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Bipolar disorder (BD) of childhood and adolescence is not rare but difficult to diagnose because of its atypical presentation compared with that of adults. Similar to treatment for adults with BD, pharmacotherapy is considered as the first-line treatment for pediatric BD and usually involve the use of mood stabilizing agents such as lithium, carbamazepine, and valproate and antipsychotic agents, such as risperidone, olanzapine, and quetiapine. Sufficient data was not obtained about pharmacotherapy of BD and most of the studies to date do not have standard assessment protocols and placebo control groups. In this article we aimed to review all controlled , open, and special designed studies and to inform about their findings. According to results from published studies: 1- There are few well-designed clinical trials and systematic treatment with prospective follow-up is essential for methodology, 2- lithium and divalproex sodium appear to have comparable efficacy at the end of the trials, 3- some controlled data were obtained for safety and efficacy of quetiapine, 4- stimulants should be used cautiously but are not contraindicated. [ABSTRACT FROM AUTHOR]

This report was aimed to evaluate the efficacy of olanzapine treatment as an adjunct therapy to mood stabilizers in the treatment of four adolescents responding insufficiently to mood stabilizers. All patients were diagnosed with bipolar I disorder according to DSM IV criteria. YMRS (Young mania rating scale) and CGI (Clinical global impression, improvement and therapeutic effectiveness scales) were used to evaluate overall response of the episode to the drugs. All patients with no adequate response to mood stabilizers did respond to adjunctive olanzapine treatment (10–30 mg/per day). It has been suggested that antipsychotics may be useful as an adjunct to mood stabilisers in bipolar disorder. However, further research is warranted regarding the use of atypical antipsychotics in children and adolescents. [ABSTRACT FROM AUTHOR]