Maybe you should contact one of these people instead, perhaps Biederman, Findling, Hellander,Wozniak or Kay Jamison,or Nanci Schiman, for interest. Also, could it be, because CABF wrotea 23 page report/ Treatment Guidelines for Childhood Bipolar in 2005?

"Bipolar Disorder: Child Psychiatric Workgroup on
Bipolar Disorder

ROBERT A. KOWATCH, M.D., MARY FRISTAD, PH.D.,BORIS BIRMAHER, M.D.,KAREN DINEEN WAGNER, M.D., ROBERT L. FINDLING, M.D., MARTHA HELLANDER, J.D.,AND THE WORKGROUP MEMBERS

ABSTRACT

Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment ofpediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute treatment, and maintenancetreatment. These guidelines are not intended to serve as an absolute standard of medical or psychological care but rather to serve as clinically useful guidelines for evaluation and treatment that can be used in the care of children and adolescents with bipolar disorder. These guidelines are subject to change as our evidence base increases and practice patterns evolve.

J. Am. Acad. Child Adolesc. Psychiatry, 2005;44(3):213–235 Key Words:bipolar,treatment guidelines, consensus, mood stabilizer, atypical antipsychotic.

"In July 2003, a group of 20 clinicians and CABF members met over a 2-day period to develop these guidelines. There were four work groups: diagnosis, led by Mary Fristad; comorbidity,
led by Boris Birmaher; and treatment, in two groupsled by Karen Wagner and Robert Findling, respectively."

"Limitations of DSM-IV Criteria

There is continued debate over the appropriateness of DSM-IV criteria for classifying BPD in children and young adolescents (Biederman et al., 2000a;Findling et al., 2001). For these guidelines, we have used DSM-IV criteria, acknowledging that the current DSM-IV criteria for mania were developed for adults and are frequently difficult to apply to children."

"Activation and disinhibition on psychotropic drugs,unfortunately, are not uncommon (Wilens et al.,1999). If symptoms appear to have been triggered by a prescription drug (e.g., stimulant, antidepressant, steroid),a 7- to 10-day washout period is recommended(2–3 weeks for steroids or fluoxetine). If symptoms continue after that point, a diagnosis of BPD shouldbe considered."
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[Imagine, giving 10 days for steroids, antidepressants and stimulants to "wash out" --then end up with a Bipolar dx. Hmmm. That isn't allowing months of careful titrating off of those often prescribed drugs is it?]

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"Fig. 1 Algorithm I: Bipolar I disorder, manic or mixed, acute, without psychosis. Algorithm II: Bipolar I disorder, manic or mixed, acute, with psychosis.

Li = lithium; VAL = valproate; CBZ = carbamazepine; OLZ = olanzapine; RISP = risperidone; QUE = quetiapine; RISP = risperidone; OXC = oxcarbazepine;ARI = aripiprazole; ECT = electroconvulsive therapy."

ECT recommended for teens?

"Stage 5: Alternate Monotherapy Plus
Atypical Antipsychotic

If medications used in stages 1 through 4 all fail, then alternate monotherapy (oxcarbazepine) plus an atypical antipsychotic is recommended, based on clinical experience(level D).

Stage 6: ECT or Clozapine [Clozaril]

For children and adolescents who have not responded to combinations of treatment with three medications,clozapine is recommended. ECT is recommended for adolescents only."

WOW.

An estimated 1 percent to 2 percent of adults have this condition, and a long-term National Institute of Mental Health study of adults shows at least 65 percent felt their illness onset in childhood or adolescence.

From what I've read in general, early onset in the teens to early twenties is a marker for bipolar disorder. A first unipolar episode is typically later twenties or more. And with with the onset of puberty coming at smaller ages you might expect traits of the illness to appear earlier.

Estimates vary, but the suicide rate in untreated bipolar disorder is 30 to 60 times higher than that of the general population.

Kay Redfield Jamison's Night Falls Fast has a great deal of information about suicide and mental illness. On page 100 she cites that 90 to 95 percent of those who commit suicide had a diagnosable psychiatric illness. See page 340 for the references.

Page 101 shows a bar chart of data drawn from 250 clinical studies showing the increase in risk of suicide compared to the general population for various disorders. The highest risk of suicide is by those who have made previous suicide attempts, at some 39 times the expected rate. Depression's about 21 times and bipolar disorder about 15 times.

You also have to a little careful in reading the numbers. For example, abusers of opiates have a 15 times elevated suicide risk while abusers of alcohol have only a 7 times elevated risk. But there are far far more people abusing alcohol than opiates so absolute numbers it is much more lethal. Just some thoughts.

"Early diagnosis and treatment are lifesaving." This is the line I object to. Who says early diagnosis and treatment are lifesaving? I say this is very unlikely. First of all the diagnosis is being based on subjective criteria and is stigmatizing. It's even self fulfilling. Secondly the treatment is toxic and has all sorts of long term harmful effects on the brain and body of a child. As I've said so often before if the child wasn't ill before, they sure will be ill afterwards. This is not about "healing"; this is about harming.