Rapid, continuous cycling and psychiatric co-morbidity in pediatric bipolar I disorder

Objectives: The primary purpose of this study was to describe the clinical presentation of bipolar I disorder (BP-I) as it occurs in children and adol escents and to assess whether the manifestations of BP-I were similar in bo th age groups. Method: Ninety youths between the ages of 5 and 17 years meeting full diagn ostic symptom criteria for BP-I were included in this study. The diagnosis of BP-I was established for these youths based on the results of a semi-str uctured diagnostic interview and a clinical assessment by a child and adole scent psychiatrist. The course of a subset of these youngsters' illnesses w as assessed using the Life Charting Method (LCM). Data regarding the clinic al presentation, longitudinal history, psychiatric co-morbidities and paren tal psychopathology were also obtained. Results: The clinical presentation of BP-I was similar in children and adol escents. Youths meeting diagnostic criteria for BP-I developed an average o f approximately 5.8 of the 7 symptoms of mania during periods of elevated o r irritable mood. BP-I was found to be a cyclic disorder characterized by h igh rates of rapid cycling (50%) with almost no inter-episode recovery. Alm ost 75% of these subjects also met diagnostic symptom criteria for a disrup tive behavior disorder. High rates of mood disorders were found in fathers. Conclusions: These data suggest that the presentation of juvenile BP-I is a cyclic and valid clinical condition with manifestations on a continuum wit h the later-onset forms of this illness.