title: DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls.
abstract: OBJECTIVE
  To compare the prevalence of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP) to those with attention deficit hyperactivity disorder (ADHD) and normal community controls (CC).
  
  
  METHODS
  To optimize generalizeability, subjects with PEA-BP and ADHD were consecutively ascertained from outpatient pediatric and psychiatric sites, and CC subjects were obtained from a random survey. All 268 subjects (93 with PEA-BP, 81 with ADHD, and 94 CC) received comprehensive, blind, baseline research assessments of mothers about their children and of children about themselves. PEA-BP was defined by DSM-IV mania with elation and/or grandiosity as one criterion to ensure that subjects had one of the two cardinal symptoms of mania and to avoid diagnosing mania only by criteria that overlapped with those for ADHD.
  
  
  RESULTS
  Five symptoms (i.e., elation, grandiosity, flight of ideas/racing thoughts, decreased need for sleep, and hypersexuality) provided the best discrimination of PEA-BP subjects from ADHD and CC controls. These five symptoms are also mania-specific in DSM-IV (i.e., they do not overlap with DSM-IV symptoms for ADHD). Irritability, hyperactivity, accelerated speech, and distractibility were very frequent in both PEA-BP and ADHD groups and therefore were not useful for differential diagnosis. Concurrent elation and irritability occurred in 87.1% of subjects with PEA-BP. Data on suicidality, psychosis, mixed mania, and continuous rapid cycling were also provided.
  
  
  CONCLUSIONS
  Unlike late teenage/adult onset bipolar disorder, even subjects with PEA-BP selected for DSM-IV mania with cardinal symptoms have high rates of comorbid DSM-IV ADHD. High rates of concurrent elation and irritability were similar to those in adult mania.
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri 63110, USA. gellerb@medicine.wustl.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Geller
authors.forename: Betsy
authors.initials: B
authors.lastname: Zimerman
authors.forename: Marlene
authors.initials: M
authors.lastname: Williams
authors.forename: Melissa P
authors.initials: MP
authors.lastname: Delbello
authors.forename: Kristine
authors.initials: K
authors.lastname: Bolhofner
authors.forename: James L
authors.initials: JL
authors.lastname: Craney
authors.forename: Jeanne
authors.initials: J
authors.lastname: Frazier
authors.forename: Linda
authors.initials: L
authors.lastname: Beringer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Nickelsburg
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification* / Q000150:complications / Q000235:genetics*; D001714:Bipolar Disorder / Q000145:classification* / Q000150:complications / Q000235:genetics*; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006970:Disorders of Excessive Somnolence / Q000145:classification / Q000209:etiology / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000209:etiology / Q000235:genetics; D019964:Mood Disorders / Q000145:classification / Q000209:etiology / Q000235:genetics; D010641:Phenotype; D012016:Reference Values; D019529:Sexuality / Q000145:classification