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Treatment for full\u2010criteria BD I or II in children has been partially described in the literature, but major uncertainties exist regarding non\u2010classic presentations, which were originally designated as bipolar \u201cnot otherwise specified\u201d (BP\u2010NOS) in DSM\u2010IV and in DSM\u20105 and ICD\u201011 as either other specified or unspecified BD (S\u2010USBD). This review aims to provide literature\u2010based recommendations on the treatment of S\u2010USBD, with a focus on a fear of harm (FOH) subtype, now termed temperature and sleep dysregulation disorder (TSDD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A broad systematic literature review with AI assistance was conducted to identify all articles in PubMed providing data on the treatment of children with either atypical BD, BD\u2010NOS, USBD, specified BD, rapid cycling BD, or a phenotype of BD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Given the paucity of pharmacological treatment literature on any of the earliest forms of BD prior to their achieving a BP I or BP II diagnosis, it was felt that there was a critical need to review the existent literature on the earliest presentations and prodromes, which now fall under the rubric of specified (BD S\u2010USBD). Here, the focus is on the prevalent BP\u2010NOS subtype, which meets all the classical presentations of BP except for the brief durations of mania, and a more newly recognized form of S\u2010USBD called TSDD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven family\u2010focused psychotherapy studies were identified, including nine randomized controlled trials (RCTs) with uniformly positive results versus the comparative group, which was treatment as usual (TAU) for unclear subtypes and subtypes of S\u2010USBD. Only three psychopharmacological RCTS were reported, and only one on aripiprazole in unspecified subtypes of S\u2010USBD in high\u2010risk children showed a significant difference from placebo. None of the controlled trials and only two case series provided separate outcome data on the S\u2010USBD subtypes, except for one that focused exclusively on the TSDD subtype. These two case series reports preliminarily defined the TSDD subtype and provided novel pharmacological treatment data, including lithium, clonidine, and ketamine, which led to good outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Good support was provided in the 11 studies for the use of adjunctive family\u2010focused psychotherapeutic approaches, and this approach should be considered an important part of any treatment regimen. The pharmacological treatment landscape for S\u2010USBD lacks a systematic research base, warranting further exploration with controlled clinical trials. Case series indicate promising treatment outcomes for TSDD with high\u2010dose lithium, clonidine, ketamine, and other cooling measures. Validation of this novel treatment strategy in controlled trials is needed to advance the management of the S\u2010USBD variants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.13817","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T21:54:10Z","timestamp":1747173250000},"page":"156-179","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Treatment of Early\u2010Onset Specified and Unspecified Bipolar Disorders: A Systematic Review and Strategies for Identifying and Managing a Thermally Dysregulated Subtype in Children"],"prefix":"10.1111","volume":"152","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1590-7746","authenticated-orcid":false,"given":"Demitri F.","family":"Papolos","sequence":"first","affiliation":[{"name":"Juvenile Bipolar Research Foundation  Irvine California USA"},{"name":"Department of Psychiatry Albert Einstein College of Medicine  New York 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