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Pediatric bipolar disorder: Clinical manifestations and course of illness

Boris Birmaher, MD
Section Editor
David Brent, MD
Deputy Editor
David Solomon, MD


Bipolar disorder in children and adolescents is characterized by recurrent episodes of elevated mood (mania or hypomania), which exceed what is expected for the child’s developmental stage and are not better explained by other psychiatric and general medical conditions [1-4]. In addition, youth with bipolar disorder usually have recurrent episodes of major depression; however, depressive episodes are not necessary for making the diagnosis. Pediatric bipolar disorder severely affects normal development and psychosocial functioning, and increases the risk for behavioral, academic, social, and legal problems, as well as psychosis, substance abuse, and suicide [1,2,5].

Multiple retrospective studies have reported that in up to 60 percent of adults with bipolar disorder, onset of mood symptoms occurred before age 20 [1,6-8]. However, pediatric bipolar disorder is often not recognized, and many youth with the disorder do not receive treatment or are treated for comorbid conditions rather than bipolar disorder [9]. A retrospective study of 88 pediatric patients with bipolar disorder found that the duration of untreated bipolar disorder, from onset of the first mood episode to first mental health contact, was nearly two years [10]. The longer it takes to start appropriate treatment, the worse the adult outcomes.  

This topic describes the clinical features and course of illness in pediatric bipolar disorder. The epidemiology, pathogenesis, comorbidity, assessment, diagnosis, and treatment of bipolar disorder in children and adolescents are discussed separately.

(See "Pediatric bipolar disorder: Epidemiology and pathogenesis".)

(See "Pediatric bipolar disorder: Comorbidity".)

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Literature review current through: Sep 2017. | This topic last updated: Oct 11, 2017.
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