Current concepts in the validity, diagnosis and treatment of paediatric bipolar disorder

Abstract

Despite ongoing controversy, the view that paediatric bipolar disorder is rare or non-existent has been increasingly challenged not only by case reports but also by systematic research. This research strongly suggests that paediatric bipolar disorder may not be rare but that it may be difficult to diagnose. Since children with bipolar disorder are likely to become adults with bipolar disorder, the recognition and characterization of childhood-onset bipolar disorder may help identify a meaningful developmental subtype of bipolar disorder worthy of further investigation. As recommended by Robins and Guze [American Journal of Psychiatry (1970), 126, 983-987], a psychiatric disorder may be considered a valid diagnostic entity if it can be shown to have differentiating features, evidence of familiality, specific treatment responsivity and a unique course. The goal of this article is to review our work and the extant literature within this framework to describe the evidence supporting bipolar disorder in children as a valid clinical diagnosis.

Mood disorders in childhood and adolescence

“…48 This may explain the fact that 80% of children and adolescents suffering from BD do not reach functional remission. 49 The functional impairment of patients with PBD is remarkable. The disorder interferes with emotional, cognitive, and social development across the lifecycle.…”

“…Massachusetts General Hospital, Harvard Medical School 49 -DSM-IV-TR. -When severe irritability is present, there is no need for change in the usual mood pattern.…”

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

“…Some investigators, however, have argued that children with bipolar disorder can have non-episodic, chronic mania and irritability (Biederman et al, 2003). More generally, there is disagreement among researchers as to what constitutes an episode (Tillman et al, 2004).…”

Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: A controlled study

“…Juvenile BPD in its various forms affects from 1-4% of pediatric groups (Lewinsohn, et al, 1995) with up to one-fifth of psychiatrically referred children and adolescent psychiatric outpatients manifesting BPD (Weller, et al, 1986, Wozniak, et al, 1995. The literature also documents the concurrent, face, and predictive validity of BPD in childhood (Biederman, et al, 2003). Recent work suggests that pediatric onset BPD may represent a unique developmental type of BPD characterized by a chronic course, mixed presentations, and high levels of severe irritability , Biederman, et al, 2003, Carlson, 1984, Geller, et al, 2006, Geller, et al, 2004, Wozniak, et al, 1995.…”

“…The literature also documents the concurrent, face, and predictive validity of BPD in childhood (Biederman, et al, 2003). Recent work suggests that pediatric onset BPD may represent a unique developmental type of BPD characterized by a chronic course, mixed presentations, and high levels of severe irritability , Biederman, et al, 2003, Carlson, 1984, Geller, et al, 2006, Geller, et al, 2004, Wozniak, et al, 1995. For instance, two ongoing multisite, National Institute of Mental Health (NIMH) funded studies show that children and adolescents with BPD maintain a functionally impaired status characterized by a highly relapsing and remitting course , Birmaher, 2004, Geller, et al, 2006, Geller, et al, 2004.…”