Clinical characteristics of bipolar disorder in very young children.
BACKGROUND
Clinical information about bipolar disorder (BPD) in preschool-age (3-7 years old) children is extremely limited. This study examined clinical presentations, applicability of the DSM-IV diagnostic criteria, comorbidity, recovery and relapse rates, as well as some treatment strategies used in the management of BPD in preschoolers.


METHODS
The charts of 26 outpatient children, ages 3-7, refereed to a child psychiatry outpatient clinic with mood and behavioral symptoms, were retrospectively reviewed.


RESULTS
The majority of the patients were referred with the tentative diagnosis of ADHD but the most common diagnoses made by child and adolescent psychiatrists at the time of initial evaluation were BPD NOS (61.5%), followed by BPD I (26.9%), and mood disorder NOS (23.1%). Thirty-eight percent of the patients had one or more comorbid diagnoses. The most common presenting symptoms were irritability (84.6%) and aggression (88.5%). The most widely prescribed class of medications after diagnosis in the clinic was atypical antipsychotics and mood stabilizers. Twenty-six percent of the patients were treated with a combination of atypical antipsychotics and mood stabilizers.


CONCLUSIONS
Retrospective design; small sample size; lack of a comparison group.


CONCLUSIONS
The course of BPD with onset in preschool years is complicated with high recovery and relapse rates. The questions of development of age-appropriate diagnostic criteria, long-term prognosis and treatment strategies used in this population require further intensive investigation.
Danielyan
Arman
A
Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, D-3014, Cincinnati, OH 45229, United States. arman.danielyan@cchmc.org
Pathak
Sanjeev
S
Kowatch
Robert A
RA
Arszman
Sarah P
SP
Johns
Erin S
ES
D000374:Aggression / Q000187:drug effects / Q000523:psychology; D000927:Anticonvulsants / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D002675:Child, Preschool; D015897:Comorbidity; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007508:Irritable Mood / Q000187:drug effects; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000523:psychology; D010044:Outpatient Clinics, Hospital; D012189:Retrospective Studies
D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents