Conflict of interest statement: No conflicts declared.
Pediatric bipolar disorder: evidence for prodromal states and early markers
Article first published online: 18 JAN 2010
© 2010 The Authors. Journal compilation © 2010 Association for Child and Adolescent Mental Health
Journal of Child Psychology and Psychiatry
Volume 51, Issue 4, pages 459–471, April 2010
How to Cite
Luby, J. L. and Navsaria, N. (2010), Pediatric bipolar disorder: evidence for prodromal states and early markers. Journal of Child Psychology and Psychiatry, 51: 459–471. doi: 10.1111/j.1469-7610.2010.02210.x
- Issue published online: 11 MAR 2010
- Article first published online: 18 JAN 2010
- Manuscript accepted 30 November 2009
- Childhood bipolar disorder;
Background: Childhood bipolar disorder remains a controversial but increasingly diagnosed disorder that is associated with significant impairment, chronic course and treatment resistance. Therefore, the search for prodromes or early markers of risk for later childhood bipolar disorder may be of great importance for prevention and/or early identification.
Methods: Literature searches were conducted to identify reviews, case reports and empirical papers addressing the issue of prodromes of childhood bipolar disorder.
Results: A total of 54 articles were found that related to bipolar prodromes, risk factors for later childhood bipolar disorder, childhood risk for adult bipolar disorder, mania manifestations in early childhood, and neuropsychological and biological markers of childhood bipolar disorder. A review of articles suggest (a) childhood bipolar prodromes may be detectable prior to the onset of the disorder, (b) prodromal symptoms may display episodicity during childhood, (c) there is evidence of possible endophenotypic markers such as deficits in executive function, sustained attention, and emotion labeling, (d) there is a potential association with functional, structural, and biochemical alterations evident in brain structures involved in mood regulation, (e) a link between childhood bipolar disorder with early tempermental markers, such as emotional regulation and behavioral disinhibition and (f) there is some early but promising evidence of effective psychotherapeutic preventions.
Conclusions: There has been very limited investigation of early prodromes of childhood bipolar disorder. Based on the promising findings of prodromes as well as high-risk states and possible endophenotypic markers, more controlled and targeted investigations into the early markers of bipolar disorder appear warranted and potentially fruitful. Until such longitudinal studies with appropriate controls are conducted, specific markers for bipolar prodromes will remain elusive, although evidence suggests they are manifest in at least some subgroups. The finding of promising psychotherapeutic prevention programs underscores the need to find specific and sensitive markers of bipolar prodromes in childhood.