Course and Outcome of Bipolar Affective Disorder in Children

Systematic studies of juvenile bipolar disorder have been carried out only in recent decades. Initially, Kraepelin considered bipolar disorder to be a relatively benign illness, However, recent literature suggests that bipolar disorder may present as chronic episodes with persistent deficits. Various studies, mainly naturalistic in design, have been carried out to answer questions regarding the course and outcome of bipolar disorder in children and adolescents. Indian findings differ considerably from those in Western populations. Western data suggest poor recovery from index episodes, especially in prepubertal bipolar children, longer episode duration, high rates of chronicity and rapid cycling, and a high relapse rate. Data from India, however, suggest that there is good recovery from the index episode, shorter episode duration, lower rates of chronicity, and rapid cycling. However, a higher relapse rate has been reported from Indian studies as well. The effectiveness of lithium as a prophylactic agent for childhood onset bipolar disorder needs to be reviewed.