Vol 11, N°1 Child and Adolescent Psychiatry
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hildren and adolescents with disturbed moods, affective instability, behavioral disturbances, attention problems, aggression, and agitation are frequently diag- nosed as having pediatric bipolar disorder (PBD), often referred to as early-onset bipolar disorder (BD). Current research centers around a debate on the covariance and respective co-occurrence of early-onset BD with atten- tion-deficit/hyperactivity  disorder  (ADHD),  and  the question as to whether these two disorders share com- mon underlying neurobiological processes which produce the  same  phenomenology  and  characteristic  clinical symptom patterns as outlined above.1,2 This debate is highly controversial, because PBD symptoms have fre- quently been shown to overlap with symptom character- istics related to ADHD (Figures 1 and 2), thus making the task of differentiating the diagnosis of both these dis- orders extremely difficult.This diagnostic challenge is fur- ther complicated by the fact that not only have PBD and ADHD been frequently found to be comorbid, but that they co-occur with other disruptive behavior disorders (DBD) such as oppositional defiant disorder (ODD) or conduct disorder (CD) characterized by aggression and uninhibited behavior, a symptom complex also associated with bipolarity—particularly adult bipolarity. From   a   developmental   viewpoint,  the   relationship between primary clinical manifestation and later symp- tom development could be seen as decisive for a better understanding of early-onset BD and ADHD and their diagnostic differentials and possible psychopathophysio- logical entity. Child and adolescent psychiatrists in charge of treatment are doubtless faced with formidable chal- lenges to their diagnostic and clinical abilities.As prelim- inary evidence shows that these two disorders could pos- sibly be inter-related on the grounds of common organic developmental   factors   and   corresponding   clinical C l i n i c a l   r e s e a r c h C Copyright © 2009 LLS SAS.  All rights reserved www.dialogues-cns.org Attention deficit-hyperactivity disorder and early-onset bipolar disorder: two facets of one entity? Florian D. Zepf, MD Keywords:   attention  deficit-hyperactivity  disorder;  pediatric bipolar  disorder; imaging; genetics; neurochemistry; CBCL-PBD profile Author  affiliations:  Department  of  Child  and  Adolescent  Psychiatry  and Psychotherapy, J. W. Goethe University, Frankfurt am Main, Germany    Address for correspondence: Dr med Florian D. Zepf, Dept of Child and Adolescent Psychiatry   and   Psychotherapy,   J.   W.   Goethe-University,    Deutschordenstr.  50/ Building 92, D-60528 Frankfurt am Main, Germany (e-mail: f.zepf@med.uni-frankfurt.de) Early-onset bipolar disorder (BD) and attention-deficit- hyperactivity disorder (ADHD) have recently been the sub- ject of highly controversial debate, due to theories regard- ing underlying pathophysiological processes and a clinical overlap of symptoms. Epidemiological data, clinical aspects, neuroimaging, neurochemical, and genetic studies suggest that there may be a possible relationship between biolog- ical factors and clinical characteristics in the development of symptoms. However, longitudinal data supporting the hypothesis of a diagnostic shift from BD to ADHD symp- toms and vice versa are currently not available. These would be essential to enable further investigations into whether these two disorders possibly represent two differ- ent aspects of an underlying common psychopathophysi- ological entity.       © 2009, LLS SAS Dialogues Clin Neurosci.  2009;11:63-72.