CNS Drugs

, Volume 12, Issue 6, pp 437–450 | Cite as

Bipolar Disorder in Children and Adolescents

A Guide to Diagnosis and Treatment
  • Raul R. Silva
  • Fredrick Matzner
  • Jose Diaz
  • Sanjay Singh
  • E. Steven DummitIII
Disease Management


The assessment and treatment of juvenile bipolar disorder presents a number of unique challenges and risks. Despite some advances, there is still much to learn about this illness and appropriate interventions.

The diagnosis of bipolar disorder in children and adolescents is established using the same DSM-IV criteria as are used in adults. In children, the differential diagnosis between bipolar disorder and attention deficit hyperactivity disorder requires special care.

Somatic treatments have been less well studied in children and adolescents than in adults, especially for relatively rare conditions such as bipolar disorder, which is uncommon before the age of 10 years. This is unfortunate because it may be inappropriate to translate standard practice for adults to use in children. Medications may have different pharmacokinetics in peripubertal compared with adult patients and may show different interactions according to stages of endocrine development. Lithium, for example, has a shorter half-life in children than in adults, and maintenance treatment with the drug in adolescents appears to be associated with high relapse rates, perhaps because of differences in drug kinetics.

Since illnesses with earlier onset tend to be more severe, and more treatment resistant, it is especially important to rigorously evaluate treatments in juvenile onset conditions. The anticonvulsants that are useful in adults have not been evaluated in controlled trials in children. It appears that adolescent patients with bipolar disorder are more likely to require adjunctive antipsychotics than adults. Since typical antipsychotics are associated with the risk of tardive dyskinesia during long term use and juvenile patients will be exposed to medication over a long period, it is important to evaluate atypical antipsychotics in these patients.

Juvenile forms of functional psychoses appear to show higher genetic loads, and parents and families should be evaluated for their contributions to the patient’s treatment context. Juvenile patients with bipolar disorder are at significant risk of self-injurious behaviours and require careful supervision. Medication regimens must be supervised closely.


Attention Deficit Hyperactivity Disorder Bipolar Disorder Adis International Limited Valproic Acid Conduct Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Esquirol E. Mental maladies. Atreatise of insanity. Philadelphia (PA): Lea and Blanchard Philadelphia, 1845Google Scholar
  2. 2.
    Goodwin F, Jamison K. Manic depressive illness. New York (NY): Oxford University Press, 1990Google Scholar
  3. 3.
    Berrios GE. Depressive and manic states during the nineteenth century. In: Georgotas A, Cancro R, editors. Depression and mania. New York (NY): Elsevier Science Publishing Co., 1988: 13–25Google Scholar
  4. 4.
    Biederman J, Wozniak J, Kiely K, et al. CBCL clinical scales discriminate prepubertal children with structured interview-derived diagnosis of mania from those with ADHD. J Am Acad Child Adolesc Psychiatry 1995; 34: 464–71PubMedGoogle Scholar
  5. 5.
    Wozniak J, Biederman J, Mundy E, et al. A pilot family study of childhood-onset mania. J Am Acad Child Adolesc Psychiatry 1995; 34: 1577–83PubMedGoogle Scholar
  6. 6.
    Birmaher B, Ryan ND, Williamson D, et al. Child and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry 1997; 35: 1427–39Google Scholar
  7. 7.
    Geller B, Luby J. Child and adolescent bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997; 36: 1168–76PubMedGoogle Scholar
  8. 8.
    Hechtman L, Greenfield B. Juvenile onset bipolar disorder. Curr Opin Paediatr 1997; 9: 346–53Google Scholar
  9. 9.
    McClellan J, Werry J. Practice parameters for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 1997; 36: 157S–176SPubMedGoogle Scholar
  10. 10.
    Weller EB, Weller RA, Fristad MA. Bipolar disorder in children: misdiagnosis, underdiagnosis, and future directions. J Am Acad Child Adolesc Psychiatry 1995; 34: 709–14PubMedGoogle Scholar
  11. 11.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  12. 12.
    McElroy SL, Strakowski SM, West SA, et al. Phenomenology of adolescent and adult mania in hospitalised patients with bipolar disorder. Am J Psychiatry 1997; 154: 44–9PubMedGoogle Scholar
  13. 13.
