A GWAS study in China differentiated patients with a good response and those with a poor response to lithium with a sensitivity of 93% and showed the strongest association with a response to lithium when the exons, exon-intron boundaries, and part of the promoter of the gene encoding glutamate decarboxylase-like protein 1 ( Go to Bipolar Affective Disorder for complete information on this topic.Hallmark symptoms of mania include an abnormal, often expansive, and elevated mood lasting for at least 1 week.Hypomanic and manic states must impair normal functioning to be considered pathologic states and are often more difficult to recognize and diagnose in children than in adults.

Outcome studies show that compared with unipolar depression, bipolar disorder causes more work disability and overall poorer outcome 15 years after an index hospitalized manic episode even when mania is in remission for at least 1 year.

Randomized controlled trials of combination mood stabilizer treatment (more than one mood stabilizer such as atypicals lithium valproate) suggest this may improve outcome by increasing the time to relapse for any mood episode compared with monotherapy as maintenance therapy for Bipolar I.

Fourth, the mood disturbance is severe enough to cause marked social impairment in occupational functioning, social activities, or relationships with others.

Hospitalization may be necessary to prevent harm to self or others or if psychotic features are present.

Parental history of ADHD increases the risk of DMDD by 4 times that in control populations, however, risk of DMDD is 20 times higher in families where there are offspring with DMDD.

Comorbid diagnosis of autism spectrum disorder (ASD), especially with ADHD symptoms, are predictive of a more challenging clinical course that may require multiple different medications for remission.Mood disturbances in children and adolescents are often more difficult to recognize and diagnose than those in adults.Some of the difficulty arises in recognizing atypical symptoms, including irritability, tantrums, physical aggression, and other behavioral problems (eg, expressions of mood disruptions).Therefore, the person’s financial accounts or important relationships may be in such disarray as to lead to adverse outcomes, including loss of important friends and family support or connections, serious financial setbacks, job losses, legal problems, and homelessness.Especially in older children and adolescents, bipolar disorder may be a more severe form with increased risk of suicide attempts and the adverse effects of the disorder can contribute to dysfunction in the school setting, potentially leading to expulsion or peer rejection.Early identification of medication nonresponders would be extremely helpful in the treatment of bipolar disorder.