Paediatric bipolar disorder – an update

The diagnosis of paediatric bipolar disorder (PBD) polarizes views, and many question its existence as it differs in presentation from typical adult bipolar disorder. Debate surrounds the applicability of elation and episodicity as essential features in children. The ‘narrow phenotype’ that insists on both elation and episodicity has greater support in being PBD, compared with the ‘broader phenotype’ defined by chronic irritability and explosive rage. Few children meet criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, bipolar I and II, but bipolar not otherwise specified is frequently diagnosed. A theoretical, conceptual PBD spectrum model that accommodates the current viewpoints is provided in this article. Diagnosis should be made by a specialist in child and adolescent mental health, assisted by prospective mood charting, and symptoms should be evaluated against age expected norms, temperament, and considered in their context. Despite disagreements regarding the appropriate label, treating severe and impairing affective dysregulation remains crucial. Treatment of PBD should essentially combine pharmacological and psychosocial interventions.