title: Preschool-onset mania: incidence, phenomenology and family history.
abstract: OBJECTIVE
  To ascertain the incidence of mania among preschool children presenting in a community mental health clinic over a 24-month period, to describe the signs and symptoms of the children meeting criteria for mania and present their family histories based on systematic diagnostic interview.
  
  
  METHODS
  Forty children less than the age of 5 years presented between October 2001 and September 2003. Signs of mania were determined using a structured interview. Family history was determined via live, structured interview of parents. Those meeting the criteria for major depressive disorder (MDD) or bipolar disorder (BP) were classified as having mood disorder.
  
  
  RESULTS
  Eleven of the 40 children (27.5%) met the criteria for mania, of which only 3 (27.3%) were mixed manic. Symptoms often included "classic" mania features (i.e. euphoric, elated mood), despite co-existing features of attention-deficit hyperactivity disorder (ADHD)--such as incessant, chaotic, even frenetic motor activation--in all of them. Seven of the 11 (63.6%) had at least one parent with BP and a total of 8 (72.7%) had a parental history of affective illness when parents with MDD were counted. One child without a first-degree relative with BP had a second degree relative with this illness. Thus, 8 of 11 (72.7%) had a relative with BP, and 9 (81.8%) a family history of mood disorder (counting both MDD and BP).
  
  
  CONCLUSIONS
  Open case series.
  
  
  CONCLUSIONS
  There was a surprisingly high incidence of mania with classical features in this population. The family history data strongly support the view that these children have BP. Preschool mania appears to be strongly linked to the presence of familial affective illness. Admittedly, preschool mania is a controversial topic, and data from other centers is needed to further characterize its clinical and familial features.
authors.affiliation: Mental Health Mental Retardation Clinic, Rio Grande City, TX, USA. StevenDilsaver@aol.com
authors.forename: Steven C
authors.initials: SC
authors.lastname: Dilsaver
authors.forename: Hagop S
authors.initials: HS
authors.lastname: Akiskal
mesh_terms: D000339:Affect; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000235:genetics* / Q000523:psychology; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D008297:Male; D019964:Mood Disorders / Q000235:genetics; D010375:Pedigree; D012189:Retrospective Studies