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

248 B. Birmaher and D. Axelsonwith mixed presentations and/or rapid cycles appear to have a poorer responseto the mood stabilizers. More recently, open studies have shown that BP childrenand adolescents may respond to the atypical antipsychotics (e.g., Frazier et al.,2001). In contrast, studies including children with very short periods of mania/depression and ‘‘continuous’’ symptoms of BP disorder have contradictoryresponses to the mood stabilizers. However, more RCT studies with large samplesare indicated.SummaryFor the past decade it has become clear that children and adolescents mayexperience DSM-IV BP syndromes. However, it appears that most of these childrenand adolescents have shorter episodes of mania, hypomania, and depression,higher prevalence of mixed and rapid episodes, and worse prognosis than theiradult counterparts. Epidemiological, follow-up, family, and treatment studieshave helped to validate the presence of BP disorder in children and adolescentsbut further studies are needed, especially to validate the diagnosis of BP disorder inyouth, in particular those with very rapid or continuous mood lability. It is ofcritical importance to be aware of the BP diagnosis in children and adolescents andto be able to differentiate from other psychiatric disorders (e.g., ADHD, ODD)because BP children and adolescents have a poor prognosis and are at risk forsuicide and development of other psychiatric conditions (e.g., substance abuse,behavior problems) unless they have the appropriate treatment.ACKNOWLEDGMENTThe authors would like to thank Carol Kostek for her assistance with the manuscriptpreparation.REFERENCESAkiskal, H. S., Downs, J., Jordon, P., et al. (1985). Affective disorders in referred children andyounger siblings of manic-depressives: mode of onset and prospective course. Archi. Gen.Psychiatry, 42, 996–1004.American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders4th edn (DSM-IV). Washington, DC: American Psychiatric Association.Axelson, D., Birmaher, B., Ulloa, R. E., et al. (1998). Bipolar children and adolescents from amood disorder clinic. 45th Annual Meeting of the American Academy of Child andAdolescent Psychiatry, Anaheim, CA.