Clinical implications of DSM-IV subtyping of bipolar disorders in referred children and adolescents

Gabriele Masi, Giulio Perugi, Stefania Millepiedi, Maria Mucci, Cinzia Pari, Chiara Pfanner, Stefano Berloffa, Cristina Toni

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: According to DSM-IV, bipolar disorders (BDs) include four subtypes, BD I, BD II, cyclothymic disorder, and BD not otherwise specified (NOS). We explore the clinical implications of this subtyping in a naturalistic sample of referred youths with BD I, BD II, and BD-NOS. METHOD: The sample consisted of 217 patients, 135 males and 82 females, ages between 8 and 18 years (mean age, 13.6 ± 2.9 years), diagnosed according to historical information, prolonged observations, and a structured clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version). The location of the study was the Stella Maris Scientific Institute of Child Neurology and Psychiatry of Pisa (Italy). RESULTS: Seventy-eight patients (35.9%) had BD I, 97 (44.7%) had BD II, and 42 (19.4%) had BD-NOS. Patients with BD I presented more frequently psychotic symptoms and elated rather than irritable mood. Patients with BD II were less severely impaired, presented more frequently depression as the intake affective episode, and had the highest comorbidity with anxiety disorders. Patients with BD-NOS presented an earlier onset of the disorder, a chronic rather than episodic course, an irritable rather than an elated mood, and a more frequent comorbidity with attention-deficit/hyperactivity disorder and oppositional defiant disorder. CONCLUSIONS: DSM-IV categorization of BD may have meaningful implications in youths, but needs to be detailed further. Copyright 2007

Original languageEnglish
Pages (from-to)1299-1306
Number of pages8
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number10
Publication statusPublished - Oct 2007


  • Bipolar disorder
  • Course
  • Mania
  • Phenotype

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology


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