Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

10Bipolar disorder in children and adolescentsBoris Birmaher and David AxelsonUniversity of Pittsburgh Medical Center, Pittsburgh, PA, USAIntroductionThere is no doubt that children and adolescents may experience classicalKraepelinian (1921) orDiagnostic and Statistical Manual of Mental Disorders(DSM)-type bipolar disorder (BP-I, II, mixed, rapid-cycling; AmericanPsychiatric Association, 1994). However, as discussed in detail below, many BPchildren and adolescents have very short and frequent periods of mania, hypomania,or depression and, more controversially, some have continuous moodlability and irritability (Nottelman et al., 2001). Children and adolescents withBP disorder usually have poor psychosocial outcome, increased risk for suicide,substance abuse, and psychosis (Lewinsohn et al., 1995, 2000; Strober et al., 1995;Geller et al., 1998a, b, 2000a, b, 2001; Birmaher, 2001), indicating the need foraccurate diagnosis and prompt treatment of this illness.Since the research on BP disorder in children and adolescents is in its earlier stages,below we present the extant literature following in most part the criteria described byRobins and Guze (1970) to validate a psychiatric disorder, including the presence ofa reliable diagnosis that can be differentiated from other psychiatric disorders,specific course, family history, response to treatment, and biological characteristics.Because of their scarcity, no biological studies are presented in this chapter.PrevalenceA large adolescent community study, using the Schedule for Affective Disordersand Schizophrenia for School-Aged Children (6–18) epidemiologic version (K-SADS) (Chambers et al., 1985), found that, similar to adult epidemiologicalstudies, DSM-IV bipolar disorder was approximately 1% (Lewinsohn et al.,1995). However, most adolescents had BP-II (periods of major depression andhypomania) and cyclothymic disorders. Another 6% of the sample showed# Cambridge University Press, 2005.