In adolescents, bipolar disorder may resemble any of the following classical adult presentations of the illness, as indicated in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV):
- Bipolar I. In this form of the disorder, the adolescent experiences alternating episodes of intense and sometimes psychotic mania and depression.
Symptoms of mania include:
- elevated, expansive or irritable mood
- decreased need for sleep
- racing speech and pressure to keep talking
- grandiose delusions
- excessive involvement in pleasurable but risky activities
- increased physical and mental activity
- poor judgment
- in severe cases, hallucinations
Symptoms of depression include:
- pervasive sadness and crying spells
- sleeping too much or inability to sleep
- agitation and irritability
- withdrawal from activities formerly enjoyed
- drop in grades and inability to concentrate
- thoughts of death and suicide
- low energy
- significant change in appetite
Periods of relative or complete wellness occur between the episodes.
- Bipolar II. In this form of the disorder, the adolescent experiences episodes of hypomania between recurrent periods of depression. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy. Hypomania can be a time of great creativity.
- Cyclothymia. Adolescents with this form of the disorder experience periods of less severe, but definite, mood swings.
- Bipolar Disorder NOS (Not Otherwise Specified). Doctors make this diagnosis when it is not clear which type of bipolar disorder is emerging.