This study took place over a six week period with adolescent subjects diagnosed with bipolar disorder and substance dependence. Average age of bipolar disorder onset was 9.6 years; average age of substance dependence was 15.3 years. For the purposes of this short-term study, lithium was shown to be a useful treatment for adolescents suffering from both disorders. (August 1997)
by Barbara Geller, M.D. and Joan Luby, M.D.
J Am Acad Child Adoles Psychiatry 36:1168-1176, 1997
Objective: To provide a review of the epidemiology, phenomenology, natural course, comorbidity, neurobiology, and treatment of child and adolescent bipolar disorder (BP) for the past 10 years. This review is provided to prepare applicants for recertification by the American Board of Psychiatry and Neurology. Method: Literature from Medline and other searches for the past 10 years, earlier relevant articles, and the authors' experience and ongoing National Institute of Mental Health-funded project "Phenomenology and Course of Pediatric Bipolarity" were used. Results: Age-specific,developmental (child, adolescent, and adult) DSM-IV criteria manifestations; comorbidity and differential diagnoses; and episode and course features are provided. Included are age-specific examples of childhood grandiosity, hypersexuality, and delusions. Differential diagnoses (e.g. specific language disorders, sexual abuse, conduct disorder [CD], schizophrenia, substance abuse), suicidality, and BP-II are discussed. Conclusion: Available data strongly suggest that prepubertal onset BP is a nonepisodic, chronic, rapid cycling, mixed manic state that may be comorbid with attention-deficit hyperactivity disorder(ADHD) and CD or have features of ADHD and/or CD as initial manifestations. Systematic research on pediatric BP is in its infancy and will require ongoing and future studies to provide developmentally relevant diagnostic methods and treatment. J Am Acad Child AdolesPsychiatry, 1997, 36(9):1168-1176.
Complex and Rapid Cycling in Bipolar Children and Adolescents:
A Preliminary Study
by Barbara Geller, M.D.; Kai Sun, Ph.D.; Betsy Zimerman, M.A.; Joan Luby, M.D.; Jeanne Frazier, B.S.N.; Marlene Williams, R.N.
Twenty-six subjects aged 7-18 years old were studied. Diagnoses of bipolar disorders were established using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present Episode Version-1986 modified for DSM-III-R criteria and for rating the number and duration of manic and hypomanic episodes. Complex cycling patterns were observed. These included numerous, brief episodes suggesting continuous, rapid-cycling in 80.8% of cases. Mean age of onset was early (8.5±4.4 years). Psychotic phenomena, suicidality, hyperactivity, and "mixed mania" were highly prevalent. Data in this report provide support for complex and rapid-cycling patterns in childhood onset BP.