Bipolar Disorder In Children Research Articles

Bipolar disorder in children and adolescents: an update on diagnosis

Converging evidence from both community and clinical settings shows that pediatric bipolar disorder is a valid diagnosis and a debilitating condition. While the field has evolved considerably, there remain gaps in diagnosis, assessment, research and practice. This article critically appraises: advances in understanding of the phenomenology of pediatric bipolar disorder; changes in diagnostic criteria from the Diagnostic and Statistical Manual (DSM)-IV to DSM-5 and corresponding controversies; the epidemiology of pediatric bipolar disorder; current assessment and diagnostic practices; and cultural factors influencing treatment seeking and diagnosis. We recommend using an evidence-based framework for bridging the gap between research and clinical practice.

Timely topics in pediatric psychiatry.

This section of Focus on Childhood and Adolescent Mental Health presents findings on an array of topics including inflammation and child and adolescent depression, glutamatergic dysregulation and pediatric psychiatric disorders, predictors of bipolar disorder in children with attention-deficit/hyperactivity disorder (ADHD), and the continuum between obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD). There is increased interest in the role of inflammation in psychiatric disorders. Kim and colleagues conducted a systematic literature review to examine the relationships between inflammatory processes, inflammation, medical conditions, and depression and suicidality in children and adolescents.

Correlates of incident bipolar disorder in children and adolescents diagnosed with attention-deficit/hyperactivity disorder.

The greater severity and chronicity of illness in youths with co-occurring attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder deserve further investigation as to the risk imparted by comorbid conditions and the pharmacotherapies employed. A retrospective cohort design was employed, using South Carolina's Medicaid claims dataset covering outpatient and inpatient medical and psychiatric service claims with International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses and medication prescriptions between January 1996 and December 2006 for patients ≤ 17 years of age. The cohort included 22,797 cases diagnosed with ADHD at a mean age of 7.8 years; 1,604 (7.0%) were diagnosed with bipolar disorder at a mean age of 12.2 years. The bipolar disorder group developed conduct disorder (CD)/oppositional defiant disorder (ODD), anxiety disorder, and a substance use disorder later than the ADHD-only group. The odds of a child with ADHD developing bipolar disorder were significantly and positively associated with a comorbid diagnosis of CD/ODD (adjusted odds ratio [aOR] = 4.01), anxiety disorder (aOR = 2.39), or substance use disorder (aOR = 1.88); longer treatment with methylphenidate, mixed amphetamine salts, or atomoxetine (aOR = 1.01); not being African American (aOR = 1.61); and being treated with certain antidepressant medications, most notably fluoxetine (aOR = 2.00), sertraline (aOR = 2.29), bupropion (aOR = 2.22), trazodone (aOR = 2.15), or venlafaxine (aOR = 2.37) prior to the first diagnosis of mania. Controlling for pharmacotherapy differences, incident bipolar disorder was more likely in individuals clustering specific patterns of comorbid psychiatric disorders, suggesting that there are different pathways to bipolarity and providing a clinical impetus for prioritizing prevention and preemptive strategies to reduce their hazardous influence.

Profile of aripiprazole in the treatment of bipolar disorder in children and adolescents.

Bipolar disorder is a pernicious illness. Compared with the later-onset form, early onset bipolar disorder is associated with worse psychosocial outcomes, and is characterized by rapid cycling and increased risks of substance abuse and suicide attempts. Controlling mood episodes and preventing relapse in this group of pediatric patients requires careful treatment. Here, we review the effectiveness of aripiprazole for bipolar disorder in children and adolescents, with discussion of this drug’s unique pharmacological profile and various clinical study outcomes. Aripiprazole acts as a serotonin 5-HT2A receptor antagonist, as well as a partial agonist of the serotonin 5-HT1A and dopamine D2 receptors. It can be safely used in children and adolescents, as it is highly tolerated and shows lower rates of the side effects typically observed with other antipsychotic drugs, including sedation, weight gain, hyperprolactinemia, and extrapyramidal syndrome. The presently reviewed randomized controlled trials (RCTs) and non-RCTs generally reported aripiprazole to be effective and well-tolerated in children and adolescents with bipolar disorder. However, due to the limited number of RCTs, the present conclusions must be evaluated cautiously. Furthermore, aripiprazole cannot yet be considered a preferred treatment for children and adolescents with bipolar disorder, as there is not yet evidence that aripiprazole shows greater efficacy compared to other second-generation antipsychotics. Additional data are needed from future head-to-head comparison studies.

