Progress in diagnosis and treatment of bipolar disorder among children and adolescents: an international perspective

Abstract

Bipolar disorder (BPD) is a potentially lifelong condition characterised by extreme changes in mood that may begin in childhood and cause substantial impairment. Over the past decades, BPD has been the focus of increased attention mainly due to controversies surrounding its prevalence, diagnosis and treatment in children and adolescents. This report addresses these controversies by reviewing the extant evidence base, providing clinicians with a summary of the literature on diagnosis, phenomenology and treatment of paediatric BPD. The debate regarding diagnosing children with BPD based on severe irritability and aggression is mostly resolved. The current data support utilising the diagnostic criteria based on episodic changes of mood polarity. Therefore, longitudinal course of illness should be explored in detail when diagnosing BPD. Given high rates of genetic predisposition for BPD, assessment of youth should focus on obtaining accurate family history of this condition. Additionally, there has been a substantial increase in randomised placebo-controlled clinical trials evaluating pharmacological agents for mood stabilisation in children and adolescents, which we summarise in this review. Despite significant progress being made in the field of paediatric BPD, more research is needed in the areas of phenomenology, pathophysiology, course and treatment of this condition in youth.

Bipolar disorder in children and adolescents

“…We can therefore say that the clinician should be particularly attentive when prodromal symptoms appear in children or adolescents from high-risk families (both parents), and this all the more so if the clinic also reports substance abuse and / or suicide attempts [25].…”

Mania symptoms in a Swedish longitudinal population study: The roles of childhood trauma and neurodevelopmental disorders

“…In this study we have chosen to focus on juvenile mania symptoms as mania usually emerges for the first time in adolescence and is an important first sign of severe "adult-type" mental illness such as BD (Faedda et al, 2015;Findling et al, 2018;Van Meter et al, 2016). Our study aimed to investigate, in a prospective design, the relative contribution of childhood traumatic events (CTEs) and NDDs to symptoms of mania in adolescence, and whether children who have experienced CTEs and have NDDs are at a greater risk of developing mania symptoms than the children who have experienced either CTEs or NDDs (i.e., whether the risk associated with CTEs and NDDs is additive).…”

Bipolar disorder increases the risk of poor sleep quality among senior high school students

“…(10) The need to gain a deeper understanding on bipolar disorder, particularly in children and adolescents, is commonly acknowledged. (11) It is considered important to add studies from non-Western countries since most published literature come from the Northern hemisphere. (2) Since mental health among children and adolescents will impose a serious health burden on developing countries like Indonesia, research from our country to gain more comprehensive insight concerning paediatric bipolar disorder would be very strategic and valuable.…”