Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-18T10:43:17.984Z Has data issue: false hasContentIssue false

10 - Bipolar disorder in children and adolescents

Published online by Cambridge University Press:  10 August 2009

By
Boris Birmaher  and
David Axelson
Edited by
Andreas Marneros  and
Frederick Goodwin
Boris Birmaher
Affiliation:
University of Pittsburgh Medical Center Pittsburgh PA USA
David Axelson
Affiliation:
University of Pittsburgh Medical Center Pittsburgh PA USA
Andreas Marneros
Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin
Affiliation:
George Washington University, Washington DC
Get access

Summary

Introduction

There is no doubt that children and adolescents may experience classical Kraepelinian (1921) or Diagnostic and Statistical Manual of Mental Disorders (DSM)-type bipolar disorder (BP-I, II, mixed, rapid-cycling; American Psychiatric Association, 1994). However, as discussed in detail below, many BP children and adolescents have very short and frequent periods of mania, hypomania, or depression and, more controversially, some have continuous mood lability and irritability (Nottelman et al., 2001). Children and adolescents with BP disorder usually have poor psychosocial outcome, increased risk for suicide, substance abuse, and psychosis (Lewinsohn et al., 1995, 2000; Strober et al., 1995; Geller et al., 1998a, 1998b, 2000a, b, 2001; Birmaher, 2001), indicating the need for accurate diagnosis and prompt treatment of this illness.

Since the research on BP disorder in children and adolescents is in its earlier stages, below we present the extant literature following in most part the criteria described by Robins and Guze (1970) to validate a psychiatric disorder, including the presence of a reliable diagnosis that can be differentiated from other psychiatric disorders, specific course, family history, response to treatment, and biological characteristics. Because of their scarcity, no biological studies are presented in this chapter.

Prevalence

A large adolescent community study, using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (6–18) epidemiologic version (K-SADS) (Chambers et al., 1985), found that, similar to adult epidemiological studies, DSM-IV bipolar disorder was approximately 1% (Lewinsohn et al., 1995). However, most adolescents had BP-II (periods of major depression and hypomania) and cyclothymic disorders.

