Preschool bipolar disorder: Brazilian children case reports

Objective: This study describes the clinical phenomenology and family history of preschool age onset Bipolar Disorder (BD). Methods: Eight children and adolescents out of 118 cases (6.78%), both genders, meeting current DSM-IV criteria diagnosis of BD were described. The clinical assessment, CBCL, DICA-TV and CGAS were performed directly with each patient and their parents. Results: Most (87.5%) presented classical symptoms of mania: euphoria, grandiosity, irritability, psychomotor agitation and agitated sleep or, in the same proportion, sleeplessness. Hyperactivity and increase of energy were found in all eight cases. The clinical course varied from a rapid, ultra-rapid, ultradian cycle to a continued pattern. Five out of eight children (62.5%) presented aggressiveness toward others and one deliberate self-harm. Most (87.5%) had psychiatric family history. The average number of medications used during their life was 4.5 drugs. Limitation: The small sample and retrospective reports of the first manic symptoms in three of the cases (cases V, VI and VII). Conclusion: An important incidence of classical manic features was found in very young children. The clinical course tended to be continuous, and preschool BD seems to have a strong association with affective disorder family history. (c) 2007 Elsevier B.V. All rights reserved.