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Parents are often exasperated by their moody teenagers. After all, teens are known to be irritable, to sleep a lot and to resist authority figures. So how can a concerned parent determine when a teenager is just being a typical teen and when their child has a mental illness such as bipolar disorder?

Bipolar teenagers can have dramatic mood changes within a single day and may have different symptoms than adults. Below, Dr. Barbara Geller, a professor of psychiatry at Washington University in St. Louis, discusses how to recognize and treat bipolar disorder in adolescents.

What is bipolar disorder?
The specific definition for bipolar disorder includes certain symptoms that patients must have to make a diagnosis. Bipolar people have to experience both depressed and manic episodes. For example, to fit the depressed part, a teen would need to be sad, to lose enjoyment in usual activities, to have trouble sleeping and eating, to be guilt-ridden or suicidal. To fit the manic part, they'd have to have elation: a mood of being happy as if the most wonderful thing in your life is happening except it's on a day that's like any other day. Parents will often see their child get suddenly silly, giddy, joking without an apparent reason.

How can parents distinguish between a moody teenager and a mood disorder?
It's extremely important for parents to get a professional evaluation if they have any suspicion. If it is not evaluated, and you let it go on, it can devastate a child's life. The consequences for a lack of treatment can be great: suspensions from school, sexually transmitted diseases, depression and even suicide. So it's very important, especially in families with a history of bipolar disorder or depression, for parents to seek professional help at the first sign of any suspicion.

When does bipolar disorder usually first appear?
It's really only been in the last decade that people have started to pay attention to bipolar disorder in young children and early adolescents. So many adults looking back realize that they had the illness, but it may not have been recognized at that time. It's estimated from current studies that maybe as many as half of adults who have bipolar disorder had it before they were 17 years old.

How is the bipolar disorder different in younger children?
In adults, what people are used to thinking is that there will be a discrete episode with a clear onset and a clear offset. You generally have mostly a high or a low, and people function somewhat better between episodes.

What is seen in the younger population is they have continuous illness, but on a daily basis, they can be both high and low. So they may spend four hours of the day high and giddy and silly, and it's very infectious and amusing. However, in the next four hours they are morose, gloomy, not wanting to be with friends and thinking of hurting themselves. There may be these very rapid cycles shifting from extreme high to extreme low on a daily basis, day in and day out, year after year.

And in children, the highs manifests a little differently than adults. So what doctors are looking for in children is being super happy, as if it were Christmas morning, and then being severely depressed, as if someone had died, except it's the average day in school.

What are some of the risk factors for bipolar disorder?
The biggest factor is genetic. Bipolar symptoms also can occur with use of certain prescription medications such as steroids, with some illicit drugs such as cocaine and with various neurological issues such as stroke, tumors and trauma.

What are some of the warning signs in teenagers?
What families may notice is an exaggeration of all the stereotypes of what people say teenagers do. So many people think of teenagers as being irresponsible and being irritable, but the child with bipolar disorder may suddenly decide, "I'm not going to school. They're not teaching me anything. I'm going to be President of the United States anyway, why do I have to go to school?" They have very grandiose behaviors that are out of keeping with reality.

They can also get very hypersexual. Many people think of adolescents getting very interested in the opposite sex, but bipolar adolescents will feel an urgent need to have multiple partners. They'll also begin using very sexual language in inappropriate places and times.

Are teenagers with bipolar disorder more likely to have drug and alcohol problems?

There is a very high rate among people with bipolar disorder of using alcohol and drugs across the age span.

What treatment is recommended to teenagers with bipolar disorder?
There are three classes of medication that are used for bipolar illness across the age span. The antimania drug lithium is the mainstay. Lithium is especially good if other family members with a bipolar disorder has responded to that treatment. The second class of drugs is called anticonvulsants because they were originally developed to treat epilepsy. And the third class of drugs is called neuroleptics.

It's very important to learn as much as possible so the entire family can adapt and take part of the child’s treatment. It is also very important to notify your teenager’s school and teachers so a positive learning environment can be created while they are getting treatment.

How well does medication control the disease?
Some kids do very well and become indistinguishable from other children as long as they take their medication regularly. The medication essentially has to be taken indefinitely, as it is in adults. Most who take it regularly will have fewer hospitalizations and suicide attempts. Most likely they will be able to hold jobs better and have more stable personal relationships. For others, bipolar disorder is very difficult to treat, and it can be months of trying to find the right combination of treatments.

Are there strategies for helping teenagers stay on their medication?
Strategies have really not been formally researched and developed. This is a very important area for future research. One thing that doctors find very helpful to do with adolescents is to grieve with them. The way parents have to mourn the loss of a child who's well, the children themselves have to mourn the loss of their former well self.

But grief hurts a millimeter less every day, so doctors usually can tell them that 6 months from now, it'll be more automatic just to take the medication and go about your other business.