Review of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis, by Stuart L. Kaplan

Journal of Child and Adolescent PsychopharmacologyVol. 24, No. 8 Book ReviewReview of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis, by Stuart L. KaplanLauren SpringLauren SpringSearch for more papers by this authorPublished Online:20 Oct 2014https://doi.org/10.1089/cap.2014.24112AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 24Issue 8Oct 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Lauren Spring.Review of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis, by Stuart L. Kaplan.Journal of Child and Adolescent Psychopharmacology.Oct 2014.468-470.http://doi.org/10.1089/cap.2014.24112Published in Volume: 24 Issue 8: October 20, 2014Online Ahead of Print:October 6, 2014PDF download

Le trouble disruptif avec dysrégulation de l’humeur

Disruptive mood dysregulation disorder (DMDD) is a new DSM 5 diagnosis specifically addressing children and adolescents. DMDD belongs to the category of mood disorders and has been created to improve recognition of a condition characterized by both mood and behavioral symptoms and to avoid a diagnosis of bipolar disorder in children and adolescents with severe chronic irritability and temper tantrums. Its validity and possible overlap with disruptive behavior disorders such as oppositional defiant disorder or conduct disorder and neurodevelopmental disorder such as attention deficit hyperactivity disorder – especially in children with severe emotional liability or comorbidities – are still subject to debate. This review addresses the background of DMDD, diagnosis and neuropsychological correlates.

Link Found Between Glutamate, Adolescent Bipolar Disorder

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessLink Found Between Glutamate, Adolescent Bipolar DisorderVabren WattsVabren WattsSearch for more papers by this authorPublished Online:17 Jul 2014https://doi.org/10.1176/appi.pn.2014.7a17AbstractGlutamte may serve as a potential biomarker to predict pathophysiologies of specific psychiatric disorders in youth.For decades, researchers have suggested that glutamate is the most prominent excitatory neurotransmitter in the brain, yet its specific role in psychiatric disorders is still unclear. To shed light on the actions of glutamate, a team of scientists from Massachusetts General Hospital investigated how dysregulation of the glutamatergic system can have negative consequences for mental health—in particular, bipolar disorder in children and adolescents. Andrea Spencer, M.D., hopes her systematic review of child and adolescent bipolar disorder will spark more researchers to examine the consequences of glutamatergic dysregulation on pediatric psychiatric disorders.Massachusetts General Hospital“There has been an increased interest in glutamatergic regulation in both adult and pediatric bipolar disorder,” Andrea Spencer, M.D., an instructor and researcher in psychiatry at Massachusetts General Hospital, said in an interview with Psychiatric News. “What is interesting for us as child and adolescent researchers is that glutamate is involved in the development of the brain.”As the major excitatory neurotransmitter, glutamate plays a critical role in brain function, adaptation of the brain in response to external stimuli, and brain maturation. Malfunction of the glutamatergic system has been associated with multiple psychiatric disorders, many of which have their onset in childhood, Spencer said. “We know that mood disorders often start in childhood,” she noted. “It is very important that we not only investigate the association of glutamate with the pathophysiology of adult bipolar disorder, but also investigate such association as it relates to pediatric bipolar disorder.”To explore whether such a link exists, Spencer and colleagues conducted a systematic review of the literature that examined glutamatergic dysregulation as it relates to all psychiatric disorders in children and adolescents. To meet inclusion criteria, the studies were required to have measured glutamatergic metabolites—glutamate, glutamine, or both—via magnetic resonance spectroscopy (MRS), a noninvasive method that detects protons of a chemical compound in a specified region of the brain.The results, which were presented at an APA annual meeting session in May titled “Advances in Pediatric Bipolar Research,” showed that decreased concentration of glutamatergic metabolites was consistently associated with children who had a diagnosis of bipolar disorder, compared with those without a bipolar disorder diagnosis. Metabolite levels were more likely to normalize in those who were administered medication as a treatment for the mood disorder.In addition, major depressive disorder in children was associated with low levels of glutamatergic metabolites, while other psychiatric disorders, such as attention-deficit/hyperactivity disorder and autism spectrum disorder, were found to be associated with elevated levels of glutamatergic metabolites. “It was important that we looked at all child and adolescent psychiatric disorders, because there can be so much overlap [such as in symptomatology] of the disorders,” Spencer explained. She said that the research approach was necessary to assess the potential for biomarkers—such as glutamate—to predict pathophysiologies of specific mental disorders in youth.Spencer noted that the current findings from her group have generated numerous hypotheses about glutamatergic regulation in bipolar illness and other psychiatric disorders that develop in childhood. “Right now we do not know a lot about the variability of glutamatergic metabolites in bipolar disorder. We really hope that this specific work will catalyze interest in examining glutamatergic regulation in child and adolescent psychopathology,” Spencer concluded.The research was supported by the Pediatric Psychopharmacology Research Council Fund. ■A video interview with Psychiatric News can be accessed here. ISSUES NewArchived

