Introduction: There are no definitively established acute or maintenance treatments for juvenile bipolar disorder.

Method: Two randomized, blind, maintenance clinical trials in children and adolescents with bipolar disorders are ongoing at the University Hospitals of Cleveland/Case Western Reserve University Stanley Clinical Research Center for bipolar disorder. The first is comparing the safety and effectiveness of lithium carbonate (Li+) to divalproex sodium (VPA) for up to 76 weeks in youths with stabilized bipolar illness (type 1 or 2). The second study is designed to compare the efficacy of VPA to placebo in the acute management of subsyndromal symptoms of bipolar disorder (‘cyclotaxia’) and the prevention of the full syndrome in children at risk. Both studies use the prospective life-chart method as an outcome measure.

Results: Sixty-six youths have received study medication as part of the trial that is comparing Li+ to VPA as a maintenance therapy. In addition, 32 youths have received blinded treatment as part of the ‘cyclotaxia’ prevention study. Combination Li+A/PA treatment appears generally well tolerated and seems to have robust anti-manic and antidepressant effects.

Discussion: Since the blind has not been broken on either of these clinical trials, conclusions about the maintenance effectiveness of either VPA or Li+ in youths with bipolar disorder type 1 or 2 cannot be made yet. Similarly, it is unclear whether VPA is superior to placebo in genetically high-risk youths with cyclotaxia. The final results of these trials should provide valuable information about the treatment of juvenile bipolar disorders.

Background: Regulatory control of cognition is implicated in the amplification of mood variability in cyclothymia. Aims: This study examined whether cognitive behavioural therapy (CBT) directed at enhanced awareness and mood change could change global functioning, mood variability and regulatory control. Method: Using a prospective single case experimental design, mood and cognitive control ratings were recorded every 4 hours for 51 weeks by a patient diagnosed with cyclothymia, including a 5-week baseline, a 35-week (19 session) CBT intervention period and an 11-week follow-up period. Results: Findings indicated that the patient experienced reduced mood variability and greater regulatory control, became happier and less anxious but felt less energetic. Following CBT, high energy became negatively associated with positive mood, and this change was mediated by an increase in control over thoughts. Conclusions: The results suggest that CBT directed at cognitive control and mindfulness skills may help in the treatment of cyclothymia.

Subcomponents of the N200 component of the event-related brain potential believed to be differentially sensitive to involuntary and voluntary cognitive processes were examined. Nonpatients (N = 131) identified initially by the Chapman and Depue research scales and classified later on the basis of diagnostic symptom clusters and family psychiatric history provided converging evidence for an intact mismatch negativity subcomponent. In contrast, the N2b subcomponent distinguished several groups of subjects. Results suggested abnormal voluntary cognitive processing, perhaps reflecting compensatory efforts in subjects at risk for or manifesting psychopathology, particularly those showing negative symptoms.