JUVENILE-ONSET BIPOLAR DISORDERS AND PRE-BIPOLAR AFFECTIVE TEMPERAMENTS

Bipolar affective disorder in children and adolescents had received re cently many research grants for studies on etiology, clinical course, biology and treatment. Firstly, this paper approaches the question of juvenile-onset bipolarity from a synthesis of a workshop organized by NIMH (Child and Adolescent Disorders Research Branch). Current knowled ge on clinical aspects, phenomenology, longitudinal course and treatme nt research in juvenile-onset bipolarity will be summarized. Secondly, the authors argue from art <<adult>> perspective, that clinically asc ertained juvenile depressions (and primary dysthymia) have affinity to bipolar spectrum disorders. This hypothesis is based (I) on early age of onset, (2) gender ratio, (3) prominence of mood lability and explo sive anger (indicators of mixed states), (4) high propensity to mood s witching under antidepressant treatment (5), high rate of recurrence, (6)family affective loading and (7) the frequent superposition on affe ctive temperamental dysregulation. The authors submit that affective t emperaments (cyclothymic, hyperthymic, dysthymic and irritable) repres ent putative developmental pathways to bipolarity. A french version of the semi-structured interview and self-assessement questionnaires for affective temperaments had been constructed by the authors in a colla borative research with a french scientific committee. These new clinic al instruments are currently under validation in two french multicente r studies (EPIMAN and EPIDEP). Preliminary data showed in EPIMAN study high score on irritable temperament in patients with <<probable>> dys phoric mania and in EPIDEP study, high score on cyclothymic temperamen t in patients with bipolar II disorder especially in patients who conv erted their mood polarity (hypomanic switch) under current antidepress ant treatment. After a long period of skepticism about the existence o f bipolarity in childhood and in early postpubertal years, the authors hoped that current knowledge and new research in this domain will enc ourage clinicians to further understanding the manic-depressive illnes s in children and adults. From a public health perspective, early dete ction of bipolarity would serve the cause of limiting the disruptive s equelae of this mood disorder. More clinical sophistication is needed to go beyond the classical <<diagnostic>> criteria and to delineate th e psycho-biological pathways to bipolarity. Clearly a great deal of wo rk remains to be done on the nature of juvenile-onset bipolar disorder s and on affective pre-bipolar temperaments.