    Keck PE, McElroy SL, Strakowski SM, et al. 12-month outcome of patients with bipolar disorder following hospitalisation for a manic or mixed episode. Am J Psychiatry 1998; 155; 646–52PubMedGoogle Scholar
  14. 14.
    Akiskal HS. Developmental pathways to bipolarity: are juvenile-onset depressions pre-bipolar?. J Am Acad Child Adolesc Psychiatry 1995; 34(6): 754–63PubMedGoogle Scholar
  15. 15.
    Biederman J, Faraone S, Mick E, et al. Attention-deficit hyper-activity disorder and juvenile mania: an overlooked comorbidity? J Am Acad Child Adolesc Psychiatry 1996; 35(8): 997–1008PubMedGoogle Scholar
  16. 16.
    Biederman J, Klein R, Pine DS, et al. Resolved: mania is mistaken for ADHD in prepubertal children. J Am Acad Child Adolesc Psychiatry 1998; 37: 1091–9PubMedGoogle Scholar
  17. 17.
    Faraone SV, Biederman J, Mennin D, et al. Attention-deficit hyperactivity disorder with bipolar disorder: a familial subtype? J Am Acad Child Adolesc Psychiatry 1997; 36: 1378–90PubMedGoogle Scholar
  18. 18.
    West SA, McElroy SL, Strakowski SM, et al. Attention deficit hyperactivity disorder in adolescent mania. Am J Psychiatry 1995; 152: 271–3PubMedGoogle Scholar
  19. 19.
    Wozniak J, Biederman J, Kiely K, et al. Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. J Am Acad Child Adolesc Psychiatry 1995; 34: 867–76PubMedGoogle Scholar
  20. 20.
    Winokur G, Coryell W, Endicott J, et al. Further distinctions between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression). Am J Psychiatry 1993; 150: 1176–81PubMedGoogle Scholar
  21. 21.
    Campbell M, Fish B, Korien J, et al. Lithium and chlorpromazine: a controlled crossover study of hyperactive severely disturbed young children. J Autism Child Schizophr 1972; 2: 234–63PubMedGoogle Scholar
  22. 22.
    Campbell M, Small AM, Green WH, et al. Behavioural efficacy of haloperidol and lithium carbonate. Arch Gen Psychiatry 1984; 41: 650–6PubMedGoogle Scholar
  23. 23.
    Campbell M, Kafantaris V, Cueva JE. An update on the use of lithium carbonate in aggressive children and adolescents with conduct disorder. Psychopharmacol Bull 1995; 31(1): 93–102PubMedGoogle Scholar
  24. 24.
    Bradley C. The behaviour of children receiving benzedrine. Am J Psychiatry 1937; 94: 577–85Google Scholar
  25. 25.
    West SA, Strakowski SM, Sax KW, et al. The comorbidity of attention-deficit hyperactivity disorder in adolescent mania: potential diagnostic and treatment implications. Psychopharmacol Bull 1995; 31: 347–51PubMedGoogle Scholar
  26. 26.
    Kovacs M, Pollock M. Bipolar disorder and comorbid conduct disorder in childhood and adolescence. J Am Acad Child Adolesc Psychiatry 1995; 34(6): 715–23PubMedGoogle Scholar
  27. 27.
    Carlson GA, Kashani JH. Manic symptoms in a non-referred adolescent population. J Affect Disord 1988; 15: 219–26PubMedGoogle Scholar
  28. 28.
    Kessler RC, Nelson CB, McGonagle KA, et al. The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilisation. Am J Orthopsychiatry 1996; 66: 17–31PubMedGoogle Scholar
  29. 29.
    Regier DA, Fanner ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264(19): 2511–8Google Scholar
  30. 30.
    Boyle MH, Offord DR. Psychiatric disorder and substance use in adolescence. Can J Psychiatry 1991; 36: 699–705PubMedGoogle Scholar
  31. 31.
    Fergusson DM, Horwood LJ, Lynsky MT. Prevalence and comorbidity of DSM-III-R diagnoses in a birth cohort of 15 year olds. J Am Acad Child Adolesc Psychiatry 1993; 32: 28–33Google Scholar
  32. 32.