Keywords

adolescentsbipolar disorderchildrenDSM-IVrapid cyclesKraepelinianmood stabilizers
Type
Chapter
Information
Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
 , pp. 237 - 251
Publisher: Cambridge University Press
Print publication year: 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, H. S., Downs, J., Jordon, P., et al. (1985). Affective disorders in referred children and younger siblings of manic-depressives: mode of onset and prospective course. Archi. Gen. Psychiatry, 42, 996–1004.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders 4th edn (DSM-IV). Washington, DC: American Psychiatric Association.
Axelson, D., Birmaher, B., Ulloa, R. E., et al. (1998). Bipolar children and adolescents from a mood disorder clinic. 45th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Anaheim, CA.
Biederman, J. (1998). Mania is mistaken for ADHD in prepubertal children (debate forum: affirmative). J. Am. Acad. Child Adolesc. Psychiatry, 37, 1091–3.Google Scholar
Birmaher, B. (2001). Course and outcome of bipolar disorders in adolescents. Fourth International Conference on Bipolar Disorders, Pittsburgh, PA.
Bowring, M. and Kovacs, M. (1992). Difficulties in diagnosing manic disorders among children and adolescents. J. Am. Acad. Child Adolesc. Psychiatry, 31, 611–14.Google Scholar
Carlson, G. A. (1995). Identifying prepubertal mania. J. Am. Acad. Child Adolesc. Psychiatry, 34, 750–753.Google Scholar
Carlson, G. A. and Weintraub, S. (1993). Childhood behavior problems and bipolar disorder: relationship or coincidence?J. Affect. Disord., 28, 143–54.Google Scholar
Chambers, W. J., Puig-Antich, J., Hirsch, M., et al. (1985). The assessment of affective disorders in children and adolescents by semi-structured interview: test–retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version. Arch. Gen. Psychiatry, 42, 696–702.Google Scholar
Chang, K. D., Steiner, H., and Ketter, T. A. (2000). Psychiatric phenomenology of child and adolescent bipolar offspring. J. Am. Acad. Child Adolesc. Psychiatry, 39, 453–60.Google Scholar
Conners, C. K., Himmelhock, J., Goyette, C. H., Ulrich, R., and Neil, J. F. (1979). Children of parents with affective illness. Am. Acad. Child Psychiatry, 18, 600–7.Google Scholar
Cytryn, L., McKnew, D. H., Bartko, J. J., Lamour, M., and Hamovitt, J. (1982). Offspring of patients with affective disorders: II. J. Am. Acad. Child Psychiatry, 21, 389–91.Google Scholar
Decina, P., Kestenbaum, C. J., Farber, S., et al. (1983). Clinical and psychological assessment of children of bipolar probands. Am. J. Psychiatry, 140, 548–53.Google Scholar
DelBello, M. P. and Geller, B. (2001). Review of studies of child and adolescent offspring of bipolar parents. Bipolar Disord., 3, 325–34.Google Scholar
Faraone, S. V., Biederman, J., Mennin, D., Wozniak, J., and Spencer, T. (1997). Attention-deficit hyperactivity disorder with bipolar disorder: a familial subtype?J. Am. Acad. Child Adolesc. Psychiatry, 36, 1378–87.Google Scholar
Frazier, J. A., Biederman, J., Tohen, M., et al. (2001). A prospective open-label treatment trial of olanzapine monotherapy in children and adolescents with bipolar disorder. J. Child Adolesc. Psychopharmacol., 11, 239–50.Google Scholar
Geller, B. and Luby, J. (1997). Child and adolescent bipolar disorder: a review of the past 10 years. J. Am. Acad. Child Adolesc. Psychiatry, 36, 1168–76.Google Scholar
Geller, B., Sun, K., Zimerman, B., et al. (1995). Complex and rapid-cycling in bipolar children and adolescents: a preliminary study. J. Affect. Disord., 34, 259–68.Google Scholar
Geller, B., Warner, K., Williams, M., and Zimerman, B. (1998a). Prepubertal and young adolescent bipolarity versus ADHD: assessment and validity using the WASH-U-KSADS, CBCL, and TRF. J. Affect. Disord., 51, 93–100.Google Scholar
Geller, B., Williams, M., Zimerman, B., et al. (1998b). Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms: grandiose delusions; ultra-rapid or ultradian cycling. J. Affect. Disord., 51, 81–91.Google Scholar
Geller, B., Bolhofner, K., Craney, J. L., et al. (2000a). Psychosocial functioning in a prepubertal and early adolescent bipolar disorder phenotype. J. Am. Acad. Child Adolesc. Psychiatry, 39, 1543–8.Google Scholar
Geller, B., Zimerman, B., Williams, M., et al. (2000b). Diagnostic characteristics of 93 cases of prepubertal and early adolescent bipolar disorder phenotype by gender, puberty and comorbid attention deficit hyperactivity disorder. J. Child Adolesc. Psychopharmacol., 10, 157–64.Google Scholar
Geller, B., Craney, J. L., Bolhofner, K., et al. (2001). One-year recovery and relapse rates of children with a prepubertal and early adolescent bipolar disorder phenotype. Am. J. Psychiatry, 158, 303–5.Google Scholar
Geller, B., Zimerman, B., Williams, M., et al. (2002a). 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., 12, 11–12.Google Scholar
Geller, B., Craney, J. L., Bolhofner, K., et al. (2002b). Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype. Am. J. Psychiatry, 159, 927–33.Google Scholar
Gershon, E. S., McKnew, D., Cytryn, L., et al. (1985). Diagnoses in school-age children of bipolar affective disorder patients and normal controls. J. Affect. Disord., 8, 283–291.Google Scholar
Grigoroiu-Serbanescu, M., Christodorescu, D., Totoescu, A., et al. (1989). Psychopathology in children aged 10–17 of bipolar parents: psychopathology rate and correlates of the severity of the psychopathology. J. Affect. Disord., 16, 167–79.Google Scholar