Bipolar Disorder in Children With ADHD: A Clinical Sample Study

Objective: To explore the impact of early-onset bipolar disorder (pediatric bipolar disorder [PBD]) on ADHD. Method: We compared ADHD symptom severity, ADHD subtype distribution, and rates of comorbid and familial psychiatric disorders between 49 ADHD children with comorbid PBD and 320 ADHD children without PBD. Results: Children with ADHD and PBD showed higher scores in the Hyperactive and Inattentive subscales of the ADHD Rating Scale, than children with ADHD alone. The frequency of combined subtype was significantly higher in ADHD children with PBD, than in those with ADHD alone. ADHD children with PBD showed a higher rate of familial psychiatric disorders than ADHD children without PBD. The rate of conduct disorder was significantly greater in children with PBD and ADHD compared with children with ADHD alone. Conclusion: ADHD along with PBD presents with several characteristics that distinguish it from ADHD alone, suggesting that these may be distinct disorders.

Major Depression, Bipolar Disorder and Psychosis in Children

Major depression and bipolar disorder in children and adolescents are diagnosed with criteria that are similar to those which are used with adults. Developmental differences occur in the symptom trajectories of both disorders which are highly heterogeneous and stem from poorly understood interactions of multidimensional risk factors. Mood disorder-related psychotic symptoms in children and adolescents frequently reflect severe patterns of illness and require comprehensive assessment and sustained, multimodal treatment approaches.

Bipolar disorder in children: the diagnostical challenge

The bipolar disorder becomes more and more frequent in the pediatric field, raising numerous questions regarding the diagnosis. In most cases, the standard criteria of the disease are not fully met in the case of a child, requiring their particularization and a more accurate classification. Also, a central issue is the differentiation and/ or detection of comorbidity with ADHD and conduct disorders in children.

Prise en charge du trouble bipolaire de type 1 chez l’enfant et l’adolescent

Lifetime prevalence of child and adolescent bipolar 1 disorder (BD1) is nearly 0.1 %. Even though it is not a frequent disorder in young people, there is an increased interest for this disorder at this age, because of the poor outcome, the severe functional impairments and the major risk of suicide. Diagnosis is complex in view of the more frequent comorbidities, the variability with an age-dependant clinical presentation, and the overlap in symptom presentation with other psychiatric disorders (e.g. disruptive disorders in prepubertal the child and schizophrenia in the adolescent). The presentation in adolescents is very similar to that in adults and in prepubertal children chronic persistent irritability and rapid mood oscillation are often at the foreground. For a while, such presentations were considered as BD-not otherwise specified (BD-NOS), which can explain the outburst of the prevalence of bipolar disorder in children in the US. Longitudinal studies that look for the outcome of such emotional dysregulations have not revealed an affiliation with bipolar disorder spectrum, but with depressive disorders in adulthood. The diagnosis of Disruptive Mood Dysregulation Disorder was proposed in the DSM-5 to identify these children and to prevent confusion with bipolar disorder. The goals of the pharmacological and psychosocial treatments are to control or ameliorate the symptoms, to avoid new episodes or recurrences, to improve psychosocial functioning and well-being, and to prevent suicide. In the US, lithium and four atypical antipsychotics have been approved by the FDA for 10 to 13-year-olds (risperidone, olanzapine, aripiprazole and quetiapine). In France, only lithium salts (after the age of 16) and aripiprazole (after the age of 13) are recommended. Psychosocial treatments, such as a familial or individual approach are developing.

