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Bipolare lidelser hos barn og ungdom

Sist revidert:
Sist revidert av:
Definisjon:
Bipolare lidelser er karakterisert ved alvorlige svingninger i energinivå og stemningsleie - maniske og ev. depressive episoder.
Forekomst:
En metaanalyse angir knapt 2% bipolart spektrum hos barn og tenåringer.
Symptomer:
Depresjonssymptomer er energitap, interessetap, tristhet og tretthet. Manisymptomer er eufori og ekstremt økt mengde energi, pratsomhet, ukritisk oppførsel og redusert søvnbehov.
Funn:
Angst, irritabilitet, konsentrasjonsvansker, søvnforstyrrelser og suicidalitet ses i alle faser.
Diagnostikk:
Bør henvises og utredes i samarbeid med barnepsykiater. Utelukk organisk årsak til symptomene. Det er som regel foreldre eller andre kontaktpersoner som reiser mistanken om diagnosen.
Behandling:
Medisinering, dagbokregistrering av symptomer, informasjon om sykdommen, samtaletilbud ved behov, minst mulig stress, sunn livsførsel med nok søvn, stor forsiktighet med alkohol. Somatiske lidelser er viktigste årsak til redusert levealder og bør få ekstra oppmerksomhet. God oppfølging forutsetter et velfungerende samarbeid mellom primærlege/barnepsykiater.
  1. Udal AH, Grøholt B. Bipolare lidelser hos barn og ungdom. Tidsskr Nor Lægeforen 2006; 126: 302-4. PubMed  
  2. Birmaher B. Bipolar disorder in children and adolescents: Assessment and diagnosis. UpToDate, last updated Dec 13, 2021. www.uptodate.com  
  3. Grøholt B, Sund AM. Bipolare lidelser. Veileder i barne- og ungdomspsykiatri. 2019. www.legeforeningen.no  
  4. Van Meter AR, Moreira AL, Youngstrom EA. Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry 2011 Sep;72(9):1250-6. . doi:10.4088/JCP.10m06290 DOI  
  5. Birmaher B, Hafeman D, Merranko J, et al. Role of Polygenic Risk Score in the Familial Transmission of Bipolar Disorder in Youth published correction appears in JAMA Psychiatry. 2022 Jun 1;79(6):632. JAMA Psychiatry. 2022;79(2):160-168. PubMed  
  6. Torres I, Garriga M, Sole B, et al. Functional impairment in adult bipolar disorder with ADHD. J Affect Disord. 2018;227:117-125. PubMed  
  7. Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170. PubMed  
  8. Soni A, Singh P, Kumar S, et al. Role of age at onset in the clinical presentation of bipolar disorder in Indian population. Ind Psychiatry J. 2021 Jan-Jun;30(1):41-46. PMID: 34483523 PubMed  
  9. Weinstein SM, Cruz RA, Isaia AR, Peters AT, West AE. Child- and Family-Focused Cognitive Behavioral Therapy for Pediatric Bipolar Disorder: Applications for Suicide Prevention. Suicide Life Threat Behav. 2018;48(6):797-811. PubMed  
  10. Manu P, Asif M, Khan S, et al. Risk factors for medical deterioration of psychiatric inpatients: opportunities for early recognition and prevention. Compr Psychiatry 2012; 53: 968-74. pmid:22520089 PubMed  
  11. Altinoz MA, Ince B. Hemoglobins emerging roles in mental disorders. Metabolical, genetical and immunological aspects. Int J Dev Neurosci 2017; 61: 73-85. pmid:28694195 PubMed  
  12. Cossu G, Carta MG, Contu F, et al. Coeliac disease and psychiatric comorbidity: epidemiology, pathophysiological mechanisms, quality-of-life, and gluten-free diet effects. Int Rev Psychiatry 2017; 29: 489-503. pmid:28681625 PubMed  
  13. Glaus J, von Känel R, Lasserre AM, et al. Mood disorders and circulating levels of inflammatory markers in a longitudinal population-based study. Psychol Med 2018; 48: 961-73. pmid:28929992 PubMed  
