title: Rapid, continuous cycling and psychiatric co-morbidity in pediatric bipolar I disorder.
abstract: OBJECTIVE
  The primary purpose of this study was to describe the clinical presentation of bipolar I disorder (BP-I) as it occurs in children and adolescents and to assess whether the manifestations of BP-I were similar in both age groups.
  
  
  METHODS
  Ninety youths between the ages of 5 and 17 years meeting full diagnostic symptom criteria for BP-I were included in this study. The diagnosis of BP-I was established for these youths based on the results of a semi-structured diagnostic interview and a clinical assessment by a child and adolescent psychiatrist. The course of a subset of these youngsters' illnesses was assessed using the Life Charting Method (LCM). Data regarding the clinical presentation, longitudinal history, psychiatric co-morbidities and parental psychopathology were also obtained.
  
  
  RESULTS
  The clinical presentation of BP-I was similar in children and adolescents. Youths meeting diagnostic criteria for BP-I developed an average of approximately 5.8 of the 7 symptoms of mania during periods of elevated or irritable mood. BP-I was found to be a cyclic disorder characterized by high rates of rapid cycling (50%) with almost no inter-episode recovery. Almost 75% of these subjects also met diagnostic symptom criteria for a disruptive behavior disorder. High rates of mood disorders were found in fathers.
  
  
  CONCLUSIONS
  These data suggest that the presentation of juvenile BP-I is a cyclic and valid clinical condition with manifestations on a continuum with the later-onset forms of this illness.
authors.affiliation: Department of Psychiatry, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, OH 44106-5080, USA. robert.findling@uhhs.com
authors.forename: R L
authors.initials: RL
authors.lastname: Findling
authors.forename: B L
authors.initials: BL
authors.lastname: Gracious
authors.forename: N K
authors.initials: NK
authors.lastname: McNamara
authors.forename: E A
authors.initials: EA
authors.lastname: Youngstrom
authors.forename: C A
authors.initials: CA
authors.lastname: Demeter
authors.forename: L A
authors.initials: LA
authors.lastname: Branicky
authors.forename: J R
authors.initials: JR
authors.lastname: Calabrese
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology*; D010507:Periodicity; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index