Bipolar Disorder, with a Focus on Childhood-onset Bipolar Disorder

Abstract

For more than 3 decades, there has been a paucity of treatment-related studies for adults with bipolar illness, despite consistent calls nationally and internationally for more research and funding. In this issue of Psychiatric Annals, I decided to focus on some of the issues infl uencing a new and even greater problem: the lack of systematic treatment information for the increasingly recognized disorder of childhood-onset bipolar illness. Because multiple factors appear to be converging to cause and continue this shortfall, I have labeled it “The Perfect Storm,” after the book by Sebastian Junger, which describes a hypothetical catastrophic storm caused by the convergence of two hurricanes and a low pressure system in the Atlantic Ocean off the coast of Newfoundland. The perfect storm of childhood-onset bipolar illness is not hypothetical and is causing real, human, shortand long-term catastrophes. Even more tragically, much of it is avoidable. The fi eld does not need to discover new treatments that may take many years to develop, but merely needs to determine how best to deploy and sequence ones that already exist and are being widely used, despite the inadequate treatment literature regarding both children and adults. More systematic comparative effectiveness and tolerability studies could readily be performed.1,2 Some might argue that the considerable controversy that has surrounded the diagnosis in children must necessarily limit studies, but this is not the case. Carefully described clinical presentations and illness subtypes could be studied and effective treatments delineated, whether or not a child fi ts the classi-