Advertisement

Neurocognitive performance in children and adolescents with bipolar disorder: a review

  • Karin HornEmail author
  • Veit Roessner
  • Martin Holtmann
Review

Abstract

A number of studies have reported the evidence of cognitive deficits in adult bipolar patients. Recently, there has been a shift in research on neurocognitive performance in bipolar disorder (BD) towards examining younger age groups. A review of the literature on neurocognitive impairments in BD in childhood and adolescence was conducted. We searched systematically for studies in samples of age groups younger than 18 years of age in average that included either a healthy control group or normative data for the cognitive tests used. Twenty-one original articles were found and reviewed. Children and adolescents with BD show deficits in a variety of cognitive areas. The most consistent results were found for impairments in verbal memory. A majority of studies also indicated impairments in working memory. Similar pattern of neurocognitive impairment was found in children and adolescents as compared to adults suffering from BD. The neurocognitive deficits need to be recognized and incorporated into individual treatment programs.

Keywords

Bipolar disorder Childhood Adolescence Neuropsychology Neurocognitive function 

Notes

Acknowledgments

The author would like to thank Colleen M. Schmitz and Douglas A. Orsini for their help with the manuscript.

Conflict of interest

Karin Horn: has no conflicts of interest to disclose. Veit Roessner: has received lecture fees from Eli Lilly, Janssen-Cilag, Medice, Novartis; was member of advisory boards of Eli Lilly, Novartis. Martin Holtmann: has received speaker bench fees from Lilly, Astra Zeneca, Novartis, Shire, Bristol-Myers Squibb and Neuroconn; was member of advisory boards of Lilly, Novartis and Bristol-Myers Squibb and consultancy of Astra Zeneca; has received a research grant from German Research Federation.

References

  1. 1.
    Altshuler LL, Bearden CE, Green MF, van Gorp W, Mintz J (2008) A relationship between neurocognitive impairment and functional impairment in bipolar disorder: a pilot study. Psychiatry Res 157:289–293PubMedCrossRefGoogle Scholar
  2. 2.
    Arts B, Jabben N, Krabbendam L, van Os J (2008) Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychol Med 38:771–785PubMedCrossRefGoogle Scholar
  3. 3.
    Balanza-Martinez V, Rubio C, Selva-Vera G, Martinez-Aran A, Sanchez-Moreno J, Salazar-Fraile J, Vieta E, Tabares-Seisdedos R (2008) Neurocognitive endophenotypes (endophenocognitypes) from studies of relatives of bipolar disorder subjects: a systematic review. Neurosci Biobehav Rev 32:1426–1438PubMedCrossRefGoogle Scholar
  4. 4.
    Balanza-Martinez V, Selva G, Martinez-Aran A, Prickaerts J, Salazar J, Gonzalez-Pinto A, Vieta E, Tabares-Seisdedos R (2010) Neurocognition in bipolar disorders—a closer look at comorbidities and medications. Eur J Pharmacol 626:87–96PubMedCrossRefGoogle Scholar
  5. 5.
    Bearden CE, Glahn DC, Caetano S, Olvera RL, Fonseca M, Najt P, Hunter K, Pliszka SR, Soares JC (2007) Evidence for disruption in prefrontal cortical functions in juvenile bipolar disorder. Bipolar Disord 9(Suppl 1):145–159PubMedCrossRefGoogle Scholar
  6. 6.
    Birmaher B, Axelson D, Goldstein B, Strober M, Gill MK, Hunt J, Houck P, Ha W, Iyengar S, Kim E, Yen S, Hower H, Esposito-Smythers C, Goldstein T, Ryan N, Keller M (2009) Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study. Am J Psychiatry 166:795–804PubMedCrossRefGoogle Scholar
  7. 7.
    Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonard H, Hunt J, Iyengar S, Keller M (2006) Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 63:175–183PubMedCrossRefGoogle Scholar
  8. 8.
    Blumberg HP, Martin A, Kaufman J, Leung HC, Skudlarski P, Lacadie C, Fulbright RK, Gore JC, Charney DS, Krystal JH, Peterson BS (2003) Frontostriatal abnormalities in adolescents with bipolar disorder: preliminary observations from functional MRI. Am J Psychiatry 160:1345–1347PubMedCrossRefGoogle Scholar
  9. 9.
    Brissos S, Dias VV, Kapczinski F (2008) Cognitive performance and quality of life in bipolar disorder. Can J Psychiatry 53:517–524PubMedGoogle Scholar
  10. 10.
    Brotman MA, Rooney MH, Skup M, Pine DS, Leibenluft E (2009) Increased intrasubject variability in response time in youths with bipolar disorder and at-risk family members. J Am Acad Child Adolesc Psychiatry 48:628–635PubMedCrossRefGoogle Scholar
  11. 11.
    Brotman MA, Schmajuk M, Rich BA, Dickstein DP, Guyer AE, Costello EJ, Egger HL, Angold A, Pine DS, Leibenluft E (2006) Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry 60:991–997PubMedCrossRefGoogle Scholar
  12. 12.
    Burdick KE, Gunawardane N, Woodberry K, Malhotra AK (2009) The role of general intelligence as an intermediate phenotype for neuropsychiatric disorders. Cogn Neuropsychiatry 14:299–311PubMedCrossRefGoogle Scholar
  13. 13.
    Cahill CM, Walter G, Malhi GS (2009) Neurocognition in bipolar disorder and juvenile bipolar disorder. J Can Acad Child Adolesc Psychiatry 18:221–230PubMedGoogle Scholar
  14. 14.
    Carrus D, Christodoulou T, Hadjulis M, Haldane M, Galea A, Koukopoulos A, Kumari V, Frangou S (2009) Gender differences in immediate memory in bipolar disorder. Psychol Med:1–7Google Scholar
  15. 15.
    Castillo M, Kwock L, Courvoisie H, Hooper SR (2000) Proton MR spectroscopy in children with bipolar affective disorder: preliminary observations. AJNR Am J Neuroradiol 21:832–838PubMedGoogle Scholar
  16. 16.
    Deckersbach T, Nierenberg AA, Kessler R, Lund HG, Ametrano RM, Sachs G, Rauch SL, Dougherty D (2009) Cognitive Rehabilitation for Bipolar Disorder: an Open Trial for Employed Patients with Residual Depressive Symptoms. CNS Neurosci TherGoogle Scholar
  17. 17.
    DelBello MP, Adler CM, Amicone J, Mills NP, Shear PK, Warner J, Strakowski SM (2004) Parametric neurocognitive task design: a pilot study of sustained attention in adolescents with bipolar disorder. J Affect Disord 82(Suppl 1):S79–S88PubMedCrossRefGoogle Scholar
  18. 18.
    Dickstein DP, Nelson EE, McClure EB, Grimley ME, Knopf L, Brotman MA, Rich BA, Pine DS, Leibenluft E (2007) Cognitive flexibility in phenotypes of pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 46:341–355PubMedCrossRefGoogle Scholar
  19. 19.
    Dickstein DP, Rich BA, Roberson-Nay R, Berghorst L, Vinton D, Pine DS, Leibenluft E (2007) Neural activation during encoding of emotional faces in pediatric bipolar disorder. Bipolar Disord 9:679–692PubMedCrossRefGoogle Scholar
  20. 20.
    Dickstein DP, Treland JE, Snow J, McClure EB, Mehta MS, Towbin KE, Pine DS, Leibenluft E (2004) Neuropsychological performance in pediatric bipolar disorder. Biol Psychiatry 55:32–39PubMedCrossRefGoogle Scholar
  21. 21.
    Doyle AE, Wilens TE, Kwon A, Seidman LJ, Faraone SV, Fried R, Swezey A, Snyder L, Biederman J (2005) Neuropsychological functioning in youth with bipolar disorder. Biol Psychiatry 58:540–548PubMedCrossRefGoogle Scholar
  22. 22.
    Doyle AE, Wozniak J, Wilens TE, Henin A, Seidman LJ, Petty C, Fried R, Gross LM, Faraone SV, Biederman J (2009) Neurocognitive impairment in unaffected siblings of youth with bipolar disorder. Psychol Med 39:1253–1263PubMedCrossRefGoogle Scholar
  23. 23.
    Duffy A, Alda M, Hajek T, Sherry SB, Grof P (2009) Early stages in the development of bipolar disorder. J Affect DisordGoogle Scholar
  24. 24.
    Ernst M, Dickstein DP, Munson S, Eshel N, Pradella A, Jazbec S, Pine DS, Leibenluft E (2004) Reward-related processes in pediatric bipolar disorder: a pilot study. J Affect Disord 82(Suppl 1):S89–S101PubMedCrossRefGoogle Scholar
  25. 25.
    Fisher M, Holland C, Subramaniam K, Vinogradov S (2009) Neuroplasticity-Based Cognitive Training in Schizophrenia: An Interim Report on the Effects 6 Months Later. Schizophr BullGoogle Scholar
  26. 26.
    Geller B, Tillman R, Bolhofner K, Zimerman B (2008) Child bipolar I disorder: prospective continuity with adult bipolar I disorder; characteristics of second and third episodes; predictors of 8-year outcome. Arch Gen Psychiatry 65:1125–1133PubMedCrossRefGoogle Scholar
  27. 27.
    Glahn DC, Bearden CE, Barguil M, Barrett J, Reichenberg A, Bowden CL, Soares JC, Velligan DI (2007) The neurocognitive signature of psychotic bipolar disorder. Biol Psychiatry 62:910–916PubMedCrossRefGoogle Scholar
  28. 28.
    Glahn DC, Bearden CE, Caetano S, Fonseca M, Najt P, Hunter K, Pliszka SR, Olvera RL, Soares JC (2005) Declarative memory impairment in pediatric bipolar disorder. Bipolar Disord 7:546–554PubMedCrossRefGoogle Scholar
  29. 29.
    Gorlyn M, Keilp JG, Grunebaum MF, Taylor BP, Oquendo MA, Bruder GE, Stewart JW, Zalsman G, Mann JJ (2008) Neuropsychological characteristics as predictors of SSRI treatment response in depressed subjects. J Neural Transm 115:1213–1219PubMedCrossRefGoogle Scholar
  30. 30.
    Gorrindo T, Blair RJ, Budhani S, Dickstein DP, Pine DS, Leibenluft E (2005) Deficits on a probabilistic response-reversal task in patients with pediatric bipolar disorder. Am J Psychiatry 162:1975–1977PubMedCrossRefGoogle Scholar
  31. 31.
    Guyer AE, McClure EB, Adler AD, Brotman MA, Rich BA, Kimes AS, Pine DS, Ernst M, Leibenluft E (2007) Specificity of facial expression labeling deficits in childhood psychopathology. J Child Psychol Psychiatry 48:863–871PubMedCrossRefGoogle Scholar
  32. 32.
    Harvey PD, Wingo AP, Burdick KE, Baldessarini RJ (2010) Cognition and disability in bipolar disorder: lessons from schizophrenia research. Bipolar Disord 12:364–375PubMedCrossRefGoogle Scholar
  33. 33.
    Henin A, Mick E, Biederman J, Fried R, Hirshfeld-Becker DR, Micco JA, Miller KG, Rycyna CC, Wozniak J (2009) Is psychopharmacologic treatment associated with neuropsychological deficits in bipolar youth? J Clin Psychiatry 70:1178–1185PubMedCrossRefGoogle Scholar
  34. 34.
    Henin A, Mick E, Biederman J, Fried R, Wozniak J, Faraone SV, Harrington K, Davis S, Doyle AE (2007) Can bipolar disorder-specific neuropsychological impairments in children be identified? J Consult Clin Psychol 75:210–220PubMedCrossRefGoogle Scholar
  35. 35.
    Hill SK, Harris MS, Herbener ES, Pavuluri M, Sweeney JA (2008) Neurocognitive allied phenotypes for schizophrenia and bipolar disorder. Schizophr Bull 34:743–759PubMedCrossRefGoogle Scholar
  36. 36.
    Holtmann M, Buchmann AF, Esser G, Schmidt MH, Banaschewski T, Laucht M (2011) The Child Behavior Checklist-Dysregulation Profile predicts substance use, suicidality, and functional impairment: a longitudinal analysis. J Child Psychol Psychiatry 52:139–147PubMedCrossRefGoogle Scholar
  37. 37.
    Holtmann M, Goth K, Wockel L, Poustka F, Bolte S (2008) CBCL-pediatric bipolar disorder phenotype: severe ADHD or bipolar disorder? J Neural Transm 115:155–161PubMedCrossRefGoogle Scholar
  38. 38.
    Hsiao YL, Wu YS, Wu JY, Hsu MH, Chen HC, Lee SY, Lee IH, Yeh TL, Yang YK, Ko HC, Lu RB (2009) Neuropsychological functions in patients with bipolar I and bipolar II disorder. Bipolar Disord 11:547–554PubMedCrossRefGoogle Scholar
  39. 39.
    Jaideep T, Reddy YC, Srinath S (2006) Comorbidity of attention deficit hyperactivity disorder in juvenile bipolar disorder. Bipolar Disord 8:182–187PubMedCrossRefGoogle Scholar
  40. 40.
    Joseph MF, Frazier TW, Youngstrom EA, Soares JC (2008) A quantitative and qualitative review of neurocognitive performance in pediatric bipolar disorder. J Child Adolesc Psychopharmacol 18:595–605PubMedCrossRefGoogle Scholar
  41. 41.
    Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlstrom K, Gillberg CG, Forssberg H, Westerberg H (2005) Computerized training of working memory in children with ADHD–a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 44:177–186PubMedCrossRefGoogle Scholar
  42. 42.
    Kowatch RA, Youngstrom EA, Danielyan A, Findling RL (2005) Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disord 7:483–496PubMedCrossRefGoogle Scholar
  43. 43.
    Kraepelin E (ed) (1915) Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Barth Verlag LeipzigGoogle Scholar
  44. 44.
    Kucyi A, Alsuwaidan MT, Liauw SS, McIntyre RS (2010) Aerobic physical exercise as a possible treatment for neurocognitive dysfunction in bipolar disorder. Postgrad Med 122:107–116PubMedCrossRefGoogle Scholar
  45. 45.
    Kurtz MM, Gerraty RT (2009) A meta-analytic investigation of neurocognitive deficits in bipolar illness: profile and effects of clinical state. Neuropsychology 23:551–562PubMedCrossRefGoogle Scholar
  46. 46.
    Kyte ZA, Carlson GA, Goodyer IM (2006) Clinical and neuropsychological characteristics of child and adolescent bipolar disorder. Psychol Med 36:1197–1211PubMedCrossRefGoogle Scholar
  47. 47.
    Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, Pine DS (2003) Defining clinical phenotypes of juvenile mania. Am J Psychiatry 160:430–437PubMedCrossRefGoogle Scholar
  48. 48.
    Lish JD, Dime-Meenan S, Whybrow PC, Price RA, Hirschfeld RM (1994) The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. J Affect Disord 31:281–294PubMedCrossRefGoogle Scholar
  49. 49.
