Adolescent Mania and Bipolar Disorder

Scott A. West, MD


Medscape Psychiatry & Mental Health eJournal. 1997;2(5) 

In This Article

Abstract & Introduction

The phenomenology and comorbidity of adolescent bipolar disorder have gained considerable attention in the past few years. Most researchers have reported high rates of mixed states, rapid cycling, prominent irritability, and a rather insidious onset. Comorbid syndromes are often present, including conduct disorder, oppositional defiant disorder, substance abuse, and attention-deficit hyperactivity disorder (ADHD). Indeed, high rates of ADHD have been reported by numerous researchers, possibly reflecting the gradual development of early-onset bipolarity. Although bipolar disorder is becoming better characterized and consequently more recognized, data are very limited regarding the pharmacologic treatment of adolescents with bipolar disorder. Lithium, valproate, and carbamazepine are commonly prescribed mood stabilizers, but the vast majority of data are derived from open trials and anecdotal reports. Therefore, controlled trials examining the efficacy and safety of pharmacologic agents in this population are needed.

Traditionally, bipolar disorder has been thought of as an illness that begins in late adolescence and early adulthood and is defined by distinct periods of depression and mania. Recent research has suggested that while this may be the case in many patients, the bipolar spectrum includes a substantial percentage of patients with childhood- and adolescent-onset bipolar disorder who may present with a range of clinical presentations. In a survey of 500 bipolar patients, Lish and colleagues[1] found that the majority of patients had clearly developed significant symptomatology by 18 years of age and that many of these patients had not been properly diagnosed or treated for years, which resulted in devastating outcomes.

This study highlights 2 important issues. First, bipolar disorder routinely begins at a young age and has a marked impact on psychosocial development. And second, while it is often easy to retrospectively chart the development and progression of early-onset bipolar disorder in adults, diagnosis in prepubertal children and adolescents is often quite difficult because of the complex constellation of symptoms that are often present.

To address the diagnostic complexity of early-onset bipolar disorder, a significant amount of research has begun to examine the phenomenology and comorbidity of this population. This research has focused largely on the neurologic and psychologic characterization of bipolar disorder with regard to variable expressions due to differing developmental stages. For example, does the immature developing brain of a child have the capacity to produce "classic" manic symptoms, such as extreme euphoria and grandiosity? Or do developing neurotransmitter systems and neuronal pruning need to reach a certain developmental level for these symptoms to emerge? This article reviews the phenomenology and comorbidity of adolescent mania and summarizes the literature on the pharmacologic management of these patients.


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