Pediatric bipolar disorder: phenomenology and course of illness

Pediatric bipolar disorder: phenomenology and course of illness Background: Specific features and diagnostic boundaries of childhood bipolar disorder (BD) remain controversial, and its differentiation from other disorders challenging, owing to high comorbidity with other common childhood disorders, and frequent lack of an episodic course typical of adult BD. Methods: We repeatedly examined children meeting DSM‐IV criteria for BD (excluding episode‐duration requirements) and analyzed their clinical records to evaluate age‐at‐onset, family history, symptoms, course, and comorbidity. Results: Of 82 juveniles (aged 10.6 ± 3.6 years) diagnosed with BD, 90% had a family history of mood or substance‐use disorders, but only 10% of patients had been diagnosed with BD. In 74%, psychopathology was recognized before age 3, usually as mood and sleep disturbances, hyperactivity, aggression, and anxiety. At onset, dysphoric‐manic and mixed presentations were most common (48%), euphoric mania less (35%), and depression least (17%). Subtype diagnoses were: BP‐I (52%) > BP‐II (40%) > cyclothymia (7%). DSM episode‐duration criteria were met in 52% of cases, and frequent shifts of mood and energy were common. Limitations: Partly retrospective study of clinically diagnosed referred outpatients without a comparison group. Conclusions: Pediatric BD is often mis‐ or undiagnosed, although it often manifests with mood lability and sleep disturbances early in life. DSM BD criteria inconsistent with clinical findings require revision for pediatric application. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Bipolar Disorders Wiley

Pediatric bipolar disorder: phenomenology and course of illness

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Publisher
Wiley
Copyright
Copyright © 2004 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1398-5647
eISSN
1399-5618
D.O.I.
10.1111/j.1399-5618.2004.00128.x
Publisher site
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Abstract

Background: Specific features and diagnostic boundaries of childhood bipolar disorder (BD) remain controversial, and its differentiation from other disorders challenging, owing to high comorbidity with other common childhood disorders, and frequent lack of an episodic course typical of adult BD. Methods: We repeatedly examined children meeting DSM‐IV criteria for BD (excluding episode‐duration requirements) and analyzed their clinical records to evaluate age‐at‐onset, family history, symptoms, course, and comorbidity. Results: Of 82 juveniles (aged 10.6 ± 3.6 years) diagnosed with BD, 90% had a family history of mood or substance‐use disorders, but only 10% of patients had been diagnosed with BD. In 74%, psychopathology was recognized before age 3, usually as mood and sleep disturbances, hyperactivity, aggression, and anxiety. At onset, dysphoric‐manic and mixed presentations were most common (48%), euphoric mania less (35%), and depression least (17%). Subtype diagnoses were: BP‐I (52%) > BP‐II (40%) > cyclothymia (7%). DSM episode‐duration criteria were met in 52% of cases, and frequent shifts of mood and energy were common. Limitations: Partly retrospective study of clinically diagnosed referred outpatients without a comparison group. Conclusions: Pediatric BD is often mis‐ or undiagnosed, although it often manifests with mood lability and sleep disturbances early in life. DSM BD criteria inconsistent with clinical findings require revision for pediatric application.

Journal

Bipolar DisordersWiley

Published: Aug 1, 2004

References

  • Review of studies of child and adolescent offspring of bipolar parents
    Delbello, Delbello; Geller, Geller
  • Externalizing disorders in consecutively referred children and adolescents with bipolar disorder
    Masi, Masi; Toni, Toni; Perugi, Perugi
  • No evidence of attentional deficits in stabilized bipolar youth relative to unipolar and control comparators
    Robertson, Robertson; Kutcher, Kutcher; Lagace, Lagace
  • A plea for integrity of the bipolar disorder concept
    Baldessarini, Baldessarini

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