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Managing bipolar disorders in children and adolescents

Nature Reviews Neurology volume 5, pages 484–491 (2009)Cite this article

Abstract

Bipolar disorders are recurrent disturbances in mood that include periods both of depression and mania. Classic bipolar disorders, with manic episodes lasting for at least several days, often start in adolescence, but are uncommon in earlier childhood. Treatment of mania in young patients should include ensuring the individual's safety, and administration of a mood-stabilizing drug, or, in severe cases, a neuroleptic. Prophylaxis with lithium or an anticonvulsant should then be considered. In younger children, brief outbursts of excessive emotion—especially anger—should be recognized as a notable clinical problem. These outbursts do not necessarily constitute the beginnings of a classic bipolar disorder, but should trigger a diagnostic differential that also includes attention-deficit hyperactivity disorder, reaction to hostile environments, severe mood dysregulation, substance misuse, and autism spectrum disorders.

Key Points

  • Bipolar disorders in children and adolescents are characterized by a repetitive pattern of episodes of depression and mania that last for 1 day or more

  • The diagnosis of mania should be made with respect to developmentally appropriate standards of euphoria and grandiosity

  • Acute treatment of mania should include measures for the safety of the young person, and a mood-stabilizing drug, or, in severe and psychotic cases, a neuroleptic

  • Prophylaxis of future episodes with lithium or antiepileptic drugs should be considered

  • Frequent, brief outbursts of excessive emotion, especially anger, that are severe and cause impairment should be recognized as a notable clinical problem

  • Differential diagnosis of emotional outbursts should include attention-deficit hyperactivity disorder, reaction to hostile or upsetting environments, severe mood dysregulation, substance misuse, anxiety or depression, and bipolar disorder

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  1. Institute of Psychiatry, King's College London, London, UK

    Eric Taylor

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Taylor, E. Managing bipolar disorders in children and adolescents. Nat Rev Neurol 5, 484–491 (2009). https://doi.org/10.1038/nrneurol.2009.117

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