Review Article Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents The phenomenology and clinical prevalence of bipolar disorder (BPD) in children and adolescents has always been controversial. Some researchers have documented high rates of occurrence of BPD in children (1, 2) while others debate this (3). But, despite these difficulties, clinicians have been diagnosing mania in children and adolescents for over 200 years. Glovinsky’s review of the history of childhood onset BPD revealed several apparent cases of mania in children as early as the year 1763 (4). In 1961, the psychoanalysts Anthony and Kowatch RA, Youngstrom EA, Danielyan A, Findling RL. Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disord 2005: 7: 483–496. ª Blackwell Munksgaard, 2005 Objective: Using predetermined criteria for study quality and methods, a literature review and meta-analysis of seven reports about pediatric bipolar disorder (BPD) was conducted to determine if there is a consistent picture of the phenomenology and clinical characteristics of BPD in children and adolescents. Methods: Searches were conducted in MedLine and PsycINFO using the terms mania, BPD, children and adolescents, and was limited to published articles in peer-reviewed journals. Seven reports were selected that met the following criteria: a systematic method for the elicitation and reporting of symptoms and clinical characteristics of subjects; subjects were interviewed by a trained researcher or clinician; ages 5–18 years; use of a diagnostic system, either DSM or RDC for categorization; a consensus method for the establishment of the diagnosis of BPD. Results: Most DSM-IV symptoms of mania were common in the children and adolescents with BPD with the most common symptoms being increased energy, distractibility, and pressured speech. On average, four of five bipolar cases also showed threshold levels of irritable mood and grandiosity, and more than 70% of all cases showed elated/euphoric mood, decreased need for sleep, or racing thoughts. Roughly 69% of cases also showed poor judgment, whereas only half of bipolar cases demonstrated flight of ideas, and slightly more than one-third showed hypersexuality or psychotic features. Conclusions: The clinical picture that emerges is that of children or adolescents with periods of increased energy (mania or hypomania), accompanied by distractibility, pressured speech, irritability, grandiosity, racing thoughts, decreased need for sleep and euphoria/elation. Robert A Kowatch a , Eric A Youngstrom b,c , Arman Danielyan b and Robert L Findling c a Department of Psychiatry, Cincinnati Children’s Hospital Medical Center/University of Cincinnati Medical Center, Cincinnati, b Department of Psychology, Case Western Reserve University, Cleveland, c Department of Psychiatry, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA Key words: adolescents – bipolar disorder – children – comorbidity – mania – phenomenology Received 1 April 2005, revised and accepted for publication 24 August 2005 Corresponding author: Robert A. Kowatch, MD, Department of Psychiatry, The University of Cincinnati Medical Center, MSB 7261, PO Box 670559, Cincinnati, OH 45267-0559. Fax: 513-558-4805; e-mail: robert.kowatch@uc.edu RAK has financial affiliations with Bristol-Myers Squibb, GlaxoSmithKline, Janssen, AstraZeneca and Abbott Laboratories. EAY receives or has received research support as a co-investigator, or has acted as a consultant for Abbott Laboratories, AstraZeneca, Eli Lilly & Co., and Otsuka. RLF receives or has received research support, acted as a consultant and/or served on a speakers bureau for Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Celltech-Medeva, Forest, GlaxoSmithKline, Johnson & Johnson, Eli Lilly & Co., New River, Novartis, Otsuka, Pfizer, Sanofi-Synthelabo, Shire, Solvay, and Wyeth. AD has no reported conflict of interest. Bipolar Disorders 2005: 7: 483–496 Copyright ª Blackwell Munksgaard 2005 BIPOLAR DISORDERS 483