Traitement par lithium dans le trouble bipolaire du sujet jeune

Bipolar disorder in youths is a severe psychiatric disorder that potentially results in high-relapse rates and disrupts the normal psychosocial development. Many adults with bipolar disorder identify the onset of their symptoms in childhood and adolescence, indicating the importance of early accurate diagnosis and treatment. The lifetime prevalence is estimated in adolescence at 0.1% for bipolar I disorder and 1% for all bipolar spectrum disorders. “Classic” bipolar disorder with well-delineated episodes is rare among prepubertal children. The treatment of bipolar disorder in youths raises challenges and difficulties. Lithium is recommended as one of the first-line treatment options of bipolar disorder in children and adolescents with FDA approval as early as 12years. Lithium prescription is approved in France for bipolar disorder only for adolescents older than 16years old. This comprehensive literature review incorporates research studies evaluating the effectiveness of lithium in children and adolescents with pediatric bipolar disorder (randomized controlled trials, open-label studies and retrospective chart reviews). Lithium was evaluated as a monotherapy, as well as part of a combination treatment, in the acute and maintenance phases. The effectiveness of a lithium monotherapy is moderate with response rates of approximately 35 to 63%. Its efficacy is similar to valproate and carbamazepine; however, lithium appears to be superior in case of psychotic symptoms. A recent study reported the superiority of risperidone over lithium in bipolar mania with a comorbid attention-deficit/hyperactivity disorder. While it is ideal to use the lowest possible dose of monotherapy medication to decrease adverse side effects, most patients require adjunctive medication treatment for the stabilization of bipolar symptoms. Data suggest that a combined treatment with lithium (using valproate, carbamazepine or risperidone) may provide a better remission of symptoms, with response rates between up to 70 and 90%. The relapse rate in lithium monotherapy is high (37 to 56%); nevertheless, very few studies have measured the long-term effects of the medication in pediatric bipolar disorder. The data from the available pharmacological studies need to be interpreted cautiously because of the controversy surrounding the definition and diagnosis of bipolar disorder in youths. The continuity between childhood-onset bipolar disorder and the current adult-oriented DSM-IV criteria in adolescence is currently debated. The diagnostic framework has evolved to distinguish the diagnoses of “Severe Emotional Dysregulation” (or “Temper Dysregulation Disorder with Dysphoria” in DSM-V) in children from bipolar I disorder in adolescents. Research samples often include both of these clinical pictures. This heterogeneity in the patient population introduces a major caveat towards the interpretation of the available literature addressing treatment strategies. The distinction between these two forms is even more relevant given the fact that preliminary studies have shown various clinical courses, family psychiatric histories, different prognoses, as well as therapeutic responses. Even if the safety profile of lithium is reassuring, the reported side effects seem to be a more frequent in youths than in adults, especially if the child is young. The most commonly reported (>20%) adverse events were nausea/vomiting, diarrhea, abdominal pain, headache, dizziness, tremor and pollakiuria. Weight gain and acne are side effects that are perceived to be particularly shameful during adolescence. No data on long-term side effects are available. The limited studies examining the pharmacokinetics of lithium may indicate the need for vigilance in the variability induced by the weight in pediatric patients. Very few studies have examined predictors and moderators in the treatment of bipolar disorder in children and adolescents. Being younger or suffering from comorbid attention-deficit/hyperactivity disorder have been associated with a poorer response to lithium. The aims of future researches in bipolar disorder in youths may establish some evidence-based strategies for lithium especially: (i) by examining the acute efficacy in mania and also in bipolar depression with a particular attention to age-specific aspects and diagnosis at inclusion, (ii) by investigating the long-term effectiveness of lithium treatment, (iii) by characterizing the long-term safety of lithium, (iv) by identifying pretreatment variables associated with the effectiveness and tolerability of lithium, (v) by studying adherence concerns in adolescents.

