There’s a new diagnostic concept in child psychiatry: The bipolar prodrome. It refers to children who are at risk for bipolar disorder but don’t have the full illness. Research in this area is gathering steam, and nearly all of it focuses on adolescents whose parent has bipolar disorder.
Consider these take-home points:
• Proceed cautiously with antidepressants and stimulants in young patients with a strong family history of bipolar disorder
• Antidepressant-induced mania often presents as a mixed state, which feels to the patient like a worsening of their depression, so take seriously any signs of worsened mood on these agents
• If manic symptoms are present, attend to them with a mood stabilizer before starting treatments that can further destabilize mood
• Stabilize the environment as well, with family therapy, skill building, and regulation of sleep and circadian rhythms.
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