Bipolar disorder in children and adolescents: diagnosis and treatment

Abstract

An improved understanding of bipolar disorder should help clinicians in the accurate diagnosis and treatment of children and adolescents with bipolar disorder. Clinicians should use preliminary evidence and sound clinical judgment when working with patients who have, or may be at risk of, bipolar disorder. Purpose of review This article reviews current literature on the diagnosis and treatment of bipolar disorder in children and adolescents. Controversies relating to diagnosis, common comorbid psychiatric disorders, and the safety and efficacy of pharmocotherapy are summarized. Recent findings The presentation of bipolar disorder in children and adolescents has been described by some as ‘atypical’ in that (1) the predominant mood is often one of irritability, (2) the irritability may be severe, persistent, and violent, (3) the pattern of cycling may be ultradian, (4) comorbid psychiatric disorders and family history of bipolar disorder are common, and (5) poor treatment response and recurrence are common. However, given the prevalence of mixed mania in adult bipolar disorder and the similarities between childhood- and adolescent-onset bipolar disorder and mixed mania, some claim that the child and adolescent variant may not be atypical after all. Adding to the confusion are the diverse manifestations of bipolar symptoms at different developmental stages. Lithium, valproate, and carbamazepine are the medications most commonly used to treat children and adolescents with bipolar disorder. However, current practice parameters are based on preliminary evidence and/or studies using adult patients. There is a need for randomized, double-blind, controlled trials to determine medication safety and efficacy in children and adolescents with bipolar disorder.