الفهرس 
Epidemiology & EtiologyOnly 14 pages are availabe for public view
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Abstract
BD is a complex, multifaceted disorder that is increasingly being investigated by researchers in adult and child populations alike. It appears to be marked by a high comorbidity overlapping with other disorders such as ADHD, CD and anxiety disorders. Additionally, it may show preponderance in boys and frequently presents with mixed states and rapid mood cycling.
In the United States, over the last decade there has been a dramatic increase in the rate at which BD is diagnosed in children and adolescents, leading to a greater number of youth being treated for this condition.
In assessing BD, it is important for clinicians to adhere consistently to the DSM-IV criteria, ascertaining clear episodes of mania or depression that differ from a child’s usual baseline behavior. Children with episodes too brief to meet DSMIV or ICD-10 criteria may warrant a diagnosis of BD-NOS.
Accurate and reliable diagnosis of the disorder is constrained by the lack of specific instruments tailored for use with this population, as well as the difficulty in clinically teasing out symptoms that overlap with other common disorders during childhood and adolescence. Further difficulties describing psychiatric disorders in these populations are inherent in the reliance on child and adolescent self-report, such that frequently the disorder may remain undiagnosed for many years.
Though findings vary somewhat among different research groups, there are several unique features that have been consistently demonstrated in studies of the phenomenology and course of pediatric BD:
(1) High rates of elevated, expansive or elated mood.
(2) Prominent irritability.
(3) Prolonged mood episodes characterized by significant periods of subsyndromal symptomatology.
(4) Depressive symptoms interspersed with manic or hypomanic symptoms.
(5) High rates of comorbid psychiatric disorders, especially ADHD, other disruptive behavior disorders and anxiety disorders.
(6) High rates of substance use disorders in older adolescents with BP.
(7) High rates of psychotic symptoms, suicide attempts and significant functional impairment.
These features emphasize the need for early recognition and treatment of children and adolescents with bipolar disorder to ameliorate ongoing syndromal and subsyndromal symptoms and to reduce or prevent the serious psychosocial morbidity.
Children and family who suffer from PBD experience numerous impairments in social, emotional, and academic functioning. Although the evidence base for effective pharmacologic and psychosocial treatments for PBD is growing.
Evaluating interventions for PBD is challenging. First, there continues to be disagreement about the diagnosis of bipolar disorder in children and adolescents. Indeed, the bipolar disorder spectrum includes a range of symptom profiles. The lack of specific, clear, and agreed-upon diagnostic criteria for PBD presents a significant challenge to rigorous research studies. Second, the episodic nature of PBD makes it difficult to discern results of an intervention from the natural course of the disorder. Indeed, one study found a 52% response rate with a placebo. Third, medication regimens for PBD are often quite complicated, involving multiple medication combinations that require frequent adjustments to address recurring symptoms and side effects.
The drugs used to treat it include mood stabilizers and antipsychotics, which carry the risk of significant side effects. Perhaps even more than the diagnosis and treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) and childhood depression before it, the ascension of the BP diagnosis in children and its treatment with medications whose risk/benefit profiles are inadequately established have generated debate in both lay and professional communities.
Evaluating the efficacy of both pharmacologic and psychosocial interventions in real-world conditions is a significant challenge. Finally, because of the chronic nature of bipolar disorder, it is necessary to evaluate pharmacologic and psychosocial interventions over an extended period of time.