assessed under the Care Programme Approach (CPA) if you have complex needs or you are vulnerable.

CPA is a package of care that is used by secondary mental health services. You will have a care plan and someone to coordinate your care. All care plans should include a crisis plan.

CPA aims to support your mental health recovery by helping you to understand your:

strengths,
goals,
support needs, and
difficulties.

CPA should be available if you have a wide range of needs from different services or you are thought to be a high risk. Both you and your GP should be given a copy of your care plan.

Your carers can be involved in your care plan and given a copy if you give your consent for this to happen.

You can find more information about:

Care Programme Approach by clicking here.
Planning your care. Advance statements and advance decisions by clicking here.
Mood stabilisers by clicking here.
Antipsychotics by clicking here.
Antidepressants by clicking here.
Medication. Choice and managing problems by clicking here.
Talking therapies by clicking here.

What if I’m not happy with my treatment?

If you aren’t happy with your treatment you can:

talk to your doctor about your treatment options,
ask for a second opinion,
get an advocate to help you speak to your doctor,
contact Patient Advice and Liaison Service (PALS), or
make a complaint.

There is more information about these options below.

How can I speak to my doctor about my treatment options?

You can speak to your doctor about your treatment. Explain why you aren’t happy with it. You could ask what other treatments you could try.

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you aren’t given this treatment, ask your doctor to explain why it isn’t suitable for you.

What’s a second opinion?

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

What is advocacy?

An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.

There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. NHS complaints advocates can help you if you want to complain about the NHS.

You can search online to search for a local advocacy service.

What is the Patient Advice and Liaison Service (PALS)?

PALS is part of the NHS. They give information and support to patients and a good place to start if you’re not happy with any aspect of the NHS.

You can find your local PALS’ details through this website link:
www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.

How can I complain?

You can complain about your treatment or any other aspect of the NHS verbally or in writing. See our information on ‘Complaining about the NHS or social services’ for more information.

You can find out more about:

Medication. Choice and managing problems by clicking here.
Second opinions by clicking here.
Advocacy by clicking here.
Complaining about the NHS or social services by clicking here.

What can I do to manage my symptoms?

You can learn to manage your symptoms by looking after yourself. Selfcare is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling.

What lifestyle changes can I make?

Making small lifestyle changes can improve your wellbeing and can help your recovery.

Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once per week.

Your healthcare professionals should offer you a combined healthy eating, exercise and sleep programme.

You can find more information about wellbeing any physical health at:
www. rethink.org/advice-and-information/living-with-mental-illness/wellbeing-physical-health/.

What are support groups?

You could join a support group. A support group is where people come together to share information, experiences and give each other support.

You might be able to find a local group by searching online. The charity Bipolar UK have an online support group. They also have face to face support groups in some areas of the country. Their contact details are in the Useful contacts at the bottom of this page.

Rethink Mental Illness have support groups in some areas. You can find out what is available in your area if you follow this link: www.rethink.org/about-us/our-support-groups. Or you can contact our General Enquiries team on 0121 522 7007 or [email protected] for more information.

What are recovery colleges?

Recovery colleges are part of the NHS. They offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. You can usually self-refer to a recovery college. But the college may inform your care team.

Unfortunately, recovery colleges aren’t available in all areas. To see if there is a recovery college in your area you can use a search engine such as Google.

What is a Wellness Recovery Action Plan (WRAP)?

Learning to spot early signs of mania or depression is important in self-management. The idea of the WRAP is to help you stay well and achieve what you would like to. The WRAP looks at areas like how you are affected by your illness and what you could do to manage them.

There are guides that can help with this. You can ask your healthcare professional to make one with you or ask them for a template of one. There is more information about the WRAP in the further reading section at the bottom of this page.

Rethink Mental Illness has created a guide called ‘Staying well with bipolar’. This is a guide based on information from people who have or support someone with bipolar disorder. You can download it here:
www.rethink.org/living-with-mental-illness/staying-well-with-bipolar.

You can find more information about ‘Recovery’ by clicking here.

Late onset bipolar disorder: Symptoms, diagnosis, and more

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Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

Ask the tough question: “Are you considering suicide?”
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Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
Stay with the person until professional help arrives.
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If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

Bipolar disorder is a lifelong condition. Because treatment focuses on managing the condition, it is important to seek help when a person first notices symptoms.

