{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T03:27:37Z","timestamp":1785554857875,"version":"3.56.0"},"reference-count":61,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T00:00:00Z","timestamp":1623369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the delay to first treatment, and both early onset and treatment delay are associated with more depressive episodes and a poor prognosis in adulthood. Ultra-rapid and ultradian cycling, consistent with a diagnosis of BP-NOS, are highly prevalent in the youngest children and take long periods of time and complex treatment regimens to achieve euthymia. Lithium and atypical antipsychotics are effective in mania, but treatment of depression remains obscure, with the exception of lurasidone, for children ages 10-17. Treatment of the common comorbid anxiety disorders, oppositional defiant disorders, pathological habits, and substance abuse are all poorly studied and are off-label. Cognitive dysfunction after a first manic hospitalization improves over the next year only on the condition that no further episodes occur. Yet comprehensive expert treatment after an initial manic hospitalization results in many fewer relapses than traditional treatment as usual, emphasizing the need for combined pharmacological, psychosocial, and psycho-educational approaches to this difficult and highly recurrent illness.<\/jats:p>","DOI":"10.3390\/medicina57060601","type":"journal-article","created":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T02:55:28Z","timestamp":1623380128000},"page":"601","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["The Challenges of Children with Bipolar Disorder"],"prefix":"10.3390","volume":"57","author":[{"given":"Robert M.","family":"Post","sequence":"first","affiliation":[{"name":"School of Medicine, George Washington University, Washington, DC 20052, USA"},{"name":"Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4712-8979","authenticated-orcid":false,"given":"Heinz","family":"Grunze","sequence":"additional","affiliation":[{"name":"Psychiatrie Schw\u00e4bisch Hall, Campus ZfPG, 74523 Schw\u00e4bisch Hall, Germany"},{"name":"Campus Nuremberg-Nord, Paracelsus Medical University, 90419 Nuremberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.jaac.2010.05.017","article-title":"Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication\u2014Adolescent Supplement (NCS-A)","volume":"49","author":"Merikangas","year":"2010","journal-title":"J. Am. Acad. Child. Adolesc. 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