Classic biphasic bipolar disorder typically first presents between the ages of 15 and 25 years. Broadband manifestations of bipolar disorder such as bipolar II and bipolar not otherwise specified are identified in younger individuals, and are important differential diagnoses for acute presentations characterized by affective instability. The construct has been further extended to include children with extreme levels of irritability and behavioural dysregulation. The diagnosis becomes controversial as one moves further from the construct of classic biphasic disorder.
Objectives: To review the course and outcome of children and adolescents who present with mania, the continuities and discontinuities of the condition between childhood and adulthood, patterns of comorbidity and their significance to diagnosis and treatment, the biological substrate to the condition, and the role of complementary medicines in its treatment.
Key messages: Findings from the available prospective studies on the course and outcome of bipolar disorder in the paediatric age group are conflicting. Mania in childhood is a signal for dysregulated behaviour and impairment, but is not predictive of bipolar I. Comorbidity is common, complicates the clinical picture and necessitates careful management planning. Amygdale volumes in juvenile patients are small compared with healthy controls, while the opposite is found in studies of adult patients. Omega-3 supplementation may reduce core symptoms of juvenile bipolar disorder.
Conclusion: There are both continuities and discontinuities between the childhood and adult manifestations of bipolar disorder. Adolescence is likely to be a critical period in the evolution of the disorder.
