BIPOLAR DISORDER IN CHILDREN AND ADOLESCENTS - CURRENT CHALLENGES

Objective: To demonstrate the diagnostic and treatment challenges inju venile-onset bipolar disorder. Method: Three case vignettes are outlin ed to demonstrate different bipolar presentations in children and adol escents. Results: These case examples illustrate important issues in t he diagnosis and management of juvenile-onset bipolar disorder. These issues include diagnostic confusion with atypical initial presentation and the effect of developmental factors on symptom expression. The re lationship among genetic risk, early affective instability, and the st ress generated by affectively ill family members is complex and circul ar. Comorbidity with disruptive behaviour disorders, as well as anxiet y disorders, is demonstrated by the cases discussed. Comorbid disorder s may affect outcome and require separate treatment intervention. Ther e is evidence for the prophylactic antimanic effect of lithium carbona te in children and adolescents, but its specificity, as an antimanic a gent is still uncertain. There is less evidence, at present, for effec tiveness of other mood stabilizers in this age group, although sodium valproate may prove more effective in mixed mania and rapid cycling, w hich are so often seen with early-onset bipolar disorder. Conclusions: While the existence of juvenile-onset bipolar disorder is no longer i n dispute several outstanding issues related to diagnosis and long-ter m management remain. Careful prospective research will be necessary to sort out these issues definitively.