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Treatment of the bipolar adolescent is best accomplished by utilizing a team approach that includes the services of a mental health counselor and a board-certified child psychiatrist, If the mental health counselor is not experienced with bipolar disorder in adolescence, he or she may want to obtain supervision or consult with a clinician who specializes in child and adolescent treatment (Child and Adolescent Bipolar Foundation). Upon consultation, a psychiatrist may prescribe medications to treat the disorder. Many of the drugs have bothersome side effects initially, but subside once the adolescent becomes accustomed to the medications. However, some side effects may persist. Medications for bipolar children and adolescents have only recently begun to be used; thus there are few studies regarding their effectiveness. Psychiatrists are presently adapting their knowledge about treatment of adults to the pediatric and adolescent population. Currently, the U.S. Food and Drug Administration has not approved these drugs for the treatment of children (Waltz).
Unfortunately, medications do not cure the underlying disorder, but can contribute to improvements in behavior and emotional stability (Waltz). The most commonly prescribed medications for bipolar disorder are mood stabilizers, Included in this class are lithium, Depakote, Tegretol, Neurontin, Lamictal, Topomax, and Gabitril. All of these drugs, except lithium, are classed as anti-convulsants. In addition to the anticonvulsants, antipsychotic drugs may be prescribed during periods of intense mania. When severe depression is present, an antidepressant may be added, but only if a mood stabilizer has already been prescribed for at least one month (Waltz). Since antidepressants have the potential to evoke mania in bipolar adolescents, once the antidepressant is added, the adolescent needs to be monitored closely for symptoms of mania. If anxiety is present, an anti-anxiety medication may be an adjunct to the regimen. Choosing the most effective medication or combination of medications is often a trial-and-error process. Alternative forms of treatment include the use of electroconvulsive therapy, repeated transcranial magnetic stimulation, and omega-3 fatty acids (Papolos & Papolos).
The mental health counselor will recognize that psychotherapy is an indispensable ingredient of a comprehensive treatment plan, rather than being considered an alternative form of treatment. The mental health counselor’s major goals, when treating bipolar disorder, are to ameliorate symptoms, prevent relapses, reduce the long-term morbidity, and promote optimum growth and development. These goals can be achieved by combining medication with supportive psychotherapeutic intervention and attending to the needs of the family and client (Remschmidt). Therapy with a mental health counselor may include cognitive behavioral therapy, psychoeducation interpersonal therapy, and multifamily support groups.
Cognitive behavioral therapy would involve identifying irrational and distorted thought patterns and altering these patterns to more accurately reflect reality. This technique is typically more effective with the depressive aspect of bipolar disorder. Daily mood logs, listing evidence that dispels the distorted thoughts, and self-monitoring and self-thought redirection are activities that the adolescent could be taught to reduce depressive symptoms.
Mental health counselors can also use psychoeducation as a method by which the adolescent learns the symptoms of the disorder, signs of the alternating mood states, and other relevant information that may assist in preventing or reducing the frequency and severity of episodes. Psychoeducation can be especially useful for mania, facilitating early recognition of and intervention in an episode, thereby reducing or preventing a full blown manic episode. Mental health counselors can also use interpersonal therapy to address the enhancement of social skills, which provide adolescents additional means through which to relate effectively with others. These goals may be accomplished through role playing, modeling, and guided in vivo practice.
Through multi-family therapy, parents can learn to assist their adolescents by teaching them relaxation techniques, anger management, decision-making skills, good communication and listening skills, and by not allowing their adolescents to become victims of their illness. In addition, parents should attempt to involve their adolescents in activities that channel their creative gifts, and they should provide as much structure as possible to their adolescent’s world of often-chaotic mood swings. According to the Child and Adolescent Bipolar Foundation, if there are educational considerations because of the adolescent’s disorder or the side effects of the medications, parents must be willing to meet with school personnel to discuss options that will ensure that needs of the child are met. Mental health counselors may facilitate this process.
Mental health counselors who work with adolescents and parents need to be better educated about bipolar disorder, its symptoms, and the effects of not treating this disorder. Early recognition and treatment will benefit society by reductions in medical costs, decreased suicides among the bipolar population of adolescents, lower school dropout rates, less substance abuse, and lower crime rates. Like many serious disorders, bipolar disorder can negatively impact the lives of those affected and their families. Clients and families pay a high price when bipolar disorder is not recognized or treated. This disorder can lead to school failure, limited career options, dependence on public assistance, legal difficulties, and expensive hospitalizations as well as suicide. Many individuals have found creative avenues in which to channel their energies. Early recognition and diagnosis of bipolar disorder in children and adolescents can facilitate productive utilization of this energy (Waltz).
- Wilkinson, Greta Buyck, Priscilla Taylor PhD, and Jan R Holt EdD; Bipolar Disorder in Adolescence: Diagnosis and Treatment; Journal of Mental Health Counseling; Oct2002, Vol. 24 Issue 4, p348
Personal Reflection Exercise #5
The preceding section contained information about treating adolescents with bipolar disorder. Write three case study examples regarding how you might use the content of this section in your practice.