Pediatric bipolar disorder: phenomenology and course of illness

Abstract

Pediatric BD is often mis- or undiagnosed, although it often manifests with mood lability and sleep disturbances early in life. DSM BD criteria inconsistent with clinical findings require revision for pediatric application.

Pediyatrik Bipolar Bozuklukta Fenomenolojik Özellikler ve Psikiyatrik Komorbidite

“…Compared to the study by Kowatch et al, we have reported much more symptoms with detailed description and frequency that were reported or observed during bipolar mood episodes. Majority of the symptoms reported in the current study are consistent with the study by Kowatch et al and other studies on the phenomenology of BD in young subjects (15,30). An important difference may be the fact that while we have reported a high rate of verbal/physical aggression (70%) during bipolar mood episodes, Kowatch et al did not include this symptom in their study (14).…”

“…Despite BD may frequently manifest in broad phenotype among young subjects, majority of the subjects in this study had DSM-IV-defined BD type I or II. However it may be important to note that many studies on pediatric BD that were cited in this paper have also included subjects with a diagnosis of BD-NOS (15,19,30). This study may have several limitations.…”

“…Verbal and/or physical aggression in these subjects were either emerged or worsened during mood episodes. However aggression, despite not a typical manic symptom, has been reported as high as 90% in young subjects with BD in the literature (3,4,9,15,30).…”

Transtorno bipolar do humor e uso indevido de substâncias psicoativas

“…Eles detectaram que aqueles com transtorno de conduta na infância tinham maior probabilidade de desenvolvimento do uso indevido de substâncias se comparados aos bipolares sem problemas de comportamento durante a infância. Há ainda a possibilidade de os transtornos de conduta e comportamentos disruptivos infantis serem, na realidade, sintomas de mania na infância, uma categoria nosológica que recebeu pouca atenção dos profissionais até recentemente, reforçando o elo causal entre o transtorno bipolar e o uso indevido de substâncias psicoativas na idade adulta (Faedda et al, 2004;Levin e Hennesy, 2004;Lima, 2004).…”

Paediatric Bipolar Disorder – Are Attachment and Trauma Factors Considered?

“…The fact that the CBCL-JBD phenotype taps into a trait relevant to a range of psychiatric disorders may help to explain the profile's lack of diagnostic specificity to juvenile-onset BPD in clinical studies." Six articles mentioned the term "abuse": physical and sexual abuse were listed in a trauma list (Wozniak et al, 1999); brief mention of sexual abuse as a differential to manic hypersexuality (Soutullo et al, 2009); physical and sexual abuse briefly mentioned in relation to PTSD (Steinbuchel et al, 2009); abuse in a citation title which is referenced in the text: "findings in the pediatric (Ackerman et al, 1998) and adult (Kessler et al, 1995) literature document high rates of comorbid PTSD in bipolar subjects" (Harpold et al, 2005); a study (Baldessarini et al, 2004) reported "no history of physical or sexual abuse was found in any case" in a cohort of 82 PBD children (73% prepubertal with 74% having "onset of first symptoms" under age 3).…”