Pediatric bipolar disorder

What is childhood bipolar disorder?

Roughly 2% of youth under the age of 18 experience bipolar disorder. For 55 to 60% of adults with bipolar disorder, the pathology begins in childhood and adolescence with displays of subthreshold forms or prodromal signs of the disorder. Early age at onset is associated with more severe symptoms and poor prognosis.

What is the evidence for childhood bipolar disorder?

Moderate quality evidence shows the most common mania symptoms reported in youths with bipolar disorder are (in decreasing order); increased energy, irritability, mood lability, distractibility, goal-directed activity, euphoric/elated mood, pressured speech, hyperactivity, racing thoughts, poor judgment, grandiosity, inappropriate laughter, decreased need for sleep, and flight of ideas.

Compared to children or youth with unipolar depression, the clinical features associated more often in children or youth with bipolar depression include more psychiatric comorbidities and behavioural problems (oppositional disorder, conduct disorder, anxiety disorders, irritability, suicidal/self-harm, social impairment, and substance use), earlier onset of mood symptoms, more severe depression, and having a family history of psychiatric illness.

Compared to adults with bipolar disorder, moderate to high quality evidence suggests irritability, aggression, and low insight are more common in youths with bipolar disorder. Odd appearance, grandiosity, flight of ideas, decreased sleep, and increased sexual interest are more common in adults with bipolar disorder.

Moderate to high quality evidence suggests having a family history of any mood disorder, subthreshold symptoms of mania, emotional dysregulation, and behaviour problems are associated with greater likelihood of switching to mania in children with major depression.

Moderate to low quality evidence suggests a medium-sized increased risk of suicide ideation in children and adolescents with bipolar disorder.
Moderate quality evidence suggests around 14% of youth treated with antipsychotics (for any diagnosis) had bipolar disorder. Among youth with bipolar disorder, 44% were on antipsychotics, and there were significant increases in antipsychotic use from 2001 to 2006.

For children with subthreshold bipolar symptoms compared to children without a mental illness, moderate quality evidence found greater severity of functional impairment, mania and depression symptoms, disruptive behaviour, suicidal ideation and attempts, and more mood and substance use disorders. Conversely, compared to children with a diagnosis of bipolar disorder, children with subthreshold symptoms showed less severe functional impairment, mania and psychosis symptoms, suicidal ideation and attempts, and less service use.

May 2020

Last updated at: 2:37 am, 28th May 2020
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