Rather than proposing a categorical diagnostic distinction between bipolar depression and major depressive disorder, we would recommend a 'probabilistic' (or likelihood) approach. While there is no 'point of rarity' between the two presentations, there is, rather, a differential likelihood of experiencing the above symptoms and signs of depression. A table outlining draft proposed operationalized criteria for such an approach is provided. The specific details of such a probabilistic approach need to be further explored. For example, to be useful, any diagnostic innovation should inform treatment choices.

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A descriptive study of bipolar affective disorder in adolescent patients, conducted over a 10-year period, is presented. The diagnosis of 30 subjects referred to an adolescent treatment facility of a major teaching hospital was reviewed using DSM-III criteria, and antecedent symptomatology and signs were documented. Common diagnostic features included schizophreniform phenomenology, motoric and vegetative changes, suicidal and inappropriate sexual behaviour and a stormy first year of illness. A positive family history was frequently noted, as was the relevance of various forms of loss as a precipitant of the first episode. Timely recognition and multidisciplinary management, including the use of lithium, are discussed. It appears that the prognosis of bipolar affective disorder in adolescence is better than was previously believed, probably as a result of earlier diagnosis and more frequent recognition.

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