Pediatric bipolar disorder had been diagnosed uncommonly in adolescents and rarely in young children. Over the past decade, recognized prevalence in both children and adolescents increased dramatically, although diagnosis and management remain controversial.
In a new American Academy of Pediatrics (AAP) clinical report, “Collaborative Role of the Pediatrician in the Diagnosis and Management of Bipolar Disorder in Adolescents,” published in the December 2012 issue of Pediatrics (released online Nov. 26), criteria for pediatric bipolar disorder are presented, along with treatment options, diagnostic guidance, and collaborative advice for pediatricians.
According to the American Psychiatric Association’s classification in The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, there are four types of bipolar disorders, all without age restrictions: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder not otherwise specified. Pediatricians should be aware of the changing classification of bipolar and related disorders, and should collaborate with child and adolescent psychiatrists for a full psychiatric evaluation to confirm a diagnosis. Bipolar disorder is often associated with manic behaviors as well as severe depression, psychosis, impairment in social, academic or occupational functioning, and suicidal thoughts and behaviors.
Medication is an important treatment, but adverse effects are common. Pediatricians should collaborate with child and adolescent psychiatrists and other mental health professionals in referring suspected new cases and those with apparent symptom exacerbation, as well as assisting in monitoring and managing adverse effects of medications.