    Kandel DB, Johnson JG, Birdh, et al. Psychiatric disorders associated with substance use among children and adolescents: findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. J Abnorm Child Psychol 1997; 25(2): 121–32PubMedGoogle Scholar
  33. 33.
    Carlson GA. Identifying prepubertal mania. J Am Acad Child Adolesc Psychiatry 1995; 34: 750–3PubMedGoogle Scholar
  34. 34.
    Geller B, Sun K, Zimerman B, et al. Complex and rapid-cycling in bipolar children and adolescents: a preliminary study. J Affect Disord 1995; 34(4): 259–68PubMedGoogle Scholar
  35. 35.
    Fristad MA, Weller EB, Weller RA. The Mania Rating Scale: can it be used in children? A preliminary report. J Am Acad Child Adolesc Psychiatry 1992; 31(2): 252–7PubMedGoogle Scholar
  36. 36.
    Werry JS, McClellan JM, Chard L. Childhood adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study. J Am Acad Child Adolesc Psychiatry 1991; 30(3): 457–65PubMedGoogle Scholar
  37. 37.
    Geller B, Fox LW, Clark KA. Rate and predictors of prepubertal bipolarity during follow-up of 6- to 12-year-old depressed children. J Am Acad Child Adolesc Psychiatry 1994; 33(4): 461–8PubMedGoogle Scholar
  38. 38.
    Lewinsohn PM, Klein DN, Seeley JR. Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry 1995; 34: 454–63PubMedGoogle Scholar
  39. 39.
    Weissman MM, Bland RC, Canino GJ, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA 1996; 276(4): 293–9PubMedGoogle Scholar
  40. 40.
    Nurnberger JI, Gershon E. Genetics. In: Paykel ES, editor. Handbook of affective disorders. 1st ed. New York (NY): Churchill-Livingstone, 1982Google Scholar
  41. 41.
    Mendlewicz J, Rainer JD. Adoption study supporting genetic transmission in manic depressive illness. Nature 1977; 265: 327–9Google Scholar
  42. 42.
    Mufson L, Fairbanks J. Interpersonal psychotherapy for depressed adolescents: a one year follow-up study. J Am Acad Child Adolesc Psychiatry 1996; 35: 1145–55PubMedGoogle Scholar
  43. 43.
    Goldman EL. CBT: ahealing odysseyforbipolar patients. Clinical Psychiatry News 1998 Sep: 27Google Scholar
  44. 44.
    Matzner FJ, Silvan M, Silva RR, et al. Intensive day program for disturbed truant adolescents. Am J Orthopsychiatry 1998; 68: 135–41PubMedGoogle Scholar
  45. 45.
    Strober M, Schmidt-Lackner S, Freeman R, et al. Recovery and relapse in adolescents with bipolar affective illness: a five-year naturalistic, prospective follow-up. J Am Acad Child Adolesc Psychiatry 1995; 34: 724–31PubMedGoogle Scholar
  46. 46.
    Kutcher S. Child and adolescent psychopharmacology. Philadelphia (PA): W.B. Saunders Co., 1997Google Scholar
  47. 47.
    Walsh BT, editor. Child psychopharmacology. Washington, DC: American Psychiatric Press, Inc., 1998Google Scholar
  48. 48.
    Weeston TF, Constantino J. High-dose T4 for rapid-cycling bipolar disorder [letter]. J Am Acad Child Adolesc Psychiatry 1996; 35: 131–2PubMedGoogle Scholar
  49. 49.
    Reisher H, Pfeffer C. Lithium pharmacokinetics. J Am Acad Child Adolesc Psychiatry 1996; 35: 130–1Google Scholar
  50. 50.
    Fras I, Major LF. Clinical experience with risperidone [letter]. J Am Acad Child Adolesc Psychiatry 1995; 34: 833PubMedGoogle Scholar
  51. 51.
    Samuel RZ. EPS with lithium [letter]. J Am Acad Child Adolesc Psychiatry 1993; 32: 1078PubMedGoogle Scholar
  52. 52.
    Kastner T, Friedman DL. Verapamil and valproic acid treatment of prolonged mania. J Am Acad Child Adolesc Psychiatry 1992; 31: 271–5PubMedGoogle Scholar
  53. 53.
