Gl. Faedda et al., PEDIATRIC-ONSET BIPOLAR DISORDER - A NEGLECTED CLINICAL AND PUBLIC-HEALTH PROBLEM, Harvard review of psychiatry, 3(4), 1995, pp. 171-195
Bipolar 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 puber
ty, are limited by historical biases against pediatric mood disorders
and by formidable diagnostic complexity and comorbidity. Although clin
ical 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, a
nd can be precipitated by antidepressant treatment. Pediatric BPD epis
odes frequently include irritability, dysphoria, or psychotic symptoms
; they are commonly chronic and carry high risks of substance abuse an
d suicide. BPD is often recognized in adolescents, but the syndrome or
its antecedents are almost certainly underrecognized and undertreated
in children. Controlled studies of short- and long-term treatment, co
urse, and outcome in this disorder remain strikingly limited, and the
syndrome urgently requires increased clinical and scientific interest.