    MacCabe JH, Lambe MP, Cnattingius S, Sham PC, David AS, Reichenberg A, Murray RM, Hultman CM (2010) Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. Br J Psychiatry 196:109–115PubMedCrossRefGoogle Scholar
  50. 50.
    Maziade M, Rouleau N, Gingras N, Boutin P, Paradis ME, Jomphe V, Boutin J, Letourneau K, Gilbert E, Lefebvre AA, Dore MC, Marino C, Battaglia M, Merette C, Roy MA (2009) Shared neurocognitive dysfunctions in young offspring at extreme risk for schizophrenia or bipolar disorder in eastern quebec multigenerational families. Schizophr Bull 35:919–930PubMedCrossRefGoogle Scholar
  51. 51.
    McCarthy J, Arrese D, McGlashan A, Rappaport B, Kraseski K, Conway F, Mule C, Tucker J (2004) Sustained attention and visual processing speed in children and adolescents with bipolar disorder and other psychiatric disorders. Psychol Rep 95:39–47PubMedGoogle Scholar
  52. 52.
    McCarthy J, Kraseski K, Schvartz I, Mercado V, Daisy N, Tobing L, Ryan E (2005) Sustained attention, visual processing speed, and IQ in children and adolescents with Schizophrenia Spectrum disorder and Psychosis Not Otherwise Specified. Percept Mot Skills 100:1097–1106PubMedGoogle Scholar
  53. 53.
    McClure EB, Treland JE, Snow J, Dickstein DP, Towbin KE, Charney DS, Pine DS, Leibenluft E (2005) Memory and learning in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 44:461–469PubMedCrossRefGoogle Scholar
  54. 54.
    McClure EB, Treland JE, Snow J, Schmajuk M, Dickstein DP, Towbin KE, Charney DS, Pine DS, Leibenluft E (2005) Deficits in social cognition and response flexibility in pediatric bipolar disorder. Am J Psychiatry 162:1644–1651PubMedCrossRefGoogle Scholar
  55. 55.
    Meyer SE, Carlson GA, Wiggs EA, Martinez PE, Ronsaville DS, Klimes-Dougan B, Gold PW, Radke-Yarrow M (2004) A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder. Dev Psychopathol 16:461–476PubMedCrossRefGoogle Scholar
  56. 56.
    Miklowitz DJ, Chang KD (2008) Prevention of bipolar disorder in at-risk children: theoretical assumptions and empirical foundations. Dev Psychopathol 20:881–897PubMedCrossRefGoogle Scholar
  57. 57.
    Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M (2007) National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry 64:1032–1039PubMedCrossRefGoogle Scholar
  58. 58.
    Olvera RL, Semrud-Clikeman M, Pliszka SR, O’Donnell L (2005) Neuropsychological deficits in adolescents with conduct disorder and comorbid bipolar disorder: a pilot study. Bipolar Disord 7:57–67PubMedCrossRefGoogle Scholar
  59. 59.
    Pavuluri MN, O’Connor MM, Harral EM, Moss M, Sweeney JA (2006) Impact of neurocognitive function on academic difficulties in pediatric bipolar disorder: a clinical translation. Biol Psychiatry 60:951–956PubMedCrossRefGoogle Scholar
  60. 60.
    Pavuluri MN, O’Connor MM, Harral EM, Sweeney JA (2008) An fMRI study of the interface between affective and cognitive neural circuitry in pediatric bipolar disorder. Psychiatry Res 162:244–255PubMedCrossRefGoogle Scholar
  61. 61.
    Pavuluri MN, Passarotti AM, Harral EM, Sweeney JA (2009) An fMRI study of the neural correlates of incidental versus directed emotion processing in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 48:308–319PubMedCrossRefGoogle Scholar
  62. 62.
    Pavuluri MN, Schenkel LS, Aryal S, Harral EM, Hill SK, Herbener ES, Sweeney JA (2006) Neurocognitive function in unmedicated manic and medicated euthymic pediatric bipolar patients. Am J Psychiatry 163:286–293PubMedCrossRefGoogle Scholar
  63. 63.
    Pavuluri MN, West A, Hill SK, Jindal K, Sweeney JA (2009) Neurocognitive function in pediatric bipolar disorder: 3-year follow-up shows cognitive development lagging behind healthy youths. J Am Acad Child Adolesc Psychiatry 48:299–307PubMedCrossRefGoogle Scholar
