INTRODUCTION The purpose of this paper is to discuss bipolar disorders in adolescents. This paper will include a discussion on what bipolar disorders are. There will be a presentation of the causes and symptoms of bipolar disorders. There will be a discussion of the medical as well as the therapeutic interventions and this paper will also include the importance of treatment. WHAT ARE BIPOLAR DISORDERS? Bipolar disorder is a disease that affects one in every five Americans.

Bipolar disorders often called Manic Depression, involve the appearance of two extreme emotional states. Adolescents that suffer from bipolar disorders alternate between manic and depressive episodes. Bipolar disorders are not just mental illnesses; bipolar disorders are medical diseases involving the brain. According to Waltz (2000), the exact causes of bipolar disorders are not yet known, even though bipolar disorders are treatable.

Evidence indicates that the genes for bipolar disorders can be inherited, however not everyone who carries the genes develop the disorder. Many adolescents experience the occasional mood swing. In these cases, even though an occasional mood swing is an unexplained one, adolescents with bipolar disorders experience different kinds of mood swings. Adolescents that suffer bipolar disorders lower and keep dropping until life doesn't feel worth living (Burns, 1999). On the other hand, the mood swings can swing so high that they start to behave out of the "norm", seem to lose touch with reality, and they can't function correctly. Waltz (2000), indicates that when these symptoms occur 2 during the important years of adolescents, they can be devastating and disrupting to normal development.

WHAT ARE THE CAUSES OF BIPOLAR DISORDERS? It is clear that in our society many people live with bipolar disorder; however, despite the abundance of adolescents suffering from it, definite explanations are still waiting to be found for the causes and cure. As explained earlier, the causes of bipolar disorders are not known but it is believed that it is caused by differences in the brain, genetic differences, neurotransmitters, and circadian rhythms (Acocella, Alloy, Bootzin, 1993). Genetic Differences The genes that a person inherits seem to have a strong influence on whether the person will develop bipolar disorder (Barondes, 1998). Studies of twins provide evidence for this genetic influence. Among genetically identical twins where one twin has bipolar disorder, the other in more than 70 percent of cases. Among pairs of fraternal twins, who have about half their genes in common, both twins have bipolar disorder in less than fifteen percent cases in which one twin has the disorder.

Waltz (2000), states that the degree of genetic influence comes from studies of adopted children with bipolar disorder. These studies show that biological relatives have a higher incidence of bipolar disorder than do people in the general population. Personal or work related stress can trigger a manic episode, but this usually occurs in people with a genetic vulnerability (Burns, 1999). Other factors such as childhood experiences and social conditions seem to have relatively little influence in causing bipolar disorder. One study examined a pair of twins 3 in which only one member of the pair had bipolar disorder. The study found that regardless of whether the parent had bipolar disorder or not, the twins had the same high ten percent rate of bipolar disorder.

This observation suggests that risk for bipolar illness comes from genetic influence, not from exposure to a parent's bipolar illness or from family problems caused by that illness. Brain Differences According to Waltz (2000), a deletion on chromosome 22 is probably at least part of the problem, likely leading to structural differences in the developing brain. The brain is the most complex and least understood organ in the body. It is the focal point of the central nervous system, which also includes the nerves of the spine. The central nervous system receives, processes, and sends billions of signals every day. The nervous system takes information from all of our senses and reacts to them in such a way that it controls every bodily activity, from basic breathing to circulation and so on.

A single mishap in one of these events can lead to a neurological event such as a memory lapse, a seizure, or a manic episode. If this occurs a lot, the person then has a neurological disease. The disease is not a result of a weak personality, as many people believe. Instead, it is a medical condition where there is instability in the transmission of nerve impulses of the brain (neurotransmitters) that signal appropriate moods.

Neurotransmitters Neurons are the brain's communication systems. Neurons have a central cell body with long arms called axons and small tentacle-like structures called dendrites (Bernstein, 4 Nash, 2002). Inside the neurons all messages are sent through electrical impulses. There are many different neurotransmitters and hormones running in the human brain (Waltz, 2000). There are several neurotransmitters that appear to be involved in bipolar disorders such as (a) serotonin; (b) dopamine; and (c) norepinephrine. Serotonin controls sleep, mood, body temperature, some types sensory perception, and appetite.

Dopamine helps controls body movement and thought patterns. Norepinephrine is used by the central nervous system and controls responses, anxiety, and memory. Circadian Rhythms Burns (1999), states that the nervous systems of adolescents with bipolar disorders frequently make specific types of regulatory errors. Many of them involve the body's internal clock, which controls the phenomena known as circadian rhythms.

