Skip to main content

Advertisement

SpringerLink
Log in

Update on pediatric bipolar disorder

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Children and adolescents with a bipolar disorder experience mood dysregulation that is often chronic with little interepisodic recovery. Although bipolar disorder in youth is recognized by more and more clinicians, much is still not known regarding how best to accurately diagnose and effectively treat it. As a result, children and adolescents with bipolar disorder are often symptomatic for long periods of time before receiving appropriate treatment. In this review of the pediatric bipolar disorder literature, the phenomenology, longitudinal course, and risk factors associated with the illness’ development are discussed. Also, recent research pertaining to neuroimaging and pharmacologic and psychological treatments are considered. Because pediatric bipolar disorder is such a pernicious condition, it is recommended that clinicians complete a careful assessment of mood symptoms and comorbid conditions when this illness is suspected so that they can provide treatments with the best chance of benefit in a timely manner.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

    Google Scholar 

  2. Pavuluri MN, Birmaher B, Naylor MW: Pediatric bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2005, 44:846–871.

    Article  PubMed  Google Scholar 

  3. McClellan J, Kowatch R, Findling RL, et al.: Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007, 46:107–125.

    Article  PubMed  Google Scholar 

  4. Goldstein BI, Levitt AJ: Further evidence for a developmental subtype of bipolar disorder defined by age at onset: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Psychiatry 2006, 163:1633–1636.

    Article  PubMed  Google Scholar 

  5. Axelson D, Birmaher B, Strober M, et al.: Phenomenology of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 2006, 63:1139–1148.

    Article  PubMed  Google Scholar 

  6. Birmaher B, Axelson D, Strober M, et al.: Clinical course of children and adolescents with bipolar spectrum disorders. Arch Gen Psychiatry 2006, 63:175–183.

    Article  PubMed  Google Scholar 

  7. Strober M, Carlson G: Bipolar illness in adolescents with major depression: clinical, genetic and psychopharmacologic predictors in a three-to four-year prospective follow-up investigation. Arch Gen Psychiatry 1982, 39:549–555.

    PubMed  CAS  Google Scholar 

  8. Mick E, Spencer T, Wozniak J, et al.: Heterogeneity of irritability in attention-deficit/hyperactivity disorder subjects with and without mood disorders. Biol Psychiatry 2005, 58:570–582.

    Article  Google Scholar 

  9. Geller B, Zimerman B, Williams M, et al.: DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls. J Child Adolesc Psychopharmacol 2002, 12:11–25.

    Article  PubMed  Google Scholar 

  10. Kowatch RA, Youngstrom EA, Danielyan A, Findling RL: Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disord 2005, 7:483–496.

    Article  PubMed  Google Scholar 

  11. Leverich GS, Post RM, Keck PE, et al.: The poor prognosis of childhood-onset bipolar disorder. J Pediatr 2007, 150:485–490.

    Article  PubMed  Google Scholar 

  12. Geller B, Tillman R, Craney JL, et al.: Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Arch Gen Psychiatry 2004, 61:459–467.

    Article  PubMed  Google Scholar 

  13. Findling RL, Gracious BL, McNamara NK, et al.: Rapid, continuous cycling and psychiatric co-morbidity in pediatric bipolar I disorder. Bipolar Disord 2001, 3:202–210.

    Article  PubMed  CAS  Google Scholar 

  14. Birmaher B, Axelson D: Course and outcome of bipolar spectrum disorder in children and adolescents: a review of the existing literature. Dev Psychopathol 2006, 18:1023–1035.

    Article  PubMed  Google Scholar 

  15. Chang KD, Steiner H, Ketter TA: Psychiatric phenomenology of child and adolescent bipolar offspring. J Am Acad Child Adolesc Psychiatry 2000, 39:453–460.

    Article  PubMed  CAS  Google Scholar 

  16. Henin A, Biederman J, Mick E, et al.: Psychopathology in the offspring of parents with bipolar disorder: a controlled study. Biol Psychiatry 2005, 58:554–561.

    Article  PubMed  Google Scholar 

  17. Farmer A, Elkin A, McGuffin P: The genetics of bipolar affective disorder. Curr Opin Psychiatry 2007, 20:8–12.

    Article  PubMed  Google Scholar 

  18. O’Donovan M, Jones I, Craddock N: Anticipation and repeat expansion in bipolar disorder. Am J Med Genet C Semin Med Genet 2003, 123:10–17.

