Bipolar disorder in children and adolescents

Abstract

Bipolar disorder (BD) was once thought to occur only rarely in youth. However, in most patients, the onset of BD was between age 12 and 22 years. The number of children and adolescents receiving a diagnosis of BD has increased markedly during the past decade throughout the world, indicating that there has been a shift in clinical diagnosing practices and conceptualization of emotional and behavioral dysregulation in youth. Pediatric BD was both under-recognized and underdiagnosed in the past, although it may now be over-diagnosed, especially "BD - Not Otherwise Specified". Prolonged episodes with rapid mood changes, sub-threshold presentations, psychotic symptoms and high rates of comorbid disorders with symptoms that overlap with BD account for the complexity and current controversies in diagnosing children and adolescents with BD. BD with early onset interferes with normal emotional, cognitive, and social development of children, and therefore early recognition and treatment are important. Effective and generally well-tolerated medications are available to treat these young patients that can, when combined with psychosocial approaches that focus on academic, social and family functioning, decrease the morbidity and mortality associated with this complex, chronic and serious illness. This article presents what is known about the disorder in juveniles, where the areas of controversy lie, and what constitutes acceptable practices and appropriate care.