    Shliselberg N, Bosch JR, Herrera J. Valproic acid in the treatment of refractory bipolar disorder [letter]. J Clin Psychopharmacol 1990; 10: 151–2PubMedGoogle Scholar
  54. 54.
    Kafantaris V, Dicker R, Coletti DJ, et al. Combined lithium and divalproex treatment of bipolar adolescents: an open pilot study. Poster presentation, New Clinical Drug Evaluation Unit 38th Annual Meeting: 1998 Jun 9–12; Boca Raton, FloridaGoogle Scholar
  55. 55.
    Donovan S, Susser ES, Nunes EV, et al. Divalproex treatment of disruptive adolescents: a report of 10 cases. J Clin Psychiatry 1997; 58: 12–5PubMedGoogle Scholar
  56. 56.
    Kafantaris V, Campbell M, Padron-Gayol MV, et al. Carbamazepine in hospitalised aggressive conduct disorder children: an open pilot study. Psychopharmacol Bull 1992; 28: 193–9PubMedGoogle Scholar
  57. 57.
    Geller B, Cooper TB, Sun K, et al. Double-blind and placebocontrolled study of lithium for adolescent bipolar disorders with secondary substance dependency. J Am Acad Child Adolesc Psychiatry 1998; 37: 171–8PubMedGoogle Scholar
  58. 58.
    Cueva JE, Overall JE, Small AM, et al. Carbamazepine in aggressive children with conduct disorder: a double-blind placebo-controlled study. J Am Acad Child Psychiatry 1996; 35(4): 480–90Google Scholar
  59. 59.
    Campbell M, Adams PB, Small AM, et al. Lithium in hospitalised aggressive children with conduct disorder: a double-blind and placebo controlled study. J Acad Child Adolesc Psychiatry 1995; 34: 445–53Google Scholar
  60. 60.
    Silva RR, Campbell M, Golden RR, et al. Side effects associated with lithium and placebo administration in aggressive children. Psychoparmacol Bull 1992; 28: 319–26Google Scholar
  61. 61.
    Strober M, Morrell W, Lampert C, et al. Relapse following discontinuation of lithium maintenance therapy in adolescents with bipolar I illness: a naturalistic study. Am J Psychiatry 1990; 147: 457–61PubMedGoogle Scholar
  62. 62.
    Strober M, Lampert C, Schmidt S, et al. The course of major depressive disorder in adolescents: I. Recovery and risk of manic switching in a follow-up of psychotic and nonpsychotic subtypes. J Am Acad Child Adolesc Psychiatry 1993; 32: 34–42Google Scholar
  63. 63.
    Kutcher SP, Marton P, Korenblum M. Adolescent bipolar illness and personality disorder. J Am Acad Child Adolesc Psychiatry 1990; 29: 355–8PubMedGoogle Scholar
  64. 64.
    Prien RF, Potter WZ. NIMH workshop report on treatment of bipolar disorder. Psychopharmacol Bull 1990; 26: 409–27PubMedGoogle Scholar
  65. 65.
    Vitiello B, Behar D, Malone R, et al. Pharmacokinetics of lithium carbonate in children. J Clin Psychopharmacol 1988; 8: 355–9PubMedGoogle Scholar
  66. 66.
    Hagino OR, Weller EB, Weiler RA, et al. Comparison of lithium dosage methods for preschool- and early school-age children. J Am Acad Child Adolesc Psychiatry 1998; 37: 60–5PubMedGoogle Scholar
  67. 67.
    Campbell M, Silva RR, Kafantaris V, et al. Predictors of side effects associated with lithium administration in children. Psychopharmacol Bull 1991; 27: 373–80PubMedGoogle Scholar
  68. 68.
    Lapierre YD, Raval KJ. Pharmacotherapy of affective disorders in children and adolescents. Psychiatr Clin North Am 1989; 12: 951–61PubMedGoogle Scholar
  69. 69.
    DeLong GR, Aldershof AL. Long-term experience with lithium treatment in childhood: correlation with clinical diagnosis. J Am Acad Child Adolesc Psychiatry 1987; 26: 389–94PubMedGoogle Scholar
  70. 70.