Hammen, C., Gordon, D., Burge, D., et al. (1987). Maternal affective disorders, illness, and stress: risk for children's psychopathology. Am. J. Psychiatry, 144, 736–41.Google Scholar
Hammen, C., Burge, D., Burney, E., and Adrian, C. (1990). Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder. Arch. Gen. Psychiatry, 47, 1112–17.Google Scholar
Kashani, J. H., Burk, J. P., Horwitz, B., and Reid, J. C. (1985). Differential effect of subtype of parental major affective disorder on children. Psychiatry Res., 15, 195–204.Google Scholar
Klein, D. N., Depue, R. A., and Slater, J. F. (1985). Cyclothymia in the adolescent offspring of parents with bipolar affective disorder. J. Abnorml. Psychol., 94, 115–227.Google Scholar
Kovacs, M. and Pollock, M. (1995). Bipolar disorder and comorbid conduct disorder in childhood and adolescence. J. Am. Acad. Child Adolesc. Psychiatry, 34, 715–23.Google Scholar
Kowatch, R. A., Suppes, T., Carmody, T. J., et al. (2000). Effect size of lithium, divalproex sodium, and carbamazepine in children and adolescents with bipolar disorder. J. Am. Acad. Child Adolesc. Psychiatry, 39, 713–20.Google Scholar
Kraepelin, E. (1921). Manic-Depressive Insanity and Paranoia. Edinburgh, Scotland: E. and S. Livingstone.
Kuyler, P. L., Rosenthal, L., Igel, G., Dunner, D. L., and Fieve, R. R. (1980). Psychopathology among children of manic-depressive patients. Biol. Psychiatry, 15, 589–97.Google Scholar
LaRoche, C., Cheifetz, P., Lester, E. P., et al. (1985). Psychopathology in the offspring of parents with bipolar affective disorders. Can. J. Psychiatry, 30, 337–43.Google Scholar
LaRoche, C., Sheiner, R., Lester, E., et al. (1987). Children of parents with manic-depressive illness: a follow-up study. Can. J. Psychiatry, 32, 563–9.Google Scholar
Lewinsohn, P. M., Klein, D. N., and Seeley, J. R. (1995). Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J. Am. Acad. Child Adolesc. Psychiatry, 34, 454–63.Google Scholar
Lewinsohn, P. M., Klein, D. N., and Seeley, J. R. (2000). Bipolar disorder during adolescence and young adulthood in a community sample. Bipolar Disord., 2, 281–93.Google Scholar
McKnew, D. H., Cytryn, L., Efron, A. M., Gershon, E. S., and Bunney, W. E. (1979). Offspring of patients with affective disorders. Br. J. Psychiatry, 134, 148–52.Google Scholar
Nottelman, E., Biederman, J., Birmaher, B., et al. (2001). National Institute of Mental Health research roundtable on prepubertal bipolar disorder. J. Am. Acad. Child Adolesc. Psychiatry, 40, 871–8.Google Scholar
Nurnberger, J. I., Hamovit, J., Hibbs, E. D., et al. (1988). A High-Risk Study of Primary Affective Disorder: Selection of Subjects, Initial Assessment, and 1- to 2-year Follow-Up. New York: Raven Press.
Orvashel, H., Puig-Antich, J., Chambers, W. J., Tabrizi, M. A., and Johnson, R. (1982). Retrospective assessment of child psychopathology with the K-SADS-E. J. Am. Acad. Child Psychiatry, 21, 392–7.Google Scholar
Pellegrini, D., Kosisky, S., Nackman, D., et al. (1986). Personal and social resources in children of patients with bipolar affective disorder and children of normal control subjects. Am. J. Psychiatry, 143, 856–61.Google Scholar
Radke-Yarrow, M., Nottelmann, E., Martinez, P., Fox, M. B., and Belmont, B. (1992). Young children of affectively ill parents: a longitudinal study of psychosocial development. J. Am. Acad. Child Adolesc. Psychiatry, 31, 68–77.Google Scholar
Robins, E. and Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am. J. Psychiatry, 126, 983–7.Google Scholar
Strober, M., Schmidt-Lackner, S., Freeman, R., et al. (1995). Recovery and relapse in adolescents with bipolar affective illness: a five-year naturalistic, prospective follow-up. J. Am. Acad. Child Adolesc. Psychiatry, 34, 724–31.Google Scholar
Strober, M., Morrell, W., Burroughs, J., and Lampert, C. (1998). A family study of bipolar I disorder in adolescence: early onset of symptoms linked to increased familial loading and lithium resistance. J. Affect. Disord., 15, 255–68.Google Scholar
Todd, R.D., Reich, W., Petti, T. A., et al. (1996). Psychiatric diagnoses in the child and adolescent members of extended families identified through adult bipolar affective disorder probands. J. Am. Acad. Child Adolesc. Psychiatry, 35, 664–71.Google Scholar
Waters, B. G. H. and Marchenko-Bauer, I. (1980). Psychiatric illness in the adult offspring of bipolar manic-depressives. J. Affecti. Disord., 2, 119–26.Google Scholar
Weller, E. B., Weller, R. A., and Fristad, M. A. (1995). Bipolar disorder in children: misdiagnosis, underdiagnosis, and future directions. J. Am. Acad. Child Adolesc. Psychiatry, 34, 709–14.Google Scholar
Wozniak, J., Biederman, J., Kiely, K., et al. (1995). Mania-like symptoms suggestive of childhood onset bipolar disorder in clinically referred children. J. Am. Acad. Child Adolesc. Psychiatry, 34, 867–76.Google Scholar
Zahn-Waxler, C., McKnew, D. H., Cummings, E. M., Davenport, Y. B., and Radke-Yarrow, M. (1984). Problem behaviors and peer interactions of young children with a manic-depressive parent. Am. J. Psychiatry, 141, 236–40.Google Scholar
Zahn-Waxler, C., Mayfield, A., Radke-Yarrow, M., et al. (1988). A follow-up investigation of offspring of parents with bipolar disorder. Am. J. Psychiatry, 145, 506–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×