Comparative effectiveness of monotherapy with mood stabilizers versus second generation (atypical) antipsychotics for the treatment of bipolar disorder in children and adolescents

This study compared the effectiveness and safety of second generation (atypical) antipsychotic (SGA) versus traditional mood stabilizers (MS) in children and adolescents with bipolar disorder. The study was a retrospective cohort study on 5 years (2003-2007) of Medicaid claims data from four geographically diversified states. Children and adolescents aged 6-18 years who initiated a new treatment episode for bipolar disorder on either an SGA or an MS were followed for 12 months to compare the effectiveness and safety between the two therapeutic categories for pediatric bipolar disorder (PBD). The outcome measures were psychiatric hospital admission, all cause medication discontinuation and treatment augmentation. Potential selection bias caused by unobserved confounding was addressed with instrumental variable methods, using physician prescribing preference and year of cohort entry as the instruments. Sensitivity analysis was conducted to test the robustness of findings against the uncertainties on PBD diagnosis. Of the 7423 bipolar children and adolescents identified, 66.60% started treatment on SGA, whereas 33.40% initiated on MS. Patients who initiated on MS and SGA had comparable risk of psychiatric hospital admission (HR=1.172, 95%CI: 0.827-1.660). However, as compared with those who initiated on MS, patients who initiated on SGA were less likely to discontinue the treatment (HR=0.634, 95%CI: 0.419-0.961) and less likely to receive treatment augmentation (HR=0.223, 95%CI: 0.103-0.484). As compared with MS monotherapy, SGA monotherapy could be a more effective and safer treatment option for PBD.

Clinical Guidelines on Long-Term Pharmacotherapy for Bipolar Disorder in Children and Adolescents

Bipolar disorder is a severe affective disorder which can present in adolescence, or sometimes earlier, and often requires a pharmacotherapeutic approach. The phenomenology of bipolar disorder in children and adolescents appears to differ from that of adult patients, prompting the need for specific pharmacotherapy guidelines for long-term management in this patient population. Current treatment guidelines were mainly developed based on evidence from studies in adult patients, highlighting the requirement for further research into the pharmacotherapy of children and adolescents with bipolar disorder. This review compares and critically analyzes the available guidelines, discussing the recommended medication classes, their mechanisms of action, side effect profiles and evidence base.

A comparison of bipolar disorders in children in Italy and the United States

BackgroundThe clinical presentation of bipolar disorders, though clearly recognized in adolescents, remains controversial in younger children and across cultures. The aim of this study was to compare the clinical presentation of bipolar disorders in Italian and American children between ages 5 and 12 years. MethodsSixty-seven children from six outpatient programs were enrolled (Italian sample: n=40; American sample: n=28) between January 2010 and June 2011. Children and their parents were interviewed by experienced clinicians using the Washington University in St. Louis Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present, Lifetime Version (WASH-U K-SADS). ResultsItalian children scored significantly higher on ratings of “elevated mood” (p=0.002), whereas American children scored significantly higher on ratings of “flight of ideas” (p=0.001) and “productivity” (p=0.001). Rates of comorbidity were different between groups. LimitationsData were acquired from several sites in Italy as compared to from a single American site. Medication and educational information were not systematically collected. Furthermore, the sample collected may only reflect characteristics of a less severely ill group of bipolar children. ConclusionsOur comparison of Italian and American children with early onset bipolar disorders found that the phenotype of bipolar spectrum disorders is largely shared across cultures, although psychiatric comorbidities differed.

Bipolar disorder in children.

Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered.

A systematic review of gender‐specific rates of unipolar and bipolar disorders in community studies of pre‐pubertal children

Gender-specific rates of unipolar and bipolar disorders are well established for cases with post-pubertal onset. However, there is less certainty about these rates in pre-pubertal children. We undertook a systematic review of community studies that report gender-specific rates for unipolar and bipolar disorders in young children, particularly cases of major depression and mania. Computer databases (Medline, EMBASE, Index to Theses, and PsychInfo) were searched for non-clinical observational studies using recognized diagnostic criteria to identify unipolar and bipolar disorders in children aged ≤ 12 years. A meta-analysis was undertaken to calculate pooled odds ratios (ORs) for caseness for major depression by gender. The limited data on bipolar disorder were summarized. Analysis of 12 studies (>15,000 children), indicated that the community prevalence of unipolar disorders was higher in boys (1.3%) than in girls (0.8%). Rates of major depression were low (0.61%), but boys were significantly more likely to meet diagnostic criteria than girls (OR = 1.61; 95% confidence interval: 1.11-2.35). Five studies, assessing >5,000 children, identified only one case with a probable diagnosis of mania. This systematic review suggests that boys aged ≤ 12 years are significantly more likely to experience major depression than girls. However, in younger children, community rates of major depression are low, and it is frequently suggested (but not proven) that most cases are comorbid. The absence of mania suggests either that childhood bipolar phenotypes do not resemble post-pubertal onset cases or that there are problems of case ascertainment.

