Pediatric bipolar disorder: phenomenology and course of illness (original) (raw)
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Pediatric-Onset Bipolar Disorder: A Neglected Clinical and Public Health Problem Gianni
Harvard Review of Psychiatry, 1995
disorder (BPD), probably the most prevalent psychotic disorder in adults, has been relatively neglected or controversial in children and adolescents over the past century. We reviewed the literature on early-onset BPD.* Estimates of prevalence, particularly before puberty, are limited by historical biases against pediatric mood disorders and by formidable diagnostic complexity and comorbidity. Although clinical features of pediatric and adult BPD have similarities, pediatric cases probably cannot be defined solely by features characteristic of adult cases. Onset was before age 20 years in at least 25% of reported BPD cases, with some increase in this incidence over the past century. Pediatric BPD is familial more often than is adult-onset BPD, may be associated with a premorbid cyclothymic or hyperthymic temperament, and can be precipitated by antidepressant treatment. Pediatric BPD episodes frequently include irritability, dysphoria, or psychotic symptoms; they are commonly chronic and carry high risks of substance abuse and suicide. BPD is often recognized in adolescents, but the syndrome or its antecedents are almost certainly underrecognized and undertreated in children. Controlled studies of shortand long-term treatment, course, and outcome in this disorder remain strikingly limited, and the syndrome urgently requires increased clinical and scientific interest. (HARVARD REV PSYCHIATRY 1995;3:171-95.) From the International Consortium on Bipolar Disorders Research (Drs.
Developmental Differences According to Age at Onset in Juvenile Bipolar Disorder
Journal of Child and Adolescent Psychopharmacology, 2006
Background: This study on a large sample of unselected, consecutive children and adolescents referred to a third-level hospital who received a diagnosis of bipolar disorder (BD) was aimed at exploring whether childhood-onset BD, as compared with adolescent-onset BD, presents specific clinical features in terms of severity, functional impairment, course, prevalent mood, pattern of co-morbidity, and treatment outcome. Methods: A total of 136 patients, 81 males (59.6%) and 55 females (40.4%), mean age 13.5 ± 2.9 years, meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnosis of BD according to a structured clinical interview Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), were included in the study. Results: Eighty patients (58.8%) had a childhood-onset BD (before 12 years of age) and 56 (41.2%) had an adolescents-onset BD. Compared with the adolescent-onset BD, patients with childhood-onset were more frequently males and had a more frequent co-morbidity with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). An episodic course was found in only 42.5% of bipolar children, but 76.8% of youngsters with adolescent-onset BD. Severity, 6-month treatment outcome, prevalent mood (elated versus irritable), and co-morbid anxiety did not differentiate the two groups. Conclusions: Our findings suggest that a very early age at onset may identify a form of BD with a more frequent subcontinuous course and a heavy co-morbidity with ADHD.
Bipolar disorder in children and adolescents: an update on diagnosis
Clinical Practice, 2014
Practice points • Despite converging evidence validating pediatric bipolar disorder (PBD), it is still challenging to diagnose PBD accurately. • Consideration of the developmental course and common comorbidities will help improve the diagnostic accuracy of PBD. • Clinical triggers such as family history, early-onset depression, antidepressant-coincident mania, episodic mood lability, episodic aggressive behavior, psychotic features and sleep disturbance should trigger a thorough evaluation of possible PBD. • Semistructured interviews remain the gold standard for assessing for PBD. • Understanding cultural dynamics such as training, class/race issues, stigma and lifestylerelated factors may help bridge the gap between research and practice. Converging evidence from both community and clinical settings shows that pediatric bipolar disorder is a valid diagnosis and a debilitating condition. While the field has evolved considerably, there remain gaps in diagnosis, assessment, research and practice. This article critically appraises: advances in understanding of the phenomenology of pediatric bipolar disorder; changes in diagnostic criteria from the Diagnostic and Statistical Manual (DSM)-IV to DSM-5 and corresponding controversies; the epidemiology of pediatric bipolar disorder; current assessment and diagnostic practices; and cultural factors influencing treatment seeking and diagnosis. We recommend using an evidence-based framework for bridging the gap between research and clinical practice.
