Diagnostic and therapeutic dilemmas in the management of pediatric-onset bipolar disorder.
Although the diagnosis of pediatric-onset bipolar disorder is controversial, an increasing literature of systematic research has challenged the traditional view that this disorder is a rare condition. This article summarizes research regarding the atypical presentation of pediatric bipolar disorder and its overlap with attention-deficit/hyperactivity disorder and other comorbid conditions, as well as family-genetic and treatment data. When structured interview data were examined, cases of pediatric mania constituted 16% of referrals to our outpatient clinic. Presentation is atypical by adult standards and includes irritability, chronicity, and mixed state. Family-genetic and treatment data help to establish diagnostic validity. Pediatric bipolar disorder is not a rare condition. Treatment requires a combined pharmacotherapy approach to address issues of comorbidity. Atypical antipsychotic medications have provided promising treatment results, but additional controlled clinical trials are needed.
Wozniak
J
J
Pediatric Psychopharmacology Unit of the Child Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. wozniak@helix.mgh.harvard.edu
Biederman
J
J
Richards
J A
JA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D002220:Carbamazepine / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D019955:Conduct Disorder / Q000175:diagnosis / Q000453:epidemiology; D005190:Family; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D016896:Treatment Outcome
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D002220:Carbamazepine