ABSTRACT
Even if bipolar disorder presents a well-established clinical picture, studies of juvenile bipolar disorder are of more recent vintage. Awareness of bipolar spectrum disorders in children and adolescents is rapidly increasing, as well as a more precise definition of their clinical subtypes and early signs. Epidemiologic studies estimate that the point prevalence of early-onset bipolar disorder may be 0.2-0.4% for the prepubertal population, and about 1% in adolescents (Lewinshon et al, 1995, 2003). Studies examining age at onset of the first episode of bipolar illness show that the median age at onset is lower by 4.5 years in subjects born in the last 50 years, and that subjects with prepubertal onset are significantly higher in the more recent cohorts, usually with a depressive episode as the first episode (Chengappa et al, 2003). Early recognition of early-onset bipolar disorder may improve prognosis of this condition by using appropriate treatments and avoiding potentially worsening medications (i.e. antidepressant monotherapy), preventing the development of chronicity and serious functional impairment. When bipolar children reach adolescence they are at higher risk for substance abuse, which is not accounted for by conduct disorder or other comorbidities (Wilens et al, 2004), as well as for suicide (Lewinshon et al, 2003). The goal of our interventions, pharmacologic as well as psychosocial, is to treat the earlier
and acute episodes of both mania and depression, to prevent or to decrease the recurrences, and to improve the psychosocial outcome.
