Debate: Bipolar disorder: extremely rare before puberty and antipsychotics cause serious harms - a commentary on Van Meter et al. (2019)

Child and Adolescent Mental Health
Peter ParryTarun Bastiampillai

Abstract

'Paediatric bipolar disorder' (PBD) remains controversial; because it is based on the hypothesis that bipolar disorder (BD) often begins in childhood with atypical forms of mania. A meta-analysis of 12 epidemiological surveys found a high prevalence of PBD among children and adolescents worldwide (1.8%), however, our study of the measurement issues (Child and Adolescent Mental Health, 23, 2018, 14) found that PBD rates were lower than claimed. Our findings are consistent with the developmental trajectory of BD, as described by most longitudinal studies of high-risk offspring. BD is extremely rare in childhood with nearly all index manic/hypomanic episodes being in midadolescence or later. Treatment for BD should not commence until the first well-defined manic/hypomanic episode, because children and younger adolescents are extremely sensitive to the side effects of second-generation antipsychotics including weight gain, metabolic syndrome, extrapyramidal side effects and the risk of cerebral atrophy, as observed in studies of juvenile animals.

References

Feb 28, 2007·Journal of Affective Disorders·M BerkJ Kulkarni
Aug 19, 2009·Journal of Child Psychology and Psychiatry, and Allied Disciplines·Argyris StringarisRobert Goodman
Jun 16, 2011·The Journal of Clinical Psychiatry·Anna R Van MeterEric A Youngstrom
May 21, 2014·Journal of the American Academy of Child and Adolescent Psychiatry·Pedro Mario PanRodrigo Affonseca Bressan
Sep 23, 2014·International Journal of Bipolar Disorders·Lars Vedel KessingPer Kragh Andersen
Nov 26, 2015·Neuropsychiatric Disease and Treatment·Michal GoetzAntonin Sebela
Sep 8, 2018·The Australian and New Zealand Journal of Psychiatry·Tarun BastiampillaiStephen Allison
May 1, 2011·Child and Adolescent Mental Health·Judy ChanTamsin Ford

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Citations

Apr 21, 2020·International Journal of Bipolar Disorders·A DuffyM H J Hillegers

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