Editorial Controversies in Paediatric Bipolar Disorder

About two thirds of adult bipolar disorder (BPD) patients report onset of bipolarity in childhood and adolescence [1]. The earlier the age of onset, the greater the risk of recurrence, functional impairment and chronicity of mood symptoms [2]. An influential paper in mid nineties suggested that juvenile mania had an insidious onset and ran a chronic course [3]. Mixed episode was most common presentation, dominated by severe irritability and affective storms. 70 % of patients had an onset <5 years of age. Despite being chronically manic, it was reported that juvenile mania was frequently comorbid with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD) and anxiety disorders [3]. Their school of thought emphasized the centrality of irritability in establishing the diagnosis and recommend diagnosing BPD if the child meets DSM-IV criteria with irritability as a core symptom, even in the absence of elation, grandiosity, and episodicity [3,4]. This was followed by an explosion in literature on paediatric BPD. Research groups differed in viewing paediatric BPD as an insidious onset chronic disorder characterized by irritability without elation or grandiosity and highly comorbid with disruptive behavioural disorder (DBD). Som