Topic: Assessment, Treatment, & Prevention of Bipolar Disorder in Children and Adolescents Population: Children and adolescents through 17 years with a DSM-5 bipolar diagnosis or with elevated risk of developing a bipolar disorder. Questions:

1. What is the comparative accuracy of approaches that can be used to screen for or diagnose bipolar disorder?
2. What are the comparative effectiveness and safety of pharmacologic and/or nonpharmacologic treatments for bipolar disorder in improving outcomes associated with bipolar disorder? How do these outcomes vary by patient characteristics, disorder characteristics, history of previous treatment, and comorbid conditions?
3. What factors convey excess risk for the development of DSM-5 bipolar disorders?
4. What is the effectiveness and safety of pharmacologic and/or non-pharmacologic approaches to the prevention of DSM-5 bipolar disorders?

Bipolar disorders are one of the most disabling types of mental illnesses, afecting up to 3% of all adults (6% if subclinical presentations are included). The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population, and a broad range of other adverse sequelae are observed, including impaired function in academic, employment, legal, marital, and parenting domains. Although the mean age of onset of the first manic episode is approximately 18 years for bipolar I disorder, premorbid problems in childhood and adolescence are common, especially difculties with emotional and behavioral dysregulation. This dysregulation pattern has been shown to persistent into adulthood, when it is associated with increased rates of anxiety, mood, disruptive behavior, and substance abuse disorders. The course of adolescent-onset bipolar disorder is more chronic and refractory to treatment than adult-onset bipolar disorder. Bipolar disorders are highly recurrent, and the great majority of bipolar I patients go on to have additional mood episodes. Recurrent episodes can approximate 4 in 10 years. Approximately 1/3 of patients remain symptomatic and functionally impaired between episodes. Over at least the past decade, there has been significant controversy regarding the possible over diagnosis of dysregulated young children with bipolar disorder, with increasing use of psychotropic medications with significant potential for side efects in this vulnerable population. The most recent US clinical practice guidelines addressing the assessment and treatment of bipolar disorder in children and adolescents were published in 2007 by the American Academy of Child & Adolescent Psychiatry. These parameters were developed in advance of the new guidelines for guidelines developed by the Institute of Medicine, which greatly increased the standards of rigor and transparency for clinical practice guidelines. As such, there is an urgent need to critically assess the extant literature to serve as the basis for updated rigorous and transparent clinical practice guidelines pertaining to the assessment, treatment, and prevention of bipolar disorder in children and adolescents

The answers to the research questions will serve as the basis for updated clinical practice guidelines pertaining to the assessment, treatment, and prevention of bipolar disorder in children and adolescents that will be published by the American Academy of Child & Adolescent Psychiatry in the Journal of the American Academy of Child and Adolescent Psychiatry and on the AACAP website as an AACAP Official Action.

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Physician and Co-Chair, Committee on Quality Issues, American Academy of Child & Adolescent Psychiatry

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AACAP

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Invitation to nominate review topic from Associate Director, AHRQ EPC Program