Pharmacotherapy of bipolar disorder in children and adolescents: an update

To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents, including the treatment of bipolar depression and comorbid attention deficit/hyperactivity disorder (ADHD). Narrative review of randomized clinical trials and open-label studies published from 2000 to 2012. The PubMed and PsycINFO websites were queried. Case series were included when a higher level of evidence was not available. Published data from randomized controlled trials (RCTs) in acute mania/hypomania with significant responses are available for lithium, topiramate, risperidone, olanzapine, and aripiprazole. Open trials of lithium and lamotrigine show that these drugs may be effective in the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors (SSRIs) have been conducted. In the treatment of comorbid ADHD, there are encouraging findings with mixed amphetamine salts and atomoxetine; conflicting results are observed with methylphenidate. Published RCTs of traditional mood stabilizers are scarce, but the best available evidence (results from meta-analytic regression) suggests that second-generation antipsychotics (SGAs) as a group are more effective in reducing manic symptoms. Risperidone was the only one included in head-to-head comparisons (vs. lithium and divalproex), showing superiority in terms of efficacy, but with more metabolic side effects, which were also more common in most of the SGAs. There are few studies addressing the treatment of ADHD and depression. Brazilian guidelines for the treatment of pediatric bipolar disorder should also include some SGAs (especially risperidone and aripiprazole) as first-line treatment, and these drugs should be provided by the public health services.

Sleep complaint as a biomarker of bipolar disorder in children and adolescent

Depressive episodes are common healthy problem and patients with (BD) bipolar disorder have higher risk of suicidal than healthy individuals. Poor quality of sleep in depressive disorders is an important marker of response to treatment and to risk of recurrence. However, the association between sleep duration and subsequent mood is less consistent for depression than for mania or hypomania. The aim of this study was assessing sleep complaints in children and adolescents with BD, and analyzing differences between their depressive episode and mania episode in a transversal study of children and adolescents with BD. Our sample includes 72 children (10 ± 2y) and adolescents (15 ± 2y) with BD. The data were obtained from two research databases of patients consecutively referred for BD treatment in an outpatient clinic at the Child and Adolescent Affective Disorder Program at the Institute of Psychiatry – Sao Paulo University in Brazil. We obtained signed consent forms from legal guardians. Depressive psychopathology was ascertained by face-to-face clinical interview and with the DSM-IV version of the Diagnostic Interview for Children and Adolescent DSM IV version – DICA IV. Sleep disturbance was defined as sleep complaints (SC) noted, during a manic and a depressive episode. we considered four disturbances: Initial Insomnia (II), Night Awakening (NA); Early Awakening (EA), Hypersomnia (Hy). The data were analyzed by Chi-Square tests. There were 22 girls and 50 boys: 42% of patient had sleep-disordered- breathing. The occurrence of SC was higher during mania than during depression (66.4% versus 52.3%, respectively). II and EA correlated with depressive episode while; NA and Hy with mania episode ( p < 0.05). The time in bed was higher during depression ( p = 0.01), and patients with Night Awakening had higher chances to develop mania. The total sleep time was shorter in child group than in an adolescent group ( p < 0.05), but the complaint of non-restaurative sleep was significant higher in adolescents, particularly during mania episode ( p = 0.048). Sleep complaints may be used as a predictor of the occurrence of a specific episode in bipolar disorder. More investigation on the sleep changes in young individuals with bipolar disorders is needed. I would love to thank the Institute of Psychiatry at University of Sao Paulo Medical School, Brazil.

A systematic review of the effectiveness of polyunsaturated fatty acids in reducing the clinical symptoms of paediatric bipolar disorder in children and adolescents

A systematic review of the effectiveness of polyunsaturated fatty acids in reducing the clinical symptoms of paediatric bipolar disorder in children and adolescents