Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review.
BACKGROUND
Pediatric bipolar disorder (BPD) can be misdiagnosed as a depressive, attention, conduct, or anxiety disorder and treatment with antidepressants and stimulants is common. Risk of adverse outcomes related to such treatment remains poorly defined.


METHODS
We analyzed clinical records of 82 children (mean age 10.6 years) meeting modified DSM-IV diagnostic criteria for BPD to evaluate risk and timing of operationally-defined treatment-emergent mania (TEM) or increased mood-cycling following pharmacological treatment.


RESULTS
Of 82 juvenile BPD patients, 57 (69%) had been given a mood-elevating agent at least once; 33/57 (58%) so-exposed met criteria for TEM, with median latency of 14 days; TEM was observed twice as often with antidepressants as stimulants (44% vs. 18%). TEM led to first-recognition of BPD in 14 cases (17%), and some drug-exposed children (4-9%) had prominent suicidal, homicidal or psychotic behavior. In addition to recent exposure to a mood-elevating agent, TEM was associated with early-onset anxiety and female gender.


CONCLUSIONS
Findings are retrospective in clinically diagnosed and treated outpatients, but involved otherwise unselected cases of juvenile BPD.


CONCLUSIONS
TEM was reported in 58% of children with probable juvenile BPD within several weeks of new exposure to a mood-elevating agent.
Lucio Bini Mood Disorders Center, New York, NY 10022, USA. gianni.faedda@moodcenter.org <gianni.faedda@moodcenter.org>
Gianni L
GL
Faedda
Ross J
RJ
Baldessarini
Ira P
IP
Glovinsky
Nancy B
NB
Austin
D017668:Age of Onset; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology*; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors
D000928:Antidepressive Agents; D000697:Central Nervous System Stimulants