  64. 64.
    Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP, Bowden CL, Sachs GS, Nierenberg AA (2004) Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry 55:875–881PubMedCrossRefGoogle Scholar
  65. 65.
    Rau G, Blair KS, Berghorst L, Knopf L, Skup M, Luckenbaugh DA, Pine DS, Blair RJ, Leibenluft E (2008) Processing of differentially valued rewards and punishments in youths with bipolar disorder or severe mood dysregulation. J Child Adolesc Psychopharmacol 18:185–196PubMedCrossRefGoogle Scholar
  66. 66.
    Rich BA, Grimley ME, Schmajuk M, Blair KS, Blair RJ, Leibenluft E (2008) Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation. Dev Psychopathol 20:529–546PubMedCrossRefGoogle Scholar
  67. 67.
    Rich BA, Vinton DT, Roberson-Nay R, Hommer RE, Berghorst LH, McClure EB, Fromm SJ, Pine DS, Leibenluft E (2006) Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proc Natl Acad Sci USA 103:8900–8905PubMedCrossRefGoogle Scholar
  68. 68.
    Robinson LJ, Thompson JM, Gallagher P, Goswami U, Young AH, Ferrier IN, Moore PB (2006) A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 93:105–115PubMedCrossRefGoogle Scholar
  69. 69.
    Rucklidge JJ (2006) Impact of ADHD on the neurocognitive functioning of adolescents with bipolar disorder. Biol Psychiatry 60:921–928PubMedCrossRefGoogle Scholar
  70. 70.
    Seidman LJ, Giuliano AJ, Smith CW, Stone WS, Glatt SJ, Meyer E, Faraone SV, Tsuang MT, Cornblatt B (2006) Neuropsychological functioning in adolescents and young adults at genetic risk for schizophrenia and affective psychoses: results from the Harvard and Hillside Adolescent High Risk Studies. Schizophr Bull 32:507–524PubMedCrossRefGoogle Scholar
  71. 71.
    Shiratsuchi T, Takahashi N, Suzuki T, Abe K (2000) Depressive episodes of bipolar disorder in early teenage years: changes with increasing age and the significance of IQ. J Affect Disord 58:161–166PubMedCrossRefGoogle Scholar
  72. 72.
    Smith PJ, Blumenthal JA, Hoffman BM, Cooper H, Strauman TA, Welsh-Bohmer K, Browndyke JN, Sherwood A (2010) Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med 72:239–252PubMedCrossRefGoogle Scholar
  73. 73.
    Tabares-Seisdedos R, Balanza-Martinez V, Sanchez-Moreno J, Martinez-Aran A, Salazar-Fraile J, Selva-Vera G, Rubio C, Mata I, Gomez-Beneyto M, Vieta E (2008) Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up. J Affect Disord 109:286–299PubMedCrossRefGoogle Scholar
  74. 74.
    Twamley EW, Jeste DV, Bellack AS (2003) A review of cognitive training in schizophrenia. Schizophr Bull 29:359–382PubMedGoogle Scholar
  75. 75.
    Voelbel GT, Bates ME, Buckman JF, Pandina G, Hendren RL (2006) Caudate nucleus volume and cognitive performance: Are they related in childhood psychopathology? Biol Psychiatry 60:942–950PubMedCrossRefGoogle Scholar
  76. 76.
    Wingo AP, Harvey PD, Baldessarini RJ (2009) Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disord 11:113–125PubMedCrossRefGoogle Scholar
  77. 77.
    Wingo AP, Wingo TS, Harvey PD, Baldessarini RJ (2009) Effects of lithium on cognitive performance: a meta-analysis. J Clin Psychiatry 70:1588–1597PubMedCrossRefGoogle Scholar
  78. 78.
    Youngstrom EA, Freeman AJ, Jenkins MM (2009) The assessment of children and adolescents with bipolar disorder. Child Adolesc Psychiatr Clin N Am 18:353–390, viii-ixGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of Child and Adolescent Psychiatry/PsychotherapyUniversity of Dresden, GermanyDresdenGermany
  2. 2.LWL-University Hospital for Child and Adolescent Psychiatry, Psychotherapy and PsychosomaticsRuhr University BochumBochumGermany

Personalised recommendations