A comment on an important question in psychiatry (QuiP): Whether paediatric bipolar disorder a valid diagnosis?

Abstract

The question of the validity of the diagnosis of paediatric bipolar disorder centres on the controversy surrounding a proposed pre-pubertal subtype. As pointed out by Malhi & Bell1 , the validity of classical bipolar disorder in adolescence, diagnosed on the basis of expert clinical assessment, is not in question. Nor is there debate around whether or not children with the proposed prepubertal phenotype have serious mental health concerns. Further, longitudinal prospective studies have provided indisputable evidence that antecedent subthreshold mood symptoms and non-mood disorders (i.e. sleep, anxiety) predict bipolar disorder in children at confirmed familial risk2 . Rather, the controversy centres on the speculation raised by Wozniak et al3 that a presentation in very young children (median age 5, mostly male sex) characterized by explosive temper, chronic irritability, comorbid ADHD and other neurodevelopmental disorders, represents an early developmental variant of bipolar disorder - so called prepubertal bipolar disorder or prepubertal mania.