Clinical characteristics of bipolar disorder in very young children

• Published in: Journal of affective disorders 2007-01, Vol.97 (1), p.51-59
• Main Authors: Danielyan, Arman, Pathak, Sanjeev, Kowatch, Robert A, Arszman, Sarah P, Johns, Erin S
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aggression - drug effects; Aggression - psychology; Anticonvulsants - therapeutic use; Antimanic Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - psychology; Biological and medical sciences; Bipolar Disorder - diagnosis; Bipolar Disorder - drug therapy; Bipolar Disorder - psychology; Bipolar disorders; Child; Child Behavior Disorders - diagnosis; Child Behavior Disorders - drug therapy; Child Behavior Disorders - epidemiology; Child Behavior Disorders - psychology; Child, Preschool; Comorbidity; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Diagnostic criteria; Female; Humans; Irritable Mood - drug effects; Male; Mania; Medical sciences; Mood disorders; Mood Disorders - diagnosis; Mood Disorders - psychology; Outpatient Clinics, Hospital; Pediatric bipolar disorder; Pharmacotherapy; Preschool; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2006.05.028

Abstract Background Clinical information about bipolar disorder (BPD) in preschool-age (3–7 years old) children is extremely limited. This study examined clinical presentations, applicability of the DSM-IV diagnostic criteria, comorbidity, recovery and relapse rates, as well as some treatment strategies used in the management of BPD in preschoolers. Methods The charts of 26 outpatient children, ages 3–7, refereed to a child psychiatry outpatient clinic with mood and behavioral symptoms, were retrospectively reviewed. Results The majority of the patients were referred with the tentative diagnosis of ADHD but the most common diagnoses made by child and adolescent psychiatrists at the time of initial evaluation were BPD NOS (61.5%), followed by BPD I (26.9%), and mood disorder NOS (23.1%). Thirty-eight percent of the patients had one or more comorbid diagnoses. The most common presenting symptoms were irritability (84.6%) and aggression (88.5%). The most widely prescribed class of medications after diagnosis in the clinic was atypical antipsychotics and mood stabilizers. Twenty-six percent of the patients were treated with a combination of atypical antipsychotics and mood stabilizers. Limitations Retrospective design; small sample size; lack of a comparison group. Conclusions The course of BPD with onset in preschool years is complicated with high recovery and relapse rates. The questions of development of age-appropriate diagnostic criteria, long-term prognosis and treatment strategies used in this population require further intensive investigation.