The condition is complex, and the alternating manic and depressive episodes can make it difficult to distinguish from other mental health conditions. According to one 2011 study, some people may wait up to 10 years to receive a diagnosis.

Getting an early diagnosis means that a person can manage their symptoms and improve their quality of life. When bipolar disorder symptoms are well controlled, a person is less likely to think about or attempt suicide.

Bipolar disorder shares symptoms with other conditions, so a healthcare professional should first rule them out using psychological tests and physical examinations.

When diagnosing bipolar disorder in older adults, the healthcare professional must consider the varied signs and symptoms. Older adults are also likely taking medications for other conditions. This makes prescribing some types of drugs more difficult.

To diagnose bipolar disorder in an older adult, the healthcare professional will:

Look at the person’s medical history.
Conduct several psychological and neuropsychological tests.
Perform a physical examination to rule out other conditions.
Run blood and urine tests and request neuroimaging.
Treat the underlying condition, which could be bipolar disorder, or change the person’s current medication to help alleviate the symptoms.

Learn more about diagnosing bipolar disorder here.

A treatment plan for bipolar disorder may include a combination of therapy and medication.

Although older adults will receive the same, or very similar, medications as younger adults, a healthcare professional may need to adjust the dosage to prevent side effects. They may also need to consider the other medications a person is taking to avoid potentially harmful drug interactions.

The following sections look at some treatment options for bipolar disorder in more detail.

Psychosocial therapy

Although there is not much information about the effectiveness of psychosocial therapies in older adults, medication adherence training appears to be effective. This training teaches people how to take their medications and what to expect from their treatment.

When older adults with bipolar disorder receive this training, they are less likely to stop taking their medication.

Medication

Healthcare professionals may prescribe several different medications for older adults with bipolar disorder.

Antipsychotic drugs, which help treat mania, can cause side effects. The Food and Drug Administration (FDA) warns that there is a higher likelihood of antipsychotics causing serious side effects in people with dementia, which is more common among older adults.

Healthcare professionals may decrease the dosage of some medications for older adults. This is due to the increased risk of side effects and interactions with other treatments.

Medication for manic episodes

Treatment for manic episodes includes:

lithium
anticonvulsant mood stabilizers
atypical antipsychotics

Medication for depressive episodes

Treatment for depressive episodes includes:

lithium
anticonvulsant mood stabilizers
atypical antipsychotics
antidepressants

Learn more about medications for treating bipolar disorder here.

A person should contact a healthcare professional as soon as they experience bipolar disorder symptoms.

Diagnosing bipolar disorder can be a long process, so it is important that people talk about their symptoms with a healthcare professional as soon as possible.

People with diagnosed bipolar disorder should contact a healthcare professional if they experience significant mood shifts or suicidal thoughts. They should also seek help if their medication has stopped working or if they experience unpleasant side effects.

Receiving a bipolar diagnosis can be challenging, especially later in life. People and their loved ones may find the following organizations useful when looking for education and support:

National Alliance for Mental Illness
Depression and Bipolar Support Alliance
7 Cups
DailyStrength
My Support Forums

Bipolar disorder can affect people of all ages. However, the average age of onset is 25 years. When a person has older age bipolar disorder, they tend to experience more depressive episodes.

Certain underlying conditions can interact with some bipolar disorder medications. For example, antipsychotics can be harmful to people with dementia. A healthcare professional may also have to reduce the dosage of some medications due to potential interactions with other treatments.

Receiving a new diagnosis later in life can be difficult. People with bipolar disorder and their families can get help from healthcare professionals and support groups.

signs, behavior, difference from ADHD

Until a few decades ago, it was believed that bipolar disorder could only occur in adults. And for obvious reasons, the symptoms of bipolar disorder in children are different from the signs and behaviors of adults with the disease.

Natalya Chebakova

legion-media

Bipolar disorder is mostly diagnosed in children aged 11-15 years. It is difficult to detect a psychopathic deviation on your own, since many schoolchildren are experiencing and experiencing stress at this time. Bipolar disorder is often confused with Attention Deficit Hyperactivity Disorder. nine0003

Contents of the article

What is bipolar disorder

Bipolar affective disorder (formerly manic-depressive psychosis) is a mental illness in which the emotional state of children changes dramatically: from extremely positive to negative.