  14. Malee K, Williams P, Montepiedra G, et al. Medication adherence in children and adolescents with HIV infection: associations with behavioral impairment. AIDS Patient Care STDS 2011; 25: 191-200. pmid:21323533 PubMed  
  15. Wilczyńska K, Simonienko K, Konarzewska B, et al. Morphological changes of the brain in mood disorders. Psychiatr Pol 2018; 52: 797-805. pmid:30584814 PubMed  
  16. Mesman E. Editorial: The Early Phenotype of Bipolar Disorder?. J Am Acad Child Adolesc Psychiatry. 2021;60(11):1351-1352. PubMed  
  17. Duffy A. The early course of bipolar disorder in youth at familial risk. J Can Acad Child Adolesc Psychiatry. Aug 2009; 18(3): 200–205. . pmid:PMC2732725
  18. Hillegers MH, Reichart CG, Wals M, Verhulst FC, Ormel J, Nolen WA. Five-year prospective outcome of psychopathology in the adolescent offspring of bipolar parents. Bipolar Disord 2005 Aug;7(4):344-50. PubMed  
  19. Geller B, Zimerman B, Williams M et al. Bipolar disorder at prospective follow-up of adults who had prepubertal major depressive disorder. Am J Psychiatry 2001; 158: 125-7. American Journal of Psychiatry  
  20. Birmaher et al. Lifetime psychiatric disorders in school-aged offspring of parents with bipolar disorder. Arch Gen Psychiatry 2009. Arch Gen Psychiatry. Mar 2009; 66(3): 287–296.
  21. Zaravinos-Tsakos F, Kolaitis G. Disentangling pediatric bipolar disorder and attention deficit-hyperactivity disorder: A neuropsychological approach. Psychiatriki. 2020;31(4):332-340. PubMed  
  22. Björk Brämberg E, Torgerson J, Norman Kjellström A, et al. Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care. BMC Fam Pract 2018; 19: 12. pmid:29316894 PubMed  
  23. Simoons M, Mulder H, Doornbos B, et al. Metabolic Syndrome at an Outpatient Clinic for Bipolar Disorders: A Case for Systematic Somatic Monitoring. Psychiatr Serv 2019; 70: 143-6. pmid:30526344 PubMed  
  24. Edgcomb JB, Kerner B. Predictors and outcomes of somatization in bipolar I disorder: A latent class mixture modeling approach. J Affect Disord 2017; 227: 681-7. pmid:29174742 PubMed  
  25. Platzer M, Fellendorf FT, Bengesser SA, et al. Adiponectin is decreased in bipolar depression. World J Biol Psychiatry 2018; 20: 1-8. pmid:30047831 PubMed  
  26. Jaworska-Andryszewska P, Rybakowski JK. Childhood trauma in mood disorders: Neurobiological mechanisms and implications for treatment. Pharmacol Rep 2019; 71: 112-20. pmid:30544098 PubMed  
  27. Volk HE, Todd RD. Does the child behavior checklist juvenile bipolar disorder phenotype identify bipolar disorder? Biol Psychiatry 2007; 62:115-120. PubMed  
  28. Lambert M, Ruppelt F, Siem AK, et al. Comorbidity of chronic somatic diseases in patients with psychotic disorders and their influence on 4-year outcomes of integrated care treatment (ACCESS II study).. Schizophr Res 2018; 193: 377-83. pmid:28778554 PubMed  
  29. Axelson D. Pediatric bipolar disorder: Overview of choosing treatment. UpToDate, last updated Aug 30, 2022. www.uptodate.com  
  30. McClellan J, Kowatch R, Findling RL. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:107-125. PubMed  
  31. Simoons M, Mulder H,4, Doornbos B, et al. Monitoring of somatic parameters at outpatient departments for mood and anxiety disorders. PLoS One 2018; 13: e0200520. pmid:30130372 PubMed  
  • Ole Rikard Haavet, professor, Avd. for allmennmedisin UiO (2019) og fastlege ved Lillestrøm Legesenter
  • Terje Johannessen, professor i allmennmedisin, Trondheim