Controversies concerning the diagnosis and treatment of bipolar disorder in children

In general, bipolar disorder with its classical presentation of regularly recurring manic and depressive episodes can be well diagnosed in adults and adolescents. However, bipolar disorder in children is a controversial issue, difficult to diagnose and to distinguish from other illnesses that frequently occur in childhood. In the US, where the diagnosis of'bipolar disorder' is made relatively often in children, not only its classical presentation but also chronic mood dysregulation and even other mood symptoms may lead to the diagnosis of bipolar disorder. The preferred view is the British one, whereby bipolar disorder is only diagnosed in children if they present with clear manic episodes and euphoric mood. Treatment of bipolar disorder in children consists of pharmacotherapy and of psychoeducation aimed at lifestyle adjustments, including reduction of stress, a stable sleep pattern, and adjustments at school.