Self-Education

Understanding Franny is a wonderful story about Bipolar Disorder in a child. Written and illustrated by Rachel, it is a touching account of pain and struggles and successes. Witty, humorous and insightful, this story is appropriate for children of all ages, and their parents/families.

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In an article appearing on Newsday on January 2nd, science reporter Jamie Talan discusses the issue of Bipolar Disorder in children.

An interview with Gianni Faedda, author of Parenting Your Bipolar Child.

New Harbinger Publications: The typical onset of bipolar disorder (BD) is late adolescence or early adulthood. How common is the childhood onset of the disease?

Gianni Faedda: This is a very complex question. First, it depends on how BD is defined: mania (BP-I) is far less common than hypomania (BP-II when alternating with Major Depression). Second, it depends on how one defines “onset”: a mild symptom, a severe symptom, a cluster of symptoms, a certain duration of symptom, meeting diagnostic criteria, and so forth. It appears as if in some people the illness might manifest somewhat differently depending on their age. For instance, in children symptoms are more chronic yet fluctuating rather than the more clearly defined episodes of adulthood. Some cases do not reach full syndromal expression until adulthood, but some symptoms are usually present (often undetected) since childhood or adolescence. And even though they might not be technically described as adult BD, these forms already have all the features of BD.

Just like other medical illnesses, BD develops and progresses over time on a genetic vulnerability; it is usually not an all or nothing type of event, like a seizure or an injury. The unfolding of the disorder is a lot more complex than the “onset” age can tell us.

This area is dedicated to patients' self education. To read about MDI, you can access our Articles' Library here or our online book here. Scroll down for a list of conferences and seminars. You can also search articles and topics in the website.
If you are interested in reading about famous people with Bipolar Disorder you will find many intersting links here. If you want to read about Anxiety Disorders follow the link.
Drs. Faedda and Austin's book on Early Onset Bipolar Disorder can be found here.

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

Journal of Affective Disorders 2004 Oct 1;82(1):149-58.

Background: Pediatric bipolar disorder (BPD) can be misdiagnosed as a depressive, attention, conduct, or anxiety disorder and treatment with antidepressants and stimulants is common. Risk of adverse outcomes related to such treatment remains poorly defined.
Methods: We analyzed clinical records of 82 children (mean age 10.6 years) meeting modified DSM-IV diagnostic criteria for BPD to evaluate risk and timing of operationally-defined treatment-emergent mania (TEM) or increased mood-cycling following pharmacological treatment.
Results: Of 82 juvenile BPD patients, 57 (69%) had been given a moodelevating agent at least once; 33/57 (58%) so-exposed met criteria for TEM, with median latency of 14 days; TEM was observed twice as often with antidepressants as stimulants (44% vs. 18%). TEM led to first-recognition of BPD in 14 cases (17%), and some drug-exposed children (4–9%) had prominent suicidal, homicidal or psychotic behavior. In addition to recent exposure to a mood-elevating agent, TEM was associated with early-onset anxiety and female gender.
Limitations: Findings are retrospective in clinically diagnosed and treated outpatients, but involved otherwise unselected cases of juvenile BPD.

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

Pediatric-onset bipolar disorder: a neglected clinical and public health problem.
Authors: Faedda GL, Baldessarini RJ, Suppes T, Tondo L, Becker I, Lipschitz DS. International Consortium on Bipolar Disorders Research, Albert Einstein College of Medicine, Bronx, N.Y., USA. Harv Rev Psychiatry 1995 Nov-Dec;3(4):171-95
Bipolar disorder (BPD), probably the most prevalent psychotic disorder in adults, has been relatively neglected or controversial in children and adolescents over the past century. We reviewed the literature on early-onset BPD. Estimates of prevalence, particularly before puberty, are limited by historical biases against pediatric mood disorders and by formidable diagnostic complexity and comorbidity. Although clinical features of pediatric and adult BPD have similarities, pediatric cases probably cannot be defined solely by features characteristic of adult cases. Onset was before age 20 years in at least 25% of reported BPD cases, with some increase in this incidence over the past century. Pediatric BPD is familial more often than is adult-onset BPD, may be associated with a premorbid cyclothymic or hyperthymic temperament, and can be precipitated by antidepressant treatment. Pediatric BPD episodes frequently include irritability, dysphoria, or psychotic symptoms; they are commonly chronic and carry high risks of substance abuse and suicide. BPD is often recognized in adolescents, but the syndrome or its antecedents are almost certainly underrecognized and undertreated in children. Controlled studies of short- and long-term treatment, course, and outcome in this disorder remain strikingly limited, and the syndrome urgently requires increased clinical and scientific interest.