Preschool bipolar disorder: three cases and their follow-up

Objective: Three preschool mania cases were presented discussing clinical phenomenology and treatment with relevant literature. Methods: Psychiatric assessments were done based on Diagnostic and Statistical Manual of Mental Disorders 5(th) edition (DSM-5) criteria. Symptom severity was measured using Young Mania Rating Scale. Results: All met criteria for bipolar disorder type I and attention deficit hyperactivity disorder (ADHD). Familial depression, anxiety and stressful life events increased symptom severity and treatment resistance. Premature dropouts and referrals due to repetitive manic episodes were frequent. While no clinical improvement was observed in a case where valproate was single agent, new generation antipsychotics (risperidone, olanzapine, aripiprazole, paliperidone) were well-tolerated. Discussion: We believe nature, clinical course and treatment of bipolar disorder in preschoolers needs to be further enlightened with larger sample groups and longitudinal follow-up studies, as this rare condition is an important cause of morbidity and functional loss mainly for this age group where lower rates of treatment response and follow-up and comorbidity with other psychiatric disorders, especially ADHD is common.