These rhythms are changes in waking and sleeping and sensations of hunger or thirst. According to Waltz (2000), with each regulatory error, the person's symptoms become more noticeable and more serious. Eventually this can lead to extreme mood swings, extreme depression, mania or other abnormal states of mind. The affected person may have noticeable errors in thinking. The person may have a very disordered condition in their nervous system and this may show a great deal outwardly. Symptoms Bipolar disorder usually begins in a person's adolescent stage (Waltz, 2000).

According to Barondes (1998), Men usually experience mania as the first mood episode. On the other hand, women may experience depression first. These episodes may last from several weeks to several months. Burns, (1999) stresses the fact that many 5 adolescents with bipolar disorders function normally between the episodes of depression and mania.

However, five to fifteen percent of all cases, a person experiences four or more mood episodes within a year and may have little or no normal functioning in between episodes. In rare cases, according to Waltz (2000), mood swings between mania and depression occur over a period of days. Adolescents in the depressive phase of bipolar disorder may feel intensely sad or profoundly indifferent to work, activities, and people that once brought them pleasure (Waltz, 2000). In addition, they may think slowly, concentrate poorly, feel tired, and experience changes in their sleep and appetite. They often feel a sense of worthlessness or helplessness. They feel pessimistic or hopeless about the future and may think about or attempt suicide.

In some cases of severe depression, adolescents may experience symptoms such as delusions or hallucinations (Burns, 1999). According to Barondes (1998), in the manic phase of bipolar disorder, adolescents feel intensely and inappropriately happy, self important, and irritable. In this highly energized state they sleep less, have racing thoughts, talk rapidly, and may have delusions of grandeur. Waltz (2000), indicates that mania may make people impatient and abrasive, and when frustrated, physically abusive. They often behave in socially inappropriate ways, think irrationally, and show impaired judgment. INTERVENTIONS Medical There is a wide range of medications available to treat bipolar disorders, and they work with varying degrees of effectiveness in adolescents (Waltz, 2000).

Most commonly used, lithium carbonate, a natural mineral salt, can help control both mania 6 and depression in bipolar disorder (Acocella, Alloy, Bootzin, 1993). The drug takes two to three weeks to become effective. Adolescents with bipolar disorder may take lithium during periods of relatively normal mood to delay or prevent episode of mania or depression. Common side effects of lithium include nausea, increased thirst and urination, vertigo, loss of appetite, and muscle weakness (Waltz, 2000).

If used for a long time, lithium can impair the functioning of the kidneys. Acocella, Alloy, Bootzin, (1993), indicates that from 20 to 40 percent of adolescents do not respond to lithium therapy. Doctors may prescribe carbamazepine and valproate and do not use antidepressants to treat bipolar disorders because it carries the risk of triggering a manic episode (Acocella, Alloy, Bootzin, 1993). Therapeutic Medication alone can help to reduce the symptoms of bipolar disorders, but it can't cure the illness entirely. It can't help a teenager cope with the stress, alienation, and the symptoms that remain. That's where therapy comes in.

Therapy is not a cure, but being that it explores one's feelings, motivations, strategies for change, and personal goals, it can contribute to adolescent's functioning and happiness. In adolescents, a therapy session may include discussing the nature of her illness and how it can be treated, identifying personal mood swing triggers, identifying ways to prevent or shorten mood swings, coping with problem symptoms and medication side effects, improving behavior at home, school, or the community, obtaining support for making positive lifestyle changes, and developing personal strengths, resiliency, and self esteem (Waltz, 2000). Therapy cannot produce dramatic changes in an adolescent with bipolar disorder unless 7 their troubles and symptoms are starting to decrease. A person who is actively psychotic, extremely manic, or depressed to the point of needing hospitalization usually cannot benefit from therapy.

Once there is a medical intervention, there are more chances of a positive therapeutic intervention. IMPORTANCE OF TREATMENT Bipolar disorders, is a very serious disorder. If this disease is left untreated, bipolar disorders can plunge an adolescent into absolute hell. Waltz (2000), indicates that without proper treatment, a teenager can be dealing with antisocial, and borderline personality disorders. The families of bipolar teens pay greatly if this disorder isn't recognized and treated. Suicide is a common outcome, school failures, and expensive hospitalizations.

SUMMARY In summary, the purpose of this paper was to discuss bipolar disorders in adolescents. The discussion included the causes and symptoms of the disorder. Medical as well as the therapeutic interventions and the importance of treatment were also discussed. In it is this writer's opinion that bipolar disorders are serious medical problems. In the result of this writer's research, medical and therapeutic interventions are key in treating adolescents with bipolar disorder..