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Treatment of the early stages of bipolar disorder

  • Thomas Elias Elanjithara, Sophia Frangou and Philip McGuire


For many patients with bipolar disorder there is a long delay between the onset of illness and receiving a diagnosis and the initiation of treatment. This may have an adverse effect on the clinical outcome. Early intervention in bipolar disorder has received less attention than in schizophrenia, and there are relatively few specialist services in this area. This article reviews the literature on the early detection of bipolar disorder and on the effectiveness of pharmacological, psychological and psychosocial interventions in the early phase of the disorder.

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Corresponding author

Professor Philip McGuire, Institute of Psychiatry, Box PO67, De Crespigny Park, London SE5 8AF, UK. Email:


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Treatment of the early stages of bipolar disorder

  • Thomas Elias Elanjithara, Sophia Frangou and Philip McGuire
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Bipolar Illness in Children and Young People

Rajendra Prabhu, Locum Consultant
05 August 2011

Recognising bipolar illness in the prodromal phase is a challenge especially in children and young people (1). The diagnosis remains controversial in the non-adult population (2). Some experts follow the criteria in DSM IV. Nevertheless, the illness has to be distinguished from conditions including attention deficit hyperactivity disorder, oppositional defiant and conductdisorder. Some argue that irritability is a distinct marker which differentiates this condition from others (2).

Historically, Emil Kraeplin noted that manic episodes were rare before puberty and the onset of bipolar was below 0.5%. In later years misdiagnosis was also common with schizophrenia due to co-occurrence of psychosis and mania (3). The American Paediatric Association advise clinicians to consider the age and normal behaviour of these individuals, prior to such a diagnosis. The National Institute of Clinical Excellence in the UK (2006) took the view that Bipolar 1 was possible to diagnose in prepubertal children on the basis of an episode of mania alone without any depressive episode and irritability was not essential for diagnosis (4).

Apart from the controversy, the symptoms cause significant impairment in the young person's education, psychosocial areas and it is a chronic condition which persists throughout the lifetime. The treatment studies of Bipolar in children are scarce and are mainly derived from research on adults. Pharmacological interventions are common initially to reduce the symptoms to make them more amenable to other psychotherapeutic interventions thereafter (2).

Perhaps to address this controversial issue in children, Temper dysregulation with Dysphoria (TDD) is a new diagnostic category proposed into the Mood disorder section of the new DSM 5.


1.Symptoms and signs of the initial prodrome of bipolar disorder. A systematic review. Skjelstad DV, Malt UF, Holte A (2009). Journal of Affective Disorders 126 (1-2):1-13.

2."Pediatric bipolar disorder". Annual review of clinical psychology. Leibenluft E, Rich BA (2008). Vol 4: pg 163-87.

3.Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. McClellan J, Kowatch R, Findling RL(Jan 2007). Journal of American Academy of Child and Adolescent Psychiatry. Vol 46(1) Pg 107-125.

4.Bipolar disorder: The management of bipolar disorder in adults, children and adolescents in primary and secondary care. NICE (November 2006) p526.

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Conflict of interest: None declared

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