DECADE OF DISCOVERY IN PEDIATRIC BD

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.

Summary

In this review of a decade of literature on pediatric bipolar disorder (BD), the debate about what constitutes core symptoms of BD in children and adolescents continues. Children younger than 10 years often have labile and changeable moods because they have not yet reached emotional, neurocognitive, and physical maturity. Authorities agree on several features that are typical of persons with pediatric BD, including prominent irritability, high rate of comorbid attention deficit hyperactivity disorder (ADHD), predominantly mixed episodes and/or rapid cycling, and chronicity with long episodes.

It is difficult to differentiate BD from ADHD. In addition, BD often coexists with ADHD, oppositional defiant disorder, conduct disorder, and anxiety disorder.

The FDA has not approved any psychotropic medications for patients with pediatric BD, with the exception of lithium for patients younger than 13 years. In published studies, the combination of mood stabilizers and atypical antipsychotic agents seems effective for acute management and stabilization of pediatric BD.

For persons who have comorbid BD and ADHD, combination therapy with a mood stabilizer and a stimulant may be helpful. The authors conclude that more randomized controlled trials are needed. Models of psychoeducation and cognitive behavior therapy for child and family are being studied.

Commentary

In this article, Pavuluri and colleagues present a comprehensive, timely, and balanced review of what is currently known about BD in children and adolescents. They discuss the following about BD: clinical characteristics, epidemiology, assessment measures, differential diagnosis, comorbidity, outcome studies, biologic studies, psychosocial risk factors, early clinical indicators, pharmacotherapy, and psychotherapy.

The well-written article is an excellent review for both researchers and clinicians who work with children or adolescents with mood disorders, and BD in particular. The authors address the controversies surrounding this diagnosis in children and adolescents and offer future directions for research.

If you want to read one article on the latest findings about pediatric BD, this should be it.

Robert A. Kowatch, MD Professor of Psychiatry and Pediatrics University of Cincinnati College of Medicine Director, Pediatric Mood Disorders Center Cincinnati Children's Hospital Medical Center Cincinnati