Introduction

Bipolar disorder in adolescents and children has recently become the focus of increasing study. Debate about its age of onset, phenomenology, comorbidity, course, outcome, and treatment is vigorous and yet, in many cases, still uninformed by sufficient evidence. The “classic” prototype of bipolar I disorder has emerged with some clarity in this population. Less is known about bipolar II or the spectrum of biphasic mood lability of mood dyscontrol.

Diagnostic issues

Epidemiology

There have only been a small number of reports regarding bipolar mood disorder (BMD) in children and adolescents. A retrospective study of adult BMD patients estimated that 0.5% had an age of onset of 5–9 years and 7.5% had an onset of 10–14 years when the first manic episode struck (Loranger and Levine, 1978; Geller et al., 1995). North American studies estimate the point prevalence at 0.2–0.4% for the prepubertal population and about 1.0% in adolescents (Lewinsohn et al., 1995; Zarate and Tohen, 1996; Bland, 1997) with no identified gender differences in prevalence.

Diagnosis and phenomenology

Case reports of mania in preschool and prepubertal children have appeared dating back to the mid-19th century and early Greek writers identified this disorder as being of adolescent onset (Weller et al., 1995). However, explicit criteria to diagnose mania in children first came into practice only in 1960.