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August 14, 2019

Attention-Deficit/Hyperactivity Disorder, Hypomania, and Bipolar Disorder in Youth

Author Affiliations
  • 1McLean Hospital, Belmont, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Center for Quantitative Health, Department of Psychiatry, Massachusetts General Hospital, Boston
JAMA Psychiatry. Published online August 14, 2019. doi:10.1001/jamapsychiatry.2019.1926

The diagnostic entity of bipolar disorder has evolved substantially over time, in particular in children and adolescents. The introduction of hypomania as a diagnostic entity in DSM-III-R broadened the definition of bipolar disorder to include patients with symptoms of mania of shorter duration without significant impairment, and subsequent work has demonstrated substantial morbidity in patients with bipolar II disorder due to the predominance of depressive episodes. The broadening of the concept of bipolar disorder in youth has been much more controversial. Previous research has established that many adults with bipolar disorder recall symptom onset during childhood or adolescence.1 However, divergent definitions of bipolar disorder in pediatric populations stemmed from the notion that bipolar disorder may present differently in youth. Rather than having clear episodes of mania or hypomania, the diagnosis of bipolar disorder was applied to children with mood lability such that many of the children had ultradian symptoms of mood lability over the course of the day2 or persistent nonepisodic chronic irritability.3 This broadening of the definition likely contributed to a 40-fold increase in the diagnosis of bipolar disorder in youth.4

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