Children generally tend to exhibit mixed states, with short periods of strong lability of mood and irritability . This causes diagnostic difficulties and creates situations of underdiagnosis. In adolescents, the clinical presentation is very similar to that of adults: elated mood or irritability, pressured speech, excessive sexuality, delusions of grandeur and lack of sleep.
A psychotic profile can accompany depression or mania, and this is an indication of seriousness and a risk factor for recurrence.
Epidemiological studies show that children and adolescents suffering from bipolar disorder almost always develop additional disorders . These generally include CD, ODD and ADHD, as well as substance abuse and anxiety disorders. Several researchers are convinced that bipolar disorder appearing at a young age represents a more difficult and persistent form of the illness . Suicidal ideation and attempts are at least as frequent in bipolar adolescents as in adults.
A striking characteristic is the familial connection between ADHD, bipolar disorder and behavioural disorders, and the branching out at later stages of one diagnosis (bipolar disorder) from the earlier diagnoses (ADHD or behavioural disorder). This indicates the importance of bipolar disorder in relation to the "difficult" child, who is generally diagnosed initially as suffering from ADHD or behavioural disorder or from a combination of the two.
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