Pediatric Mania: The Controversy Between Euphoria and Irritability

Abstract

Introduction

Pediatric bipolar disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders, with high levels of morbidity and disability and with a great risk of suicide.

Objectives

While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified.

Aims

To assess the prevalence, demographics, clinical correlates and course of these euphoric versus irritable pediatric mania.

Methods

Systematic review of the available studies assessing the phenomenology, course and outcome of pediatric mania.

Results

Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common. Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age.

Conclusions

Severe irritability is the most common presentation of abnormal mood described in children with bipolar disorder. Longitudinal studies of samples with irritable versus elated mood presentation and chronic versus episodic course may help clarify whether these are factors predicting different long-term course, treatment-response and outcome of pediatric onset bipolar disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.