    Article  PubMed  Google Scholar 

  19. Frazier JA, Ahn MS, DeJong S, et al.: Magnetic resonance imaging studies in early-onset bipolar disorder: a critical review. Harv Rev Psychiatry 2005, 13:125–140.

    Article  PubMed  Google Scholar 

  20. Blumberg HP, Krystal JH, Bansal R, et al.: Age, rapid-cycling, and pharmacotherapy effects on ventral prefrontal cortex in bipolar disorder: a cross-sectional study. Biol Psychiatry 2006, 59:611–618.

    Article  PubMed  CAS  Google Scholar 

  21. Davanzo P, Yue K, Thomas MA, et al.: Proton magnetic resonance spectroscopy of bipolar disorder versus intermittent explosive disorder in children and adolescents. Am J Psychiatry 2003, 16:1442–1452.

    Article  Google Scholar 

  22. Chang K, Adleman N, Dienes K, et al.: Decreased N-acetylaspartate in children with familial bipolar disorder. Biol Psychiatry 2003, 53:1059–1065.

    Article  PubMed  CAS  Google Scholar 

  23. Moore CM, Frazier JA, Glod CA, et al.: Glutamine and glutamate levels in children and adolescents with bipolar disorder: a 4.0-T proton magnetic resonance spectroscopy study of the anterior cingulated cortex. J Am Acad Child Adolesc Psychiatry 2007, 46:524–534.

    Article  PubMed  Google Scholar 

  24. Pavuluri MN, Schenkel LS, Aryal S, et al.: Neurocognitive function in unmedicated manic and medicated euthymic pediatric bipolar patients Am J Psychiatry 2006, 163:286–293.

    Article  PubMed  Google Scholar 

  25. Henin A, Mick E, Biederman J, et al.: Can bipolar disorder-specific neuropsychological impairments in children be identified? J Consult Clin Psychol 2007, 75:210–220.

    Article  PubMed  Google Scholar 

  26. Blumberg HP, Leung HC, Skudlarski P, et al.: A functional magnetic resonance imaging study of bipolar disorder: state- and trait-related dysfunction in ventral prefrontal cortices. Arch Gen Psychiatry 2003, 60:601–609.

    Article  PubMed  Google Scholar 

  27. Chang K, Adleman NE, Dienes K, et al.: Anomalous prefrontal-subcortical activation in familial pediatric bipolar disorder: a functional magnetic resonance imaging investigation. Arch Gen Psychiatry 2004, 61:781–792.

    Article  PubMed  Google Scholar 

  28. McClure E, Pope K, Hoberman A, et al.: Facial expression recognition in adolescents with mood and anxiety disorders. Am J Psychiatry 2003, 160:1–3.

    Article  Google Scholar 

  29. Rich BA, Vinton DT, Roberson-Nay R, et al.: Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proc Natl Acad Sci U S A 2006, 103:8900–8905.

    Article  PubMed  CAS  Google Scholar 

  30. Geller B, Cooper TB, Sun K, et al.: Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. J Am Acad Child Adolesc Psychiatry 1998, 37:171–178.

    Article  PubMed  CAS  Google Scholar 

  31. Tohen M, Kryzhanovskaya L, Carlson G, et al.: Olanzapine versus placebo for the treatment of acute mania in adolescents with bipolar disorder: efficacy and safety results of a 3-week, randomized, double-blind study. Am J Psychiatry 2007, In press.

  32. DelBello MP, Findling RL, Kushner S, et al.: Topiramate for the treatment of acute mania in children and adolescents: a double-blind, randomized, placebo-controlled study. J Am Acad Child Adolesc Psychiatry 2005, 44:539–547.

    Article  PubMed  Google Scholar 

  33. Segal S: A double-blind, placebo-controlled trial to evaluate the safety and efficacy of depakote ER for the treatment of mania associated with bipolar disorder in children and adolescents. http://www.clinicalstudyresults.org/drugdetails/?company_id=1&sort=c.company_name&page=1&drug_id=1561. Accessed June 2007.

  34. Kafantaris V, Coletti DJ, Dicker R, et al.: Lithium treatment of acute mania in adolescents: a placebo controlled discontinuation study. J Am Acad Child Adolesc Psychiatry 2004, 43:984–993.

    Article  PubMed  Google Scholar 

  35. Findling RL, McNamara NK, Youngstrom EA, et al.: Double-blind 18-month trial of lithium versus divalproex sodium maintenance treatment in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005, 44:409–417.

