The document discusses the controversy around diagnosing and treating pediatric bipolar disorder. It notes a large increase in bipolar diagnoses in children despite many not meeting DSM-IV criteria. While medications are approved to treat bipolar disorder, they often cause weight gain and metabolic issues. The document proposes "temper dysregulation disorder" as an alternative for children presenting with irritability rather than clear mania or hypomania. Comprehensive treatment including medication and psychotherapy is recommended, though more research is still needed.

3. Stephen Grcevich, MD: disclosures: Pharmaceutical Industry Consulting: Shire US (100% of compensation donated to charity since 1/1/08) Grant/Research Support Child and Adolescent Psychiatry Trials (CAPTN) Network-ASK, PARCA, NOTA studies funded through NIMH Speakers’ Bureaus None since 2006 Other Financial/Material Support Web MD/Medscape Leerink-Swann Major Shareholder None

5. Weight gain in antipsychotic naïve pediatric patients: Correll, CU et al., JAMA. 2009;302:1765–1773.

6. Metabolic effects of second-generation antipsychotics in pediatric patients: Correll, CU et al., JAMA. 2009;302:1765–1773. Agent: Metabolic Effects: Olanzapine  fasting glucose  insulin  insulin resistance Quetiapine  total cholesterol  triglycerides  HDL cholesterol  triglyceride:HDL ratio Risperidone  triglycerides Aripiprazole No significant metabolic effects

10. Differentiating between ADHD and BPD in early adolescence: Geller et al. J Affect Disord. 1998;51:81. Geller B, Luby J. J Am Acad Child Adolesc Psychiatry (1998): 37(10) 1005 Symptom BPD (n=60) % ADHD (n=60) % P Value Elated mood 86.7 5 0.001 Grandiosity 85 6.7 0.001 Hypersexuality 45 8.3 0.001 Decreased need for sleep 43.3 5 0.001 Racing thoughts 48.3 0 0.001 Hyperenergetic 96.7 91.7 0.44 Distractibility 91.7 95 0.72

25. Questions?