소아 . 청소년의 양극성장애

Bipolar Disorder in Children and Adolescents

In children and adolescents, the issue of bipolar disorders has long been an area of controversy for psychiatrists. But, recent studies confirm that bipolar disorders do exist in children and adolescents, and there are lines of evidence that biploar disorder in children and adolescents has a greater incidence than is apparent. At present, although no unifying theory of the etiology, phenomenology, treatment, or prognosis emerges from the the previous studies, we can make several conclusions concerning the bipolar disorders in children and adolescents. First, a subgroup of bipolar disorder in children and adolesents have a genetic-based vulnerability for the expression of bipolar disorder, and it seems that bipolar disorder in children and adolescents carries a higher genetic risk than that of adult populations. Second, the clinical features seem to be different from those of adult populations. Thus, to operationalze the diagnostic criteria for bipolar disorder in children and adolescents, developmental charateristics should be taken into consideration. In terms of treatment planning, lithium seems to be definitely effective in treating and preventing relapse and generally speaking, children and adolescents experience only mild side effects. Lastly, although systematic prospective, long-term studies of early-onset bipolar disorder have not been careied out, there is no evidence that this disorder beginning in childhood and adolescence is intrisically more devastating than it is in adults. Variables such as the time spent psychiatrically ill, the intermorbid functioning of the patient, and the support system available are more important to long-term function than age of onset. Regarding prospects for future research, 1) The biological studies should focus on longitudinal studies rather than cross-sectional studies to find the true “Trait Bioligical markers”. 2) Brain imaging study such as PET scanning using specific receptor ligands may permit in vivo assessment that will advance our understanding of the pathophysiology of bipolar disorder in children and adolescents.