EVOLVING TREATMENTS FOR PSYCHIATRIC DISORDERS IN YOUNG PATIENTS WITH EVIDENCE FROM BIPOLAR AND OTHER CONDITIONS

Janet Wozniak, M.D., 15 Parkman Street, WACC 725, Boston, MA 02114; Joseph Biederman, M.D.; Jennifer Richards, B.A.

Background: Although controversial, an increasing literature of systematic research has challenged the traditional view that pediatric-onset bipolar disorder is a rare condition.
Method: This paper summarizes current research regarding pediatric-onset bipolar disorder including work delineating its atypical presentation, its overlap with attention deficit-hyperactivity disorder (ADHD) and other comorbid conditions, and family-genetic and treatment data.
Results: When examining structured interview data, cases of pediatric mania made up 16% of referrals to our outpatient clinic. Presentation is atypical by adult standards, with irritability, chronicity, and mixed state. Family-genetic data and treatment data help to establish the validity of the diagnosis.
Conclusion: Pediatric bipolar disorder is not a rare condition. Treatment requires a combined pharmacotherapy approach to address issues of comorbidity, especially with ADHD. Atypical antipsychotic medications have thus far provided the most promising results, but there is a need for additional controlled clinical trials.