Clinical Manual for Management of Bipolar Disorder in Children and Adolescents

This book aims to provide clinically useful information about the diagnosis and management of bipolar disorder among children and adolescents, with a focus on reviewing the increasing number of recent publications on the topic.

Chapters 1 through 4 introduce the prevalence, definitions, course and outcome, and diagnosis of bipolar disorder among children and adolescents. They describe lifetime prevalence among adolescents (no large epidemiological studies have examined prevalence among prepubertal children), retrospective age of onset among afflicted adults, definitions of mania and hypomania among children, features typical of the disorder among youths (intense mood lability and irritability and multiple daily mood swings), the classifications of bipolar disorder, and introduction of the debate on narrow versus broad diagnostic criteria. Challenges related to having bipolar disorder in combination with other disorders and the difficulty in distinguishing these mood states from the extremes of normal childhood temperament are briefly touched upon. A separate chapter illustrates a diagnostic interview by examining the "lifeline" through a case example.

Chapter 5 reviews known and proposed genetic mechanisms in the onset of bipolar disorder: stress sensitization, kindling and episode sensitization, effects of substance use on progression of the illness, neurochemistry, and brain anatomy. The section discussing differences in incidence and vulnerability factors in the United States and a few European countries is of interest; there is a significantly higher incidence and younger age of onset of bipolar disorder in the United States. Of particular interest is the doubled incidence of early adversity in the United States and its relationship to bipolar disorder. However, I found that the explanations offered in this section were incomplete and focused on biological explanations, minimizing political-psychosocial factors.

The next section of the manual reviews the evidence behind available psychopharmacological treatments and strategies. As a child psychiatrist practicing in the community, I found the treatment algorithms somewhat problematic because they do not include advisories to the providers to revisit the diagnosis and reevaluate adequacy of psychosocial treatments. Chapter 9 discusses differential biological diagnosis and an approach to diagnosing comorbidities. It appeared to lack satisfactory focus on the effect of development, psychosocial factors, family system issues, and parent-child attachment on childhood emotional and behavioral disorders.

The next four chapters, edited by Dr. Fristad, "an expert in the family and psychosocial aspects of pediatric bipolar disorder," review symptom monitoring and mood charting, working with the educational system, and other special treatment issues. Again, these chapters focus on psychosocial treatment as an adjunct support to pharmacotherapy and provide little guidance around other psychosocial interventions.

In conclusion, this book provides a clear review of the available research on childhood bipolar disorder but is far from portraying a balanced picture, given the heated debate surrounding this diagnosis in the field. The book's editors have a strong opinion, and their book lays out the data to support it. The reader should be aware that Dr. Kowatch, Dr. Findling, and Dr. Post all disclosed a financial interest or affiliation with commercial supporters, mainly pharmaceutical companies.