Phenomenology and Course of Pediatric Bipolar Disorder

Faedda GL, Baldessarini RJ, Glovinsky IP, Austin NB.

Bipolar Disorder 2004: 6: 305–313.

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.