“…Interest in bipolar disorders in adolescents has increased, with several retrospective studies revealing that 20%-60% of adults with BD had their first symptoms before the age of 20 years (Joyce, 1984;Lish et al, 1994;Perlis et al, 2004). The phenomenology of acute manic or mixed episodes in adolescents can be summarized as follows: a higher frequency of mixed episodes than purely manic ones, more frequent aggression and irritability (McElroy et al, 1997;Patel et al, 2006), the presence of psychotic signs in 30%-60% of the cases (which can lead to diagnosis difficulties (Calderoni et al, 2001;Carlson et al, 1994;Kowatch et al, 2005;Soutullo et al, 2005)), high rates of comorbidities and a higher likelihood of a rapid cycling profile (Schurhoff et al, 2000;Birmaher et al, 2006).…”