    Picker W, Solomon G, Germer JM. Lithium side effect [letter]. J Am Acad Child Adolesc Psychiatry 1990; 29(3): 489PubMedGoogle Scholar
  71. 71.
    Ortiz A, Dabbagh M, Gershon S. Lithium: clinical use, toxicology and mode of action. In: Bernstein JG, editor. Clinical psychopharmacology. 2nd ed. Littleton (MA): John Wright-PSG Inc., 1984Google Scholar
  72. 72.
    Sokolov ST, Kutcher SP, Joffe RT. Basal thyroid indices in adolescent depression and bipolar disorder. J Am Acad Child Adolesc Psychiatry 1994; 33(4): 469–75PubMedGoogle Scholar
  73. 73.
    Kafantaris V. Treatment of bipolar disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry 1995; 34: 732–41PubMedGoogle Scholar
  74. 74.
    Cohen LS, Friedman JM, Jefferson JW, et al. A reevaluation of risk of in utero exposure to lithium. JAMA 1994; 230: 1283–7Google Scholar
  75. 75.
    Weller EB, Weiler RA, Fristad MA, et al. Saliva lithium monitoring in prepubertal children. J Am Acad Child Adolesc Psychiatry 1987; 26: 173–5PubMedGoogle Scholar
  76. 76.
    American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder. Am J Psychiatry 1994; 151(12 Suppl.): 1–36Google Scholar
  77. 77.
    Papatheodorou G, Kutcher SP, Katic M, et al. The efficacy and safety of divalproex sodium in the treatment of acute mania in adolescents and young adults: an open clinical trial. J Clin Psychopharmacol 1995; 15(2): 110–6PubMedGoogle Scholar
  78. 78.
    McConville BJ, Sorter MT, Foster K, et al. Lithium versus val-proate side effects in adolescents with bipolar disorder. Poster presentation New Clinical Drug Evaluation Unit 38th Annual Meeting: 1998 Jun 9–12; Boca Raton, FloridaGoogle Scholar
  79. 79.
    Bryant III AE, Dreifuss FE. Valproic acid hepatic fatalities. Neurology 1996; 46: 465–9PubMedGoogle Scholar
  80. 80.
    Inojarvi JIT, Laatikainen TJ, Pakarinen AT, et al. Polycystic ovaries and hyperandrogenism in women taking valproate for epilepsy. N Engl J Med 1993; 329: 1383–8Google Scholar
  81. 81.
    Irwin M, Masand P. Valproate and polycystic ovaries [letter]. J Am Acad Child Adolesc Psychiatry 1998; 37(1): 9–10PubMedGoogle Scholar
  82. 82.
    Garfinkel M, Garfinkel L, Himmelhoch J, et al. Lithium carbonate and carbamazepine: an effective treatment for adolescent manic or mixed bipolar patients. Annual meeting of the American Academy of Child and Adolescent Psychiatry, 1985; 41–42Google Scholar
  83. 83.
    Silva RR, Munoz DM, Alpert M. Carbamazepine use in children and adolescents with features of attention deficit hyperactivity disorder. J Acad Child Adolesc Psychiatry 1996; 35: 352–8Google Scholar
  84. 84.
    Varanka TM, Weller RA, Weller EB, et al. Lithium treatment of manic episodes with psychotic features in prepubertal children. Am J Psychiatry 1988; 145: 1557–9PubMedGoogle Scholar
  85. 85.
    Kafantaris V, Coletti DJ, Dicker R, et al. Are childhood psychiatric histories of bipolar adolescents associated with family history, psychosis, and response to lithium treatment? J Affect Disord 1998; 51(2): 153–64PubMedGoogle Scholar
  86. 86.
    Tohen M, Zarate CA. Antipsychotic agents and bipolar disorder. J Clin Psychiatry 1998; 59: 38–49PubMedGoogle Scholar
  87. 87.
    Sanger TM, Tohen M, Tollefson GD, et al. Olanzapine versus placebo in the treatment of acute mania [abstract]. Schizophrenia Res 1998; 29: 152Google Scholar
  88. 88.
    Fuchs DC. Clozapine treatment of bipolar disorder in a young adolescent. J Am Acad Child Adolesc Psychiatry 1994; 33: 1299–302PubMedGoogle Scholar
  89. 89.