The Concept of Bipolar Disorder in Children: A History of the Bipolar Controversy
Child and Adolescent Psychiatric Clinics of North America, 2009
Phenomenologists in child and adolescent psychiatry frequently aspire to the perceived certitude with which adult psychiatry conceptualizes bipolar disorder. However, there is a good deal of uncertainty in how this condition is operationalized, classified, and distinguished from other conditions even in adults. There are multiple issues. They include the following: (1) the degree to which mania is a spectrum that ranges from a severely psychotic, paranoid, and agitated condition that can be confused with schizophrenia to one that borders on normal behavior; (2) the degree to which depression may be punctuated by fluctuations of mood, which range from euthymia to hypomania to mania (ie, circular manic-depression, bipolar II disorder, and recurrent unipolar depression); (3) the degree to which the onset of a mood state can be distinguished from some kind of baseline state in which mood changes are part of the person's temperament or personality (eg, a hyperthymic energetic temperament or ''cluster B personality disorders'' in which chronic mood lability is present, exacerbations of which may or may not be related to manic-depression); (4) the degree to which the mood disorder is autonomous versus precipitated by, or associated with, another CNS condition, including drugs (prescribed or illicit) or illness, that is, the primary/secondary distinction. To these muddy waters, child psychopathology adds two more: (1) the degree to which symptoms and behaviors thought to be basic to the definition of mania or depression mean the same thing in children of different ages and (2) the degree to For the sake of this discussion, manic-depression will refer to a clearly episodic disorder as still described in ICD-10. Bipolar disorder refers to the post-1980 construct of people who meet symptom criteria and represent a broader spectrum.
Child and adolescent bipolar disorder
Paediatrics & Child Health, 2001
U ntil relatively recently, the concept of diagnosing bipolar affective disorder in children and adolescents was controversial. The prevailing wisdom in the early part of this century was that prepubertal onset of manic depression did not occur (1). Furthermore, according to some psychoanalytic theories, depression was not possible in children because of a lack of the development of necessary psychological structures. Over the past 20 years, there has been a significant shift toward recognizing the existence of bipolar disorder in children and adolescents. Since 1980, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition: DSM-III, (2), the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised: DSM-III-R (3), and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV (4) have applied adult criteria to diagnose mania in children, with some modifications to take into account differences in developmental stages (5). Despite the recognition of the existence of bipolar disorder in this age group, difficulty in clearly delineating the clinical characteristics of the presentation of this illness in paediatric patients relative to adult patients continues (6).
Bipolar disorder in children and adolescents
Child and Adolescent Mental Health, 2013
Background-The existence of bipolar disorder (BP) in youth is controversial. Methods-The current evidence regarding the diagnosis of BP in youth was reviewed. Results-BP is a recurrent familial disorder that occurs in 1-3% of youth, particularly in adolescents. Except for subsyndromal BP, the prevalence of BP-I is similar across most countries. Due to the child's immaturity, the presence of comorbid disorders, and divergent interpretations of manic symptomatology it is difficult to diagnose BP in youth. Youth with subsyndromal mania and family history of BP, are at high risk to develop BP-I and BP-II. Both the full and subsyndromal syndromal BP are associated with significant psychosocial difficulties and increased risk for use of substances, suicidality, legal problems, and services utilization. Conclusion-BP disorder exists in youth, but it is difficult to diagnose. The recurrent nature and psychosocial morbidity associated with this illness during critical developmental stages calls for comprehensive longitudinal evaluation and accurate recognition and treatment because delays in treatment are associated with poor outcome. Keywords children; adolescents; bipolar disorder; diagnostic controversies; family history Amy is a 9-year-old girl who for the last 2 years has been experiencing intermittent 2-3 day episodes of increased activity, silliness, poor concentration, increased creativeness and selfesteem, and lack of need for sleep without noticeable tiredness the next day. In addition, she has had periods lasting 3-5 weeks where she is more sullen, angry, sad, tired, tearful, distractible, and with less motivation and more defiant behaviors at home and at school. Amy was diagnosed with attention deficit hyperactive disorder (ADHD) and oppositional No other competing or potential conflicts of interest arise from the publication of this work.
Encyclopedia of Applied Developmental Science, 2005
Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered.