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Kraepelin distinguished between manic-depressive insanity and dementia praecox on the grounds that patients with the first disorder had better outcomes and that studies of adult bipolar illness showed high rates of recovery from an index episode of mania. This carefully done, 4-year, prospective study of 86 pediatric bipolar patients (mean age, 11 years), 81% of whom were experiencing first manic episodes, suggests worse outcomes in child patients.
Patients and their parents were interviewed seven times over 4 years. To minimize confusion with attention deficit hyperactivity disorder, which can have similar symptoms, the presence of elation or grandiosity was required to diagnose pediatric mania or hypomania.
Eighty-seven percent of patients …