    Silva RR, Alpert M, Munoz, DM, et al. Neuroleptic malignant syndrome in children and adolescents. J Am Acad Child Adolesc Psychiatry 1999; 38(2): 187–94PubMedGoogle Scholar
  90. 90.
    Silva RR, Magee HJ, Friedhoff AJ. Persistent tardive dyskinesia and other neuroleptic related dyskinesias in tourette’s disorder. J Child Adolesc Psychopharmacol 1993; 3: 137–44PubMedGoogle Scholar
  91. 91.
    McElroy SL, Soutullo CA, Keck PE, et al. A pilot trial of adjunctive gabapentin in treatment of bipolar disorder. Annals Clin Psychiatry 1997; 9: 99–103Google Scholar
  92. 92.
    Kusumakar V, Yatham L. Lamotrigine treatment of rapid cycling bipolar disorder [letter]. Am J Psychiatry 1997; 154: 1171–2PubMedGoogle Scholar
  93. 93.
    Lee DO, Steingard RJ, Cesena M, et al. Behavioural side effects of gabapentin in children. Epilepsia 1996; 37(1): 87–90PubMedGoogle Scholar
  94. 94.
    Koehler-Troy C, Strober M, Malenbaum R. Methylphenidate-induced mania in a prepubertal child. J Clin Psychiatry 1986; 47: 566–7PubMedGoogle Scholar
  95. 95.
    Max JE, Richards L, Hamdan-Allen G. Case study: antimanic effectiveness of dextroamphetamine in a brain-injured adolescent. J Am Acad Child Adolesc Psychiatry 1995; 34(4): 472–6PubMedGoogle Scholar
  96. 96.
    Carlson GA, Rapport MD, Kelly KL, et al. The effects of methylphenidate and lithium on attention and activity level. J Am Acad Child Adolesc Psychiatry 1992; 31: 262–70PubMedGoogle Scholar
  97. 97.
    Emslie GJ, Rush AJ, Weinberg WA, et al. A double-blind randomised, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 1997; 54(11): 1031–7PubMedGoogle Scholar
  98. 98.
    Kashani JH, Hodges KK, Shekim WO. Hypomanic reaction to amityptyline in a depressed child. Psychosomatics 1980; 21(10): 867, 872PubMedGoogle Scholar
  99. 99.
    Briscoe JJ, Harrington RC, Predergast M. Development of mania in close association with tricyclic antidepressant administration in children. A report of two cases. Eur Child Adolesc Psychiatry 1995; 4(4): 280–3Google Scholar
  100. 100.
    Venkataraman S, Naylor MW, King CA. Mania associated with fluoxetine treatment in adolescents. J Am Acad Child Adolesc Psychiatry 1992; 31: 276–81PubMedGoogle Scholar
  101. 101.
    Geller B, Fox LW, Fletcher M. Effect of tricyclic antidepressants on switching to mania and on the onset of bipolarity in depressed 6 to 12 year olds. J Am Acad Child Adolesc Psychiatry 1993; 32: 43–50PubMedGoogle Scholar
  102. 102.
    Hill MA, Courvoisie H, Dawkins K, et al. ECT for the treatment of intractable mania in two prepubertal male children. Convuls Ther 1997; 13: 74–82PubMedGoogle Scholar
  103. 103.
    Hsu LK. Lithium-resistant adolescent mania. J Am Acad Child Psychiatry 1986; 25: 280–3PubMedGoogle Scholar
  104. 104.
    Barton B, Gitlin MJ. Verapamil in treatment-resistant mania: an open trial. J Clin Psychopharmacol 1987; 7: 101–3PubMedGoogle Scholar
  105. 105.
    Robertson JM, Tanguay PE. Case study: the use of melatonin in a boy with refractory bipolar disorder. J Am Acad Child Adolesc Psychiatry 1997; 36: 822–5PubMedGoogle Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  • Raul R. Silva
    • 1
  • Fredrick Matzner
    • 1
  • Jose Diaz
    • 1
  • Sanjay Singh
    • 1
  • E. Steven DummitIII
    • 1
  1. 1.Division of Child and Adolescent PsychiatryNew York University School of MedicineNew YorkUSA

Personalised recommendations