Bipolar disorder in young people

Abstract

Youth bipolar disorder (YBD) describes young people with bipolar disorder (BD) who are aged between 12 and 25 years. Clinicians who work with young people will invariably encounter YBD, even if it is not immediately apparent. There is an estimated one per cent prevalence of YBD in adolescents which increases to 5.6 per cent if considering sub-threshold symptoms (Lewinsohn, Klein & Seeley, 1995), and peak age of onset of YBD is between 15 and 19 years of age (APA, 2002). The prevalence of YBD in young people may be underestimated as YBD is often misdiagnosed as unipolar depression. Australian researchers have identified an average delay from symptom onset (age 17.5 years) to diagnosis of 12.5 years (Berk et al., 2007). Despite the recognised average age of onset for BD occurring during youth, the diagnosis remains controversial. Rates of diagnosis of YBD have risen significantly over the past decade, leading some clinicians and researchers to question if normal adolescent issues or other forms of psychological difficulties are being mistaken for BD (Blader & Carlson, 2007; Moreno et al., 2007). However, evidence from numerous prolific and long established YBD research groups (such as Barbara Geller's at the University of Washington, Mani Pavuluri's at the University of Illinois and Ellen Leibenluft's at the National Institute of Health) strongly supports the diagnosis. Furthermore, there are no neurobiological reasons that BD cannot occur in young people. In the face of this research evidence, although some clinicians do not accept that BD can occur in younger people, there is a general consensus that BD does occur in youth. However, there is ongoing debate regarding the phenomenology and diagnostic boundaries of BD for children and adolescents compared to adults (Carlson et al., 2005).