Bipolar Disorder Health Center

Key points

The more you know about bipolar disorder, the better you will be able to help your child or teen cope with this serious mental health problem. There are many steps your child can take to help avoid manic episodes and to recognize and deal with an episode when symptoms begin. Your child or teen should:

• Exercise, eat a balanced diet, get a good night's sleep, and keep a consistent schedule to reduce minor mood swings that often lead to more severe episodes of mania.
• Take medicines according to the doctor's instructions to help reduce the number of manic episodes.
• Avoid triggers such as caffeine, alcohol and drug use, and stress to help prevent manic episodes.
• Learn the warning signs and seek early treatment to avoid more severe, prolonged manic episodes.
• Have a plan of action in place and a support system to help follow the plan when symptoms of a manic episode start.
• Have certain people at school or at home who know how to help during a manic episode.

Your child with bipolar disorder may have unique manic behaviors that are identifiable. Family and friends can help to identify manic behaviors, especially if they know ahead of time what to watch for. General behaviors linked with a manic episode include:

• Abnormal happiness (euphoria).
• Extreme irritability or silliness.
• Long-lasting or intense outbursts or tantrums.
• Unrealistic feelings of self-importance (delusions of grandeur).
• Intense energy levels maintained for a long period of time.
• A decreased need for sleep.
• Increased talkativeness that is hard to interrupt.
• Racing thoughts and distractibility-attention constantly moving from one thing to the next.
• An intense focus on sexual thoughts, feelings, or behaviors (hypersexuality); use of explicit sexual language.
• An intense focus on reaching a goal.
• Dangerous or reckless behavior. For example, a young child may think he or she can fly and jump off a roof. A teen may drive too fast, spend money unwisely, or have unprotected sex.
• Extreme behavior that causes problems on the job, at school, in social situations, or at home.
• Symptoms of psychosis (detachment from reality), such as hearing voices or being paranoid.

Controlling a manic episode from its beginning stages can help your child avoid going into an episode of full-blown mania. Your child may be able to avoid destructive behaviors linked with mania if the manic episode is recognized and treated right away.

The best way to manage a manic episode is to help your child avoid triggers that can cause mood swings and conditions that might make manic feelings more intense. Some simple lifestyle adjustments can help. Work with your child to:

• Maintain a stable sleep pattern. Your child should go to bed around the same time each night and awaken around the same time each morning. Changing sleep patterns can cause chemical changes in the body that trigger mood episodes.
• Maintain a regular daily routine. Your child should follow a routine of trying to do the same things every day at about the same times.
• Set realistic goals. Setting high goals and focusing too hard on achieving them can trigger a manic episode.
• Avoid alcohol and illegal drugs. It may be tempting for your child to use alcohol or drugs to help get through a manic episode. But this will make the mood changes worse. Even small amounts can interfere with sleep, mood, or medicines used to treat bipolar disorder. Nonprescription medicines for a cold, allergies, or pain can also trigger a change in mood.
• Get help from family and friends. Your child will sometimes need help getting through a manic episode, especially if he or she loses touch with reality. Having a plan in place before any mood changes occur will assist family members and friends in getting the needed help. Remember, though, that these mood changes can sometimes be upsetting to loved ones and that these people may also need to seek support.
• Reduce stress at home and at school or work. Your child should try to keep regular hours at school and at work. Doing a good job is important, but avoiding a depressive or manic mood episode is more important. Communicate with your child's teachers and guidance counselor about your child's needs. Academic adjustments or a plan such as an individualized education program (IEP) may be helpful.
• Learn to recognize the early warning signs of a new manic episode. This is one of the most important ways to avoid a full-blown manic episode. If you catch the episode in its early stages, your child may be able to avoid an intense manic episode by avoiding triggers that are causing the new mood change. You may want to keep a chart to record your child's mood changes and the activities that may trigger those changes.
• Continue treatment. It may be tempting for your child to stop treatment because he or she feels better or enjoys the euphoric feeling of a manic episode. But it is very important to continue treatment as prescribed to avoid the unpleasant consequences linked with mania. If you have concerns about treatment or the side effects of your child's medicines, talk with your doctor. Do not adjust the medicine on your own.

Now that you know the importance of having a solid plan in place to prevent and manage your child's manic episodes, you are ready to take the following steps:

• Establish daily routines and healthy lifestyle choices that help prevent manic episodes.
• Learn how to identify a developing manic episode and how to eliminate or reduce the factors that may be triggering it or making it worse. Recording mood changes and possible triggers in a calendar or notebook can be helpful in identifying patterns.
• Develop a support network of adults who know how to help your child during a manic episode.
• Make sure your child continues to follow his or her treatment program, such as taking medicines exactly as prescribed and attending counseling sessions.
• Communicate with your doctor about how to prevent manic episodes and how to cope with them when they occur.