    Article  PubMed  Google Scholar 

  36. Findling RL, McNamara NK, Gracious BL, et al.: Combination lithium and divalproex sodium in pediatric bipolarity. J Am Acad Child Adolesc Psychiatry 2003, 42:895–901.

    Article  PubMed  Google Scholar 

  37. Findling RL, McNamara NK, Stansbrey R, et al.: Combination lithium and divalproex sodium in pediatric bipolar symptom restabilization. J Am Acad Child Adolesc Psychiatry 2006, 45:142–148.

    Article  PubMed  Google Scholar 

  38. DelBello MP, Schwiers ML, Rosenberg HL, et al.: A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry 2002, 41:1216–1223.

    Article  PubMed  Google Scholar 

  39. Kowatch RA, Sethuraman G, Hume JH, et al.: Combination pharmacotherapy in children and adolescents with bipolar disorder. Biol Psychiatry 2003, 53:978–984.

    Article  PubMed  CAS  Google Scholar 

  40. Baumer FM, Howe M, Gallelli K, et al.: A pilot study of antidepressant-induced mania in pediatric bipolar disorder: characteristics, risk factors, and the serotonin transporter gene. Biol Psychiatry 2006, 60:1005–1012.

    Article  PubMed  CAS  Google Scholar 

  41. Kowatch RA, Fristad M, Birmaher B, et al.: Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005, 44:213–235.

    Article  PubMed  Google Scholar 

  42. Findling RL, Short EJ, McNamara NK, et al.: Methylphenidate in the treatment of children and adolescents with bipolar disorder and attention deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007, In press.

  43. Scheffer R, Kowatch R, Carmody T, et al.: Randomized placebo controlled trial of dexedrine for symptoms of comorbid ADHD in pediatric bipolar disorder. Am J Psychiatry 2005, 162:58–64.

    Article  PubMed  Google Scholar 

  44. Fristad MA: Psychoeducational treatment for school-aged children with bipolar disorder. Dev Psychopathol 2006, 18:1289–1306.

    Article  PubMed  Google Scholar 

  45. Fristad MA, Gavazzi SM, Soldano KW: Multi-family psychoeducation groups for childhood mood disorders: a program description and preliminary efficacy data. Contemp Fam Ther 1998, 20:385–402.

    Article  Google Scholar 

  46. Fristad MA, Arnett MM, Gavazzi SM: The impact of psychoeducational workshops on families of mood-disordered children. Fam Ther 1998, 25:151–159.

    Google Scholar 

  47. Simoneau TL, Miklowitz DJ, Richards JA, et al.: Bipolar disorder and family communication: effects of a psychoeducational treatment program. J Abnorm Psychol 1999, 108:588–597.

    Article  PubMed  CAS  Google Scholar 

  48. Miklowitz DJ, George EL, Axelson DA, et al.: Family-focused treatment for adolescents with bipolar disorder. J Affect Disord 2004, 82(Suppl 1):S113–S128.

    Article  PubMed  Google Scholar 

  49. Miklowitz DJ, Biuckians A, Richards JA: Early onset bipolar disorder: a family treatment perspective. Dev Psychopathol 2006, 18:1247–1265.

    Article  PubMed  Google Scholar 

  50. Feeny NC, Danielson CK, Schwartz L, et al.: Cognitive-behavioral therapy for bipolar disorders in adolescents: a pilot study. Bipolar Disord 2006, 8:508–515.

    Article  PubMed  Google Scholar 

  51. Pavuluri MN, Graczyk PA, Henry DB, et al.: Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: development and preliminary results. J Am Acad Child Adolesc Psychiatry 2004, 43:528–537.

    Article  PubMed  Google Scholar 

  52. Hlastala SA, Frank E: Adapting interpersonal and social rhythm therapy to the developmental needs of adolescents with bipolar disorder. Dev Psychopathol 2006, 18:1267–1288.

    Article  PubMed  Google Scholar 

  53. Frank E, Kupfer DJ, Thase ME, et al.: Two year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005, 62:996–1004.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Child and Adolescent Psychiatry, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5080, USA

    Robert L. Findling

Authors
  1. Lisa D. Townsend
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine A. Demeter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert L. Findling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert L. Findling.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Townsend, L.D., Demeter, C.A., Wilson, M. et al. Update on pediatric bipolar disorder. Curr Psychiatry Rep 9, 529–534 (2007). https://doi.org/10.1007/s11920-007-0072-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-007-0072-0

Keywords

Search

Navigation