Psychiatric disturbances in children of parents with bipolar disorder

The early symptoms of bipolar disorder in children and adolescents are often qualitatively different from the classic symptoms of mania and depression that present in adults, complicating the diagnosis of the disorder in younger populations. The focus of this article is the evaluation and treatment of children with bipolar parents who begin to develop behavioral and other psychiatric problems. The authors first review the current criteria available for diagnosing bipolar disorder in children. They consider issues related to how the DSM-IV criteria have been applied in this population, in particular the increase in the number of children diagnosed with bipolar disorder as a result of the decision to allow a "manic" episode to be diagnosed in the absence of expansive or elated mood. The practice parameters for the diagnosis and treatment of bipolar disorder in children and adolescents developed by the American Academy of Child and Adolescent Psychiatry are also discussed. The literature concerning children of parents with bipolar disorder is reviewed and indicates that these children are at increased risk for a wide range of psychiatric disorders, including bipolar disorders, other affective disorders, disruptive behavior disorders, and other psychiatric illnesses. The authors then review what is known about treatment for the early symptoms of bipolar disorder in this population and discuss the utility of mood stabilizers. The authors then discuss the role genomic screening may play in the future in identifying children at the highest risk for developing bipolar disorder. The article concludes with a summary of several endophenotypic expressions of bipolar disorder that have been described in children of parents with bipolar disorder.