For many years, bipolar disorder was considered a disease of adults. But in the 1990s, researchers showed that bipolar disorder can manifest itself in childhood in a rare form known as pediatric bipolar disorder. According to the National Institute of Mental Health, this form of bipolar disorder is often more severe than the adult-onset form, and children with the disorder have more frequent mood swings and more mixed episodes. nine0003

Bipolar disorder with early onset is rare. It can begin as early as age 6, and many children with the condition are initially misdiagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or depression, depending on how their symptoms most commonly present.

Bipolar symptoms in children and adolescents

During the manic phase

The child exhibits hyperactive, overly happy, or incredibly stupid behavior that is unusual for the child's personality.
Speaks quickly or switches the subject in mid-sentence without noticing it.
Focuses on one object or action while completely disconnecting from everything that surrounds him.

Gets irritated when obstacles come up or they say "no".
Has a rich imagination, invents complex storylines.
Quickly angry and aggressive over minor slights.
Does not feel tired or need to sleep; expresses a lack of interest in napping, resting, or going to sleep at night; often gets up at night.
Shows preoccupation with sex or sexual thoughts; talks about sex at the wrong time.
Performs public, dangerous or inappropriate acts in response to sexual desires; masturbates excessively or engages in risky sex during adolescence. nine0032
Sees or hears things that are not there.

During the depressive phase

The child behaves unusually, cries and is sad.
Complains of frequent abdominal pain and headaches.
Sleeps longer than usual.
Eats too little or too much; can gain or lose weight very quickly.
Shows little interest in normal activities.
Says he's a bad kid, or wonders out loud if everyone hates him. nine0032
Preoccupied with thoughts of death, talks about suicide. Young children talk about how it would be better for everyone if they were "gone forever" or "never born".

Symptoms of pediatric bipolar disorder in school

Bipolar disorder sometimes looks a little different in school, where the child is around peers and adults with whom he is not related.

During the manic phase

The child sometimes seems to be very sociable: he easily makes new friends and fascinates adults by thinking beyond his years.
Behaves overbearingly with friends; gets frustrated over minor disagreements or when friends don't follow his orders.
Refuses to obey teachers and other authority figures; acts "out of control"; shows excessive hyperactivity.
Shows inappropriate behavior such as removing clothes in class or singing loudly during class. nine0032
Cannot sleep during naps or read quietly.
Unable to reorganize in a new way; shows frustration or riot at undesirable changes.
Cannot concentrate on schoolwork; often cannot sit still.
May fool around and then become angry or aggressive without provocation.
Performs dangerous and impulsive acts. For example, he can climb the highest tree or run away from lessons. nine0032

During the depressive phase

Child loses interest in friends or regular play; sits alone during recess instead of participating in the fun.
Demonstrates antisocial behavior or fear of classmates, such as suddenly clinging to a parent's leg when being forced out of a car.
Thinks no one likes him.
Often complains of pain and discomfort; often asks to be released to the nurse's office or to be picked up by his parents. nine0032
Obsessed with death, often talks about it to other students or the teacher.
Unable to concentrate on schoolwork; it seems that he is "out of his mind".

Most children with bipolar disorder experience alternating mania and depression much faster than adults. Also, in adults, cycles usually last for weeks, months, or even years; in a child, these symptoms can cycle several times a day.

What is the difference between childhood bipolar disorder and ADHD

Similarities

Attention deficit hyperactivity disorder and bipolar disorder have similar symptoms, including but not limited to impulsivity, irritability, and hyperactivity. ADHD and bipolar disorder usually occur together, but rates of comorbidity vary between studies. Therefore, careful differential diagnosis is crucial for treatment.

Differences

Symptoms of ADHD typically begin in early childhood, while bipolar disorder usually develops later in life. nine0032
ADHD is chronic and always present. Bipolar disorder presents with episodes that alternate with more or less normal mood levels.
Children with ADHD have strong emotional reactions to events or triggers in their lives. Happy events lead to a very happy, excited mood. Unhappy events—especially experiences of rejection, criticism, or ridicule—cause intensely sad feelings. In bipolar disorder, mood changes come and go without any connection to life events. nine0032
As a child progresses into school, increased academic demands may exacerbate ADHD symptoms, which should not be confused with the onset of bipolar disorder.
A child with ADHD may exhibit disinhibited behaviour. It should not be confused with high spirits, which can cause bipolar disorder.
Children with ADHD may be cranky at bedtime, while children with bipolar disorder (especially during manic episodes) do not really feel tired or need to sleep. nine0032
A family history of disorders is important in the diagnosis, as bipolar disorder has a clear genetic component. When one parent has bipolar disorder, the risk for each child is 15 to 30%.

Treatment of bipolar disorder in children and adolescents

The choice of treatment for bipolar disorder depends on the severity of the clinical picture. It can be urgent (to relieve acute symptoms), ongoing (to consolidate the therapeutic effect) and supportive (to stabilize the patient's condition). nine0003

Medication and psychotherapy are used in the treatment of bipolar disorder.

Drug treatment

Bipolar disorder is an incurable disease. But with the help of drugs, success can be achieved in eliminating acute symptoms.

Drug therapy in adolescents is similar to treatment for bipolar disorder in adults, but the young age of patients must be taken into account. It is strictly forbidden to prescribe medicines on your own. Only a doctor specializing in the treatment of mental disorders can pick them up. Depending on the progressive episode and age, the patient is prescribed different groups of drugs, such as antidepressants, tranquilizers, antipsychotics, mood stabilizers, anti-anxiety drugs. nine0003

Psychotherapy

Psychotherapy has developed special methods to cope with the symptoms of the disease, as well as prevent relapses:

Cognitive-behavioral psychotherapy, which is based on the relationship between the patient and his parents to correct the patient's condition.

Dialectical Behavior Therapy is a series of sessions to reduce anxiety, depression, and the incidence of suicidal thoughts. nine0003

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Did you know that bipolar affective disorder occurs in children?

Bipolar disorder | Symptoms, complications, diagnosis and treatment

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Episodes of mood swings may occur infrequently or several times a year. nine0003

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When the mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, alertness, judgment, behavior, and the ability to think clearly.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medication and psychological counseling (psychotherapy). nine0003

Symptoms

There are several types of bipolar and related disorders. These may include mania, hypomania, and depression. The symptoms can lead to unpredictable changes in mood and behavior, leading to significant stress and difficulty in life.

Bipolar I. You have had at least one manic episode, which may be preceded or accompanied by hypomanic or major depressive episodes. In some cases, mania can cause a break with reality (psychosis). nine0032
Bipolar disorder II. You have had at least one major depressive episode and at least one hypomanic episode, but never had a manic episode.
Cyclothymic disorder. You have had at least two years - or one year in children and adolescents - many periods of hypomanic symptoms and periods of depressive symptoms (though less severe than major depression).
Other types. nine0196 These include, for example, bipolar and related disorders caused by certain drugs or alcohol or due to health conditions such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II is not a milder form of Bipolar I but is a separate diagnosis. Although bipolar I manic episodes can be severe and dangerous, people with bipolar II can be depressed for longer periods of time, which can cause significant impairment. nine0003
Although bipolar disorder can occur at any age, it is usually diagnosed in adolescence or early twenties. Symptoms can vary from person to person, and symptoms can change over time.

Mania and hypomania

Mania and hypomania are two different types of episodes, but they share the same symptoms. Mania is more pronounced than hypomania and causes more noticeable problems at work, school, and social activities, as well as relationship difficulties. Mania can also cause a break with reality (psychosis) and require hospitalization. nine0003
Both a manic and a hypomanic episode include three or more of these symptoms:

Abnormally optimistic or nervous

Increased activity, energy or excitement

Exaggerated sense of well-being and self-confidence (euphoria)

Reduced need for sleep

Unusual talkativeness

Distractibility

Poor decision-making, such as speculation, sexual intercourse, or irrational investment

Major depressive episode

Major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in daily activities such as work, school, social activities, or relationships. An episode includes five or more of these symptoms:

Depressed mood, such as feeling sad, empty, hopeless, or tearful (in children and adolescents, depressed mood may present as irritability)

Marked loss of interest or feeling of displeasure in all (or nearly all) activities

Significant weight loss with no diet, weight gain, or decreased or increased appetite (in children, failure to gain weight as expected may be a sign of depression)

Either insomnia or sleeping too much

Either anxiety or slow behavior

Fatigue or loss of energy
nine0031 Feelings of worthlessness or excessive or inappropriate guilt
Decreased ability to think or concentrate, or indecisiveness

Thinking, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorder may include other signs such as anxiety disorder, melancholia